Most of us have experienced the uncomfortable sensation of heartburn at some point in our lives. This burning feeling often occurs after overeating, eating too quickly, or indulging in spicy foods. Heartburn is primarily caused by acid reflux, a condition where stomach contents back up into the esophagus and sometimes even into the mouth. As we age, the frequency of heartburn tends to increase. “Your esophageal sphincter, the muscle that prevents acid from rising up into your esophagus, loses tone as you age,” explains Yi Qin, a gastrointestinal specialist at Cleveland Clinic.
In addition to age, gaining weight can increase the likelihood of developing a hiatal hernia, in which the upper part of the stomach protrudes through the diaphragm into the chest cavity. Both aging and hiatal hernias can trigger acid reflux and heartburn. Michael S. Smith, a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York, mentions, “Many cases of heartburn can be eased with simple lifestyle strategies and short-term use of over-the-counter medications as needed.” However, if heartburn occurs more than twice a week, it may indicate a more serious condition known as gastroesophageal reflux disease (GERD).
GERD presents not only with heartburn but also with other symptoms such as chest pain, dry cough, shortness of breath, and difficulty swallowing. This condition can potentially damage your esophagus and even increase the risk of esophageal cancer. Therefore, recognizing these symptoms is crucial for effective management and treatment.
Implementing lifestyle changes can significantly reduce the frequency of heartburn episodes. A 2021 study published in JAMA Internal Medicine by Harvard researchers found that women who maintained a healthy body weight, refrained from smoking, engaged in at least 30 minutes of exercise daily, limited their intake of coffee, tea, and soda to a maximum of two cups a day, and adhered to a prudent diet rich in fruits, vegetables, whole grains, and fatty fish were nearly 40 percent less likely to develop new heartburn.
It is advisable to avoid lying down for two to three hours after meals to prevent stomach acid from rising into the esophagus. “I recommend elevating the head of your bed, which uses gravity to keep acid in your stomach,” suggests Jacob Kurlander, a gastroenterologist at the University of Michigan. This can be achieved by placing a foam wedge at the head of your bed instead of simply stacking pillows, which may not be effective. Additionally, sleeping on your left side can help keep stomach fluids away from the esophagus, according to Qin.
If you experience heartburn once or twice a week, managing it on your own is typically acceptable. Staller advises monitoring when the heartburn occurs. For many, triggers may include caffeine, fatty foods, chocolate, alcohol, or peppermint. “If you notice heartburn after consuming certain foods, try to avoid them,” he recommends.
For quick relief from occasional heartburn, over-the-counter antacids such as calcium carbonate (Tums and generics) or aluminum hydroxide and magnesium hydroxide (Maalox and generics) can be effective. “These antacids work rapidly to neutralize the acid in your stomach and esophagus,” says Smith, although their effects generally last only 30 to 60 minutes. If heartburn persists after eating and lasts longer than an hour, Smith suggests trying OTC drugs known as alginates, like Gaviscon and Reflux Gourmet, which act as a buffer between the esophageal wall and stomach acid.
If you are over 60 and experience heartburn for the first time, it’s essential to consult a doctor, even if the discomfort is infrequent. Your healthcare provider may want to rule out inflammation or more serious conditions such as esophageal cancer. Furthermore, if you experience heartburn more than twice a week, it’s wise to seek medical advice. Your doctor may recommend a trial of a proton pump inhibitor (PPI), which are available in both OTC and prescription forms, such as lansoprazole (Prevacid), esomeprazole (Nexium), or omeprazole magnesium (Prilosec).
While PPIs can be effective, some research suggests a potential link between long-term use and health risks such as bone fractures and chronic kidney disease. However, these side effects are relatively rare. Most experts agree that using PPIs for a couple of weeks is generally safe, according to Fouad Moawad, a gastroenterologist at the Scripps Clinic in San Diego.
If you try a two-week course of PPIs and do not experience improvement in symptoms, or if symptoms return after cessation, your doctor may recommend an endoscopy. This procedure involves inserting a small, flexible tube with a camera through your mouth into your esophagus to closely examine for reflux-related damage. Staller notes that severe reflux may present as ulceration of the esophageal lining, and biopsies may be taken to check for conditions such as Barrett’s esophagus, which increases the risk of esophageal cancer.
In cases where esophageal damage is detected, long-term therapy may be necessary to prevent further damage or cancer risk. The benefits of extended PPI use often outweigh the risks in such scenarios. If tests reveal no esophageal damage but you continue to experience frequent, severe heartburn, discuss with your doctor the pros and cons of long-term PPI use.
Can reflux occur without heartburn? Yes, some older adults may experience atypical or “silent” reflux, also known as laryngopharyngeal reflux (LPR). Symptoms may include a chronic sore throat, cough, hoarseness, trouble swallowing, or the feeling of having something stuck in the throat. If you experience these symptoms, testing to measure the amount of acid in your esophagus can help determine if reflux is the underlying cause.
Maintaining a healthy weight is crucial in managing reflux symptoms. If lifestyle changes are insufficient, your doctor may recommend a short course of medications to reduce acid production.
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