There are a number of ways to treat heartburn. Patients with heartburn may wish to keep a diary in which they record information about their episodes. The diary may contain information about the date and time of occurrence, other symptoms experienced and factors that may have contributed to it. This may help patients identify what triggers heartburn and how to prevent it.

Traditionally, physicians have recommended that patients who experience heartburn avoid certain foods and beverages, including citrus fruits, chocolate, fatty foods, spicy foods, tomato sauce, mint and carbonated and/or caffeinated beverages, which may increase acid production or relax lower esophageal sphincter (LES) muscles. However, recent research questions the necessity of such dietary changes.

Other recommended lifestyle modifications include:

• Eating more slowly.
  
  
• Eating smaller meals more frequently throughout the day.
  
  
• Avoiding eating two to three hours before bedtime whenever possible.
   
• Exercising regularly. Though exercise can help prevent or alleviate heartburn, patients should avoid activities that may put too much pressure on the abdomen, such as heavy lifting.
  
  
• Raising the head of the bed 6 to 8 inches (15.2 to 20.3 centimeters). Elevating the head and shoulders over the stomach allows gravity to prevent acid from refluxing. Propping the head up with pillows will not help reflux and may increase pressure on the stomach or esophagus.
  
  
• Wearing loose-fitting clothing. Patients should not wear tight clothing (e.g., pants, belts) because it increases pressure on the abdomen.
  
  
• Reducing stress. Patients should attempt to limit stress, which can worsen heartburn.
  
  
• Sucking on hard candy. This increases the production of saliva, which protects the esophagus from stomach acid.
  
  
• Maintaining a healthy body weight. Research indicates that even just a few extra pounds can increase the incidence of heartburn.
  
  
• Stopping smoking. Cigarette smoking inhibits the production of saliva and increases stomach acid.

Cases of heartburn that do not respond to lifestyle changes may be treated with medications. Common heartburn medications include:

• Antacids. Medications that neutralize stomach acid. They are available without a prescription.
  
  
• Foaming agents. Medications that work by covering the contents of the stomach with foam to prevent reflux. They are available without a prescription.
  
  
• H2 blockers. Medications that reduce the acid levels in the stomach by blocking the chemical used to make acid. They are available over-the-counter and by prescription.
  
  
• Proton pump inhibitors (PPIs). Medications that reduce the amount of acid in the stomach. They are available over-the-counter and by prescription. It is important to note that recent research indicates that use of PPIs may increase a person's risk of hip fracture.
  
  
• Prokinetics. Medications that strengthen the lower esophageal sphincter (LES) muscle and increase stomach contractions, which helps food to pass through the digestive system more quickly. They do not affect the level of stomach acid produced. They are only available by prescription.
  

If medications are not successful in treating heartburn, or if heartburn leads to serious complications, surgery may be required. The surgery most commonly performed is called fundoplication, a procedure in which the top part of the stomach is wrapped around the lower part of the esophagus to strengthen the LES and prevent acid reflux. There are endoscopic procedures that attempt to duplicate the effect of such surgery, but they have been performed in only a relatively small number of patients and the long-term results are not known.