WITHDRAWAL OF RANITIDINE 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 professional 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.

Heartburn is a burning sensation in your chest, behind your breastbone. It occurs when stomach acid travels back up your esophagus — the tube that carries food from your mouth to your stomach. You may also experience a bitter taste in your throat or mouth. The symptoms of heartburn may get worse after you eat or when you’re lying down.

In general, you can successfully treat the symptoms of heartburn at home. If frequent heartburn makes it difficult to eat or swallow, however, your symptoms may be a sign of a more serious medical condition.

Heartburn symptoms can range from mild discomfort to extremely uncomfortable, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The most common symptom of heartburn is a burning feeling in your chest and throat.

What does heartburn feel like?

Heartburn feels like an uncomfortable or burning pain in the middle of your chest. You may also experience:

  • a burning sensation in your throat
  • pressure or pain behind your breastbone
  • difficulty swallowing
  • worsening pain after lying down or bending over
  • an acidic, sour, or bitter taste in your mouth
  • coughing or hoarseness

How long does heartburn last?

Heartburn can affect people differently. In general, heartburn symptoms begin shortly after eating and can last anywhere from a few minutes to a couple of hours, or even longer.

How long you experience symptoms depends on the underlying cause. It also depends on what you do at the first sign of symptoms. For example, sometimes heartburn symptoms last until your body digests the triggering food. Other times, it goes away if you stand up instead of lying down after eating.

If you take OTC antacids or prescription medications as part of a treatment plan, you may experience a shorter duration or fewer heartburn symptoms.

Heartburn typically occurs when contents from the stomach back up into the esophagus. The esophagus is a tube that carries food and fluids from the mouth into the stomach.

Your esophagus connects to your stomach at a juncture known as the lower esophageal sphincter. If the lower esophageal sphincter is functioning properly, it closes when food leaves the esophagus and enters the stomach.

In some people, the lower esophageal sphincter doesn’t function properly or it becomes weakened. This leads to contents from the stomach leaking back into the esophagus. Stomach acids can irritate the esophagus and cause symptoms of heartburn. This condition is known as reflux.

Certain conditions and other factors may make it more likely for you to experience heartburn. Risk factors include:

  • Hiatal hernia. A hiatal hernia occurs when the upper part of your stomach penetrates through the diaphragm, usually by way of a weakness or tear.
  • Pregnancy. Heartburn is common during pregnancy, especially during the third trimester, according to a 2015 systematic review.
  • Smoking: Smoking is weakly associated with an increased chance of developing gastroesophageal reflux disease (GERD). It is worth noting because people who quit or decreased tobacco smoking were three times more likely to have a reduction of heartburn symptoms, according to a 2018 review.
  • Being overweight or having obesity. Obesity is a major contributing risk factor to GERD, with heartburn and regurgitation being the typical way this condition manifests, according to a 2014 review.
  • Taking certain medications. Some medications, such as aspirin, ibuprofen, sedatives, and blood pressure medications, can increase your risk of heartburn, according to the NIDDK.

If you have heartburn, you may find that certain foods and drinks can trigger your symptoms. These may include:

  • carbonated drinks
  • chocolate
  • citrus fruits
  • tomatoes and tomato-based products
  • peppermint
  • fried foods
  • high fat foods
  • spicy foods
  • alcohol

Other triggers that can contribute to heartburn include:

  • eating a large meal
  • lying down immediately after eating
  • wearing tight clothes

Many people occasionally experience heartburn. However, you should contact your doctor if you experience heartburn more than twice per week or if you have heartburn that does not improve with treatment. This could be a sign of a more serious condition.

Heartburn often occurs alongside other gastrointestinal conditions, such as ulcers, which are sores in the lining of the esophagus and stomach, or GERD, according to the NIDDK. Contact your doctor if you have heartburn and develop:

  • difficulty swallowing
  • pain with swallowing
  • dark, tarry, or bloody stools
  • shortness of breath
  • pain that radiates from your back to your shoulder
  • dizziness
  • lightheadedness
  • sweating while having chest pain

Heartburn is not associated with a heart attack. However, people who have heartburn may believe they’re having a heart attack because the symptoms can be very similar. According to the Centers for Disease Control and Prevention (CDC), symptoms of a heart attack include:

  • severe or crushing chest pain or discomfort
  • difficulty breathing
  • feeling weak, lightheaded, or faint
  • jaw pain
  • arm pain

Call 911 immediately if you experience symptoms of a heart attack.

If you experience occasional heartburn, a combination of lifestyle changes and medications can help alleviate your symptoms.

Lifestyle changes, such as maintaining a moderate weight, can help reduce your symptoms. Other recommendations include:

  • avoiding foods that trigger your symptoms
  • wearing loose clothing
  • avoiding lying down right after eating
  • talking with a healthcare professional about a smoking cessation program and other supportive resources, if you smoke

Treatment options for heartburn

OTC medications can often be used to treat heartburn. The FDA identifies three classes of OTC medications for treating occasional heartburn. These include:

  • Antacids. These medications help neutralize stomach acid. They can provide quick relief of heartburn symptoms. Common antacids are:
    • Mylanta
    • Rolaids
    • Tums
    • Alka-Seltzer
    • Gaviscon
  • Histamine-2 (H2) blockers. H2 blockers reduce the amount of acid your stomach makes. They include:
    • cimetidine (Tagamet HB)
    • famotidine (Pepcid Complete or Pepcid AC)
    • nizatidine (Axid AR)
  • Proton pump inhibitors (PPIs). PPIs reduce the amount of acid in your stomach. They can also help heal damaged tissue in your esophagus. They include:
    • lansoprazole (Prevacid 24 HR)
    • esomeprazole (Nexium 24 HR)
    • omeprazole magnesium (Prilosec)
    • omeprazole and sodium bicarbonate (Zegerid)

Although these medications can be helpful, they may have side effects, according to the NIDDK. Antacids can cause constipation or diarrhea. PPIs may cause headache, diarrhea, or upset stomach. Talk with your doctor about any medications you’re already taking to see if you’re at risk for any drug interactions.

If OTC medications do not relieve your symptoms, your doctor may be able to prescribe stronger versions of these medications.

How do antacids work to treat heartburn?

Antacids help neutralize the acid your stomach makes. They provide fast, short-term relief of heartburn symptoms. Antacids work differently from H2 blockers and PPIs, which reduce or block stomach acid.

They are not intended for daily use. You should take antacids shortly after eating or when you experience symptoms.

Antacids come in liquid, tablet, or gummy form. Most contain one or more of the following ingredients:

  • calcium
  • aluminum
  • magnesium

Antacids are typically considered safe, but they may cause some side effects, such as diarrhea or constipation.

Make sure to follow the directions on the label and avoid overusing antacids. Talk with your doctor if you have any questions about using an antacid or if you experience any complications after taking one.

A doctor generally diagnoses heartburn based on your symptoms and medical history, according to the NIDDK. During the appointment when you’re diagnosed, your doctor can recommend a treatment plan.

You may need to see your healthcare professional again if lifestyle changes, OTC medication, or prescription medication don’t improve your symptoms. This may be a sign that you have a more serious condition called GERD.

To diagnose GERD, your doctor will review your medical history and ask you about your symptoms. They may also order several tests, including:

  • Ambulatory acid (pH) probe test. Your doctor will pass a small tube through your nose into your esophagus. A sensor at the tip of the tube measures the amount of stomach acid in your esophagus.
  • Esophageal pH monitoring. Your doctor places a capsule on the lining of your esophagus to measure acid reflux.
  • X-ray. You’ll drink a chalky liquid that coats your upper digestive tract. Your doctor will then use X-ray imaging to look at your esophagus, stomach, and upper intestine.
  • Endoscopy. Your doctor will pass a small tube equipped with a camera down your throat into your stomach to check for an ulcer of the esophagus or stomach lining.
  • Esophageal manometry. Your doctor will place a tube through your nose into your esophagus to measure the contractions of your esophagus when you swallow.

Depending on your diagnosis, your doctor will be able to provide you with treatment options to help reduce or eliminate your symptoms.

Occasional heartburn isn’t typically a cause for concern. However, frequent heartburn may be a symptom of GERD. This condition may require treatment with prescription medication or surgery.

If left untreated, GERD may lead to additional health problems, such as an inflammation of the esophagus, which is called esophagitis, or Barrett’s esophagus, according to a 2018 review. Barrett’s esophagus causes changes in the lining of the esophagus that can increase your risk of esophageal cancer.

Long-term heartburn can also affect your quality of life. See your doctor to determine a course of treatment if you find it difficult to carry on your daily life or are severely limited in your activities due to heartburn.

There are many steps you can take to help prevent heartburn:

  • Avoid foods or drinks that may trigger your symptoms, such as acidic foods, high fat foods, spicy foods, chocolate, alcohol, mint, and carbonated drinks.
  • Wait at least 3 hours after eating to lie down.
  • Place blocks or books under your bed to elevate the head of your bed. This can help prevent stomach acid from traveling back up your esophagus.
  • Avoid wearing tight clothes, which can put pressure on your stomach and lower esophageal sphincter.
  • Eat smaller, more frequent meals rather than two or three large ones to help ease the impact on your digestive system.
  • Chew sugarless gum after eating. A 2014 study found chewing gum can increase saliva production, helping to neutralize stomach acid and push acid back into the stomach.
  • If you smoke, talk with your doctor about ways to quit.
  • Maintain a moderate weight.