What is Heartburn?
Heartburn is a burning pain in your chest, just behind your breastbone rising up from the stomach or lower chest towards the throat. It occurs when stomach acid refluxes (flows back up) into the oesophagus (food pipe) and irritates the inner lining of the oesophagus.
This happens when the valve that separates the oesophagus and the stomach does not close properly. Symptoms are often made worse by lying down, bending forward or straining.Other symptoms of reflux include:
- Regurgitation of food or fluid into your mouth
- An acidic, sour or bitter taste in your mouth
- A sudden increase in saliva in your mouth
- A lot of burping
- Dry cough, especially at night
- Sore throat.
Frequent heartburn and reflux symptoms can be signs of gastroesophageal reflux disease (GORD). GORD involves repeated reflux of stomach acid, which can cause inflammation and damage to the lining of the oesophagus, called oesophagitis.
Factors that can cause or worsen indigestion and heartburn include:
- Certain foods (e.g., rich, spicy and fatty food, chocolate, peppermint, onions, tomatoes)
- A large meal
- Eating quickly
- Physical activity soon after a large meal
- Stress and anxiety
- Being overweight
- Wearing tight clothing around your waist
- Pregnancy, particularly late pregnancy
- Some medical conditions (e.g., GORD, stomach ulcer, gall stones)
- Certain medicines (e.g., aspirin, nonsteroidal anti-inflammatory drugs, alendronate, risedronate, doxycycline, minocycline). Ask a pharmacist for information.
What you can do
Try to identify and avoid things that make your symptoms worse. Simple changes to diet and lifestyle that can often prevent or reduce the symptoms of indigestion and heartburn include:
- Reduce the consumption of fatty and spicy food, chocolate, peppermints and other known problem foods.
- Eat smaller meals
- Eat slowly and chew food well
- Reduce alcohol intake
- Reduce consumption of caffeine (e.g., coffee, tea, cola, energy drinks)
- Don’t dry swallow medicines. Always swallow medicines with a glass of water
- Don’t eat within 2-3 hours of going to bed
- Do not slump in a chair, bend over or lie down soon after meals
- Go for a short walk after your main meal
- Avoid tight fitting clothing
- Raise the head of your bed
- Reach and keep to a healthy weight
- Avoid smoking
- Learn and use relaxation techniques to manage stress.
What are Proton Pump Inhibitors (PPIs)?
Proton Pump Inhibitors, or PPIs, are a class of drugs that are used to treat problems such as heartburn or stomach ulcers. Why use less of, or stop using a Proton Pump Inhibitor? While PPIs are selective at treating many stomach problems, such as heartburn, they are often only needed for a short period of time. Despite this, many people take PPIs for longer than they may need. Research shows that for some people, doses can be safely lowered, or the drug used just when needed for symptom relief. PPIs are generally a safe group of medications; however, they can cause headache, nausea, diarrhoea and rash. They may also increase risk of:
- Low vitamin B12 and magnesium blood levels
- Bone fractures
- Cardiovascular disease
People over the age of 18 who have been taking a PPI for more than 4 to 8 weeks should talk to a doctor, nurse practitioner or pharmacist about whether stopping a PPI is the right choice for them. Doctors, nurse practitioners or pharmacists can help to decide on the best approach to using less of a PPI. They can advise on how to reduce the dose, whether to stop it altogether, or how to make lifestyle changes that can prevent heartburn symptoms from returning. Reducing the dose might involve taking the PPI once daily instead of twice daily, lowering the number of mg (e.g. from 30mg to 15mg, or 40mg to 20mg, or 20mg to 10mg depending on the drug), or taking the PPI every second day for some time before stopping.
Alternatives to Proton pump inhibitors?
Medicines can relieve or prevent symptoms of indigestion and heartburn. Some are available from a pharmacist without a prescription. Pharmacists can advise on the best medicine for you and whether you should consult a doctor. Some of these medicines may interfere with other medicines that you take. Always ask a pharmacist or doctor for advice.
- Antacids and alginates – Antacids (e.g., Mylanta, Gastrogel, Rennie) neutralise stomach acid. Alginates (e.g., Gaviscon) form a coating on top of stomach contents, which reduces acid reflux. Antacids and alginates are usually used for quick relief of occasional symptoms.
- H2 antagonists (e.g., ranitidine, famotidine, nizatidine) – They reduce gastric acid production in the stomach.
Consult a doctor or pharmacist if:
- It is the first time you have experienced symptoms, especially if you are over 50 years or under 18 years.
- You experience indigestion, heartburn or other symptoms of reflux more than once a week
- Heartburn wakes you at night
- Symptoms are getting worse or are severe
- Symptoms are constant or keep returning, even with treatment
- It is difficult or painful to swallow
- Your bowel motions are black and tar-like or have blood in them
- You vomit and your vomit looks like coffee grounds or has blood in it
- You have lost weight and do not know why
- Symptoms get worse with or after exercise
- You have shortness of breath, sweating or pain radiating to your jaw, neck, arm or back.
For more information
Ask a pharmacist for advice when choosing a medicine.
Consumer Medicine Information (CMI)Your pharmacist can advise on CMI leaflets.
National Prescribing Service (NPS) Medicines Information
Phone: 1300 MEDICINE (1300 633 424)
Gastroenterological Society of Australia
Australian Medicines handbook. 2020. Proton pump inhibitors. Adelaide. AMH PTY.
National prescribing service. 2018. Managing reflux and heartburn. NPS Medicine wise. Available at:https://www.nps.org.au/consumers/managing-reflux-and-heartburn#referencesBack to Blog list