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Treating Heartburn and Gastro-Esophageal Reflex (GERD): Using proton-pump inhibitors (PPI) carefully

Heartburn is a feeling of burning pain in your lower chest, behind the breastbone. It comes from acid backing up from your stomach to your throat. You may have seen ads on American channels for heartburn drugs, such as pantoprazole (e.g., Tecta), omeprazole (e.g., Losec), esomeprazole (Nexium) or lansoprazole (Prevacid). These drugs are called PPIs (proton pump inhibitors). They keep the stomach from making too much acid.

In most cases, you don’t need a PPI for heartburn. You can get relief from a less powerful drug. And when you do need a PPI, you should take the lowest dose for as short a time as possible. Here’s why:

Do you need a PPI?

PPIs are powerful drugs. Studies suggest that more than half of the people who take PPIs probably do not need them. Simple heartburn can be relieved with antacids or other less powerful drugs.

PPIs have risks.

If you need a PPI, taking a low dose for less than a year is probably safe. But taking a PPI for a year or longer has been linked to:

PPIs can change the way other drugs work.

PPIs interact with some common prescription drugs. For example, some PPIs can reduce the blood-thinning effect of the drug Plavix (generic clopidogrel). This can increase the risk of heart attack and even death.

When should you consider a PPI?

If you have GERD, you probably need a PPI. Talk to your doctor if:

If your doctor thinks you need a PPI:


Ease heartburn without drugs:

Many people who have heartburn don’t need drugs at all. They can feel better by making changes in their diet and lifestyle. Try these things before you try drugs:

Watch what you eat. Try to figure out which foods and beverages give you heartburn. Then try to avoid them. Foods and drinks that may cause heartburn include:

Eat smaller meals and do not go to bed right after you eat. Do not overload your stomach. And avoid lying down for two hours after you eat.

Stop smoking. If you need a reason to stop smoking, heartburn may be it. Research shows that smoking raises your risk for heartburn and GERD.

Lose extra weight. It has been proven that losing just a few extra pounds can help lessen the effects of heartburn and GERD.

Loosen up. Don’t wear tight clothes or tight belts that press on your middle. The extra pressure can make heartburn worse.

Sleep with your head raised. Raise your upper body with pillows. Or raise the head of your bed about 15 to 20 cm (six to eight inches). Try putting wooden blocks under the top legs of the bed.