In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.

Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.

Acid reflux is a fairly common digestive problem. It occurs when stomach content moves back into the esophagus, leading to a burning sensation in the chest. This is why acid reflux is commonly called heartburn. Other names for acid reflux are:

  • acid regurgitation
  • acid indigestion
  • gastroesophageal reflux (GERD)

Most people experience acid reflux only occasionally. It is estimated that more than 60 million Americans experience acid reflux once a month. However, some people have acid reflux more than twice a week. This chronic form of acid reflux is called gastroesophageal reflux disease (GERD). GERD is more serious and can lead to serious health problems if not treated. Symptoms of GERD occur more than twice a week and include:

  • a burning sensation in the chest
  • regurgitation
  • trouble swallowing
  • a feeling of excessive fullness

Acid reflux occurs when the muscle at the end of the esophagus (the lower esophageal sphincter, or LES) doesn’t close tightly enough. The LES is supposed to open for a very short period of time when you swallow. If it fails to close properly or relaxes too frequently, digestive juices and stomach content can move back up into the esophagus.

The exact cause of acid reflux isn’t known, but the following can make acid reflux worse:

  • eating a large meal
  • stress
  • carbonated beverages
  • coffee
  • alcohol
  • certain foods, including:
    • garlic
    • onions
    • fried foods
    • high-fat foods
    • spicy foods
    • citrus
    • tomatoes
    • chocolate
    • mint
    • obesity
    • hiatal hernia (when part of the stomach bulges above the diaphragm into the chest)

Many people assume that acid reflux is caused by certain foods or by stressful situations. However, scientists suspect that, like many other diseases, acid reflux is caused by both environmental factors and genetic factors. In other words, your genes play a role in causing the muscular or structural problems in the stomach or esophagus that leads to acid reflux.

There is abundant evidence showing a link between our genes and acid reflux. Studies in people with acid reflux symptoms and GERD have identified common markers in our DNA associated with acid reflux.

Studies in Twins

One of the best ways to study the link between a particular condition and genetics is to research it in twins. Identical twins share the same DNA. If both twins have a particular disease, there is likely a genetic cause.

One study published in Alimentary Pharmacology & Therapeutics journal found that twins were more likely to both have GERD. The study included 481 identical and 505 fraternal twins. The correlation was stronger in identical twins compared to fraternal twins. This suggests that genetics play a role in causing acid reflux.

An earlier study published in Gut journal found that one twin was 1.5 times more likely to suffer from GERD if their identical twin had the condition. The study compared heartburn incidence in more than 2,000 sets of identical twins.

Family Studies

If acid reflux is genetic, this means that multiple family members are more likely to have the condition. Research at the University of Amsterdam found a pattern of inheritance of GERD among multi-generational family members. Of the 28 family members who participated in the study, 17 members from four generations were affected with GERD. However, the researchers couldn’t pinpoint the specific gene.

Studies in People with Barrett’s Esophagus

Barrett’s esophagus is a serious complication of GERD. It is linked to an increased risk of developing esophageal cancer. Genetics may play an especially important role in Barrett’s esophagus.

A study reported in the journal Nature Genetics found specific gene variants on chromosomes 6 and 16 were linked to a higher risk of Barrett’s esophagus. The study found that the closest protein-encoding gene to these variants is FOXF1, which is connected to the development and structure of the esophagus. A 2013 article in the International Journal of Cancer also reported a link among FOXF1, Barrett’s esophagus, and esophageal cancer.

A 2016 study in Nature Genetics found a significant genetic overlap among the following diseases:

  • GERD
  • Barrett’s esophagus
  • esophageal cancer

The researchers concluded that GERD has a genetic basis, and they hypothesized that all three diseases are linked to the same gene locus.

Other Studies

Many other studies have shown a link between genetics and GERD. For example, a study published in the American Journal of Gastroenterology found that a specific polymorphism (a variation in DNA) called GNB3 C825T was present in all 363 GERD patients included in the study. The polymorphism wasn’t present in the study’s healthy control population.

Even if our genes are responsible for causing acid reflux, preventing and treating the symptoms of GERD are still extremely important. GERD is classified when the symptoms of acid reflux happen more than twice a week. People with GERD will need continuous, long-term treatment. Without treatment, the risk of serious complications is much higher. Serious complications can occur if acid reflux isn’t controlled by lifestyle changes or over-the-counter (OTC) drugs. These complications can include:

  • severe chest pain
  • narrowing of the esophagus
  • bleeding in the esophagus, called Barrett’s esophagus

In most cases, lifestyle modifications can help you control occasional bouts of acid reflux. Several OTC medications are also available at your local drugstore to treat occasional symptoms.

Lifestyle Changes

Making important lifestyle changes can help prevent acid reflux. Suggested lifestyle changes include the following:

  • Avoid food and drinks that you have found make your heartburn worse. Common culprits are:
    • coffee
    • chocolate
    • carbonated beverages
    • Avoid foods that could irritate the already damaged lining of your esophagus, such as:
      • citrus
      • tomato juice
      • hot peppers
      • Lose weight if you are obese.
      • Stop smoking. Tobacco may stimulate the production of stomach acid, and may also relax the lower esophageal sphincter (LES).
      • Don’t eat anything at least two hours before bed.
      • Raise the head of your bed or use a foam wedge to elevate your head about six to 10 inches while you sleep.
      • Avoid lying down for two hours after eating.
      • Don’t wear tight clothing.
      • Avoid alcoholic beverages.

OTC Medications

There are many OTC options for minor heartburn. Examples include:

Acid Blockers (Antacids)

Antacids neutralize the stomach acid. They’re usually available as chewable or dissolving tablets. Common brands include the following:

  • Alka-Seltzer
  • Mylanta
  • Maalox
  • Pepto-Bismol
  • Rolaids
  • Tums

H-2 Blockers

This class of drugs reduces acid production in the stomach. Examples include