What are the best remedies for heartburn?

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Nov. 25 2003 12:14 PM

Be Still, My Heartburn

What's the best way to treat acid reflux?

Illustration by Mark Alan Stamaty

Acid reflux occurs when digestive acid from the belly sneaks past the lower esophageal sphincter—the muscular flap between the stomach and the esophagus—into the upper chest or throat and causes an unpleasant fiery sensation, commonly known as heartburn. Left untreated, the acid can corrode the lining of the esophagus and cause a condition called Barrett's esophagus, known to lead to cancer. That's the long-term problem.

The short term's no fun either. The most common torture of my domestic life used to be waking in the night to find that my bedside stash of Tums was tapped out. Finally, after a gantlet of holiday parties a few years ago, I saw a doctor, and he tuned me in to the powers of prevention.

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Tums and other antacids are to heartburn what breath mints are to halitosis: They provide immediate and temporary relief, but they don't address the root of the problem. Prevention usually involves treating your body more like a temple and less like a fraternity house: Cut down on fried foods and alcohol; quit smoking; eliminate unnecessary stress; exercise; give yourself three hours to digest a meal before lying down.

But if you're unwilling to give up the beer, or giving up the beer doesn't help control the acid, you'll want to explore two classes of pharmaceuticals: histamine, or H2, blockers (H2s) and proton pump inhibitors (PPIs). Neither has been shown to cause any serious side effects (though they come with your typical warnings: nausea, headache, diarrhea).

H2s are over-the-counter meds that reduce acid production in the stomach. Meant to be taken before a meal, they have an advertised staying power of eight to 12 hours and are marketed toward occasional (once a week) heartburn sufferers, though more powerful doses of H2s are sometimes prescribed for those who experience frequent attacks (twice a week or more).

PPIs are supposed to work longer and harder than H2s by deactivating the pumps that produce digestive acids. They are once-a-day pills (lasting for 24 hours) that have been shown to treat heartburn symptoms and, over time, to heal the tissue damaged by the acid. Most PPIs are available only by prescription, though this past summer the FDA approved one of them, Prilosec, for OTC sale after its prescription patent had expired. (Prilosec OTC hit stores in mid-September, accompanied by a reported $100 million ad campaign.)

The conventional wisdom is that drugs in the same class are indistinguishable from one another. (One doctor I spoke to said he takes whichever PPI he finds around the office that morning.) But no head-to-head trials have been done, so who's to say? A handful of congressional leaders, according to an article in the Aug. 24 New York Times, are pushing to set aside $75 million for government-run comparative studies on drug types popular with the Medicare/Medicaid set. But that's going to take years, if it happens at all. In the meantime, I decided to spend a couple of hundred of Slate's dollars to conduct my own (highly empirical) drug trial.

Setup

Heartburn can strike at any time, but I wanted to court it, so I devised a revolving lunch plan with foods that have triggered my heartburn in the past (details below). I accompanied each meal with some combination of beer, chocolate, peppermint, blueberries, citrus, and caffeine, all of which are considered triggers by doctors.

To better my chances of rousing the acid, I performed the trial during a period of high stress: Two weeks before starting the trial, I got married; during the trial, my wife and I moved ourselves into a new apartment, then adopted a kitten. Where applicable below, I've noted specific stress factors.

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