by Rebecca Webb, PharmD  Pharmacy Clinical Services Manager, K-VA-T Food Stores

For many of us, the holidays are a time to enjoy good food and drink with family and friends.  Unfortunately, overindulgence this time of year can lead to the unpleasant symptoms of heartburn.  This holiday season make sure you do not feel the burn.  Learn how to identify and effectively manage heartburn.


What is heartburn?
Heartburn occurs when there is a backward flow of stomach acid into your esophagus, the passageway connecting your throat to your stomach.  This is also known as acid reflux.  It causes an uncomfortable burning sensation in your chest and throat, which can last from a few minutes up to several hours.  Heartburn often happens after eating large meals, when eating certain foods and drinks, or when bending over or lying down.  Having heartburn every now and then is common.  Infrequent heartburn can often be managed by behavioral changes and over-the-counter (OTC) medications.


What lifestyle changes can help for occasional heartburn?
•    Consider eating smaller, more frequent meals throughout the day.  Also, eat slowly and thoroughly chew your food.   
•    Avoid foods and drinks that may trigger heartburn.  These include fatty foods, spicy foods, chocolate, mint, tomato products, onions, garlic, coffee, tea, alcohol, carbonated beverages, citrus fruits/juices, greasy foods, fried foods, and products with caffeine.  Try removing these foods and drinks from your diet for a period of time.  Then, try adding them back one at a time to determine which ones you can tolerate.  
•    Maintain an upright position while you eat and then for at least an hour afterwards. 
•    Finish eating several hours before laying down to sleep.
•    Avoid intense exercise for a few hours after eating. 
•    Sleep on an incline by safely putting blocks under your bedposts or by using a foam wedge support.  Ideally, your head should be six to eight inches higher than your feet.  Stacking pillows will unfortunately not provide the uniform support you need to prevent heartburn.
•    Avoid tight-fitting clothing around your abdomen area.
•    When appropriate, lose weight.  It is important to achieve and maintain a healthy weight. 
•    Quit smoking.  Also, avoid secondhand smoke.
•    Review your medications with your Food City pharmacist.  Certain medications can irritate your esophagus and potentially lead to symptoms of heartburn.  Your pharmacist will be able to identify these medications and give you advice on how to manage them.      
    Not every lifestyle modification for preventing heartburn will apply to everyone.  It is important to find which ones work for you.    


What medications are available over-the-counter for mild, infrequent heartburn?
•    Antacids neutralize stomach acid and may provide fast heartburn relief.  They include: Mylanta®, Rolaids® and Tums®.
•    H-2-receptor blockers decrease stomach acid production.  These medications do not work as quickly as antacids, however, they provide longer heartburn relief.  They include: Cimetidine (Tagamet HB®) and Famotidine (Pepcid® AC). Ranitidine (Zantac®) has currently been recalled for potential safety measures.
•    Proton pump inhibitors (PPIs) block stomach acid production and heal the esophagus.  Concerns have been raised about the long-term use of these medications and the risk for potential bone fractures.  Therefore, except in certain situations, PPI’s are recommended for short-term use only.  These medications include: Esomeprazole (Nexium® 24HR), Lansoprazole (Prevacid® 24HR) and Omeprazole (Prilosec OTC®)
•    There are also over-the-counter products that combine different classes of medications to help control symptoms of heartburn.  These include: Pepcid ® Complete and Zegerid OTC®

Remember to always read packaging information for the safe use of over-the-counter medications.  If you have questions about OTC heartburn medications and how to safely and effectively use them, ask your Food City pharmacist. Certain medications used for the management of heartburn symptoms are available by prescription only.  Consult your primary care provider or Food City pharmacist about these options.


When should you see your primary care provider about heartburn?
•    When heartburn develops more than two times per week
•    If you do not experience heartburn relief using over-the-counter medications for the recommended amount of time
•    If your symptoms of heartburn worsen
•    If you are experiencing difficulty swallowing
•    If you have nausea or vomiting
•    If there is severe pain associated with your heartburn
•    If you have certain medical conditions (i.e., pregnancy)

Talk with your local Food City pharmacist if you have questions about managing heartburn. As an important part of your health care team, our pharmacists are available to assist you with your health and wellness needs.



_{Reference:
Heartburn. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/heartburn/symptoms-causes/syc-20373223. Accessed November 21, 2019.}