THE NEW YORK TIMES: From Tums, Pepcid, Gaviscon, here’s how to find ideal heartburn treatment for you

Q: I often feel burning in my chest after meals or when I lie down, but I never know which over-the-counter heartburn medication to take. What will work best?

A: It’s the burning sensation that rises from your stomach into your chest, stings your throat and feels like the food you’ve swallowed is coming back up. Heartburn is common, regularly affecting about 20% of people in the United States.

When the valve between the stomach and esophagus weakens, it results in “the backward flow” of stomach acid into your esophagus, said Dr. Byron Cryer, president of the American Gastroenterological Association. Called acid reflux, this can lead to pain, burning and regurgitation.

Various foods and beverages — including red wine, tomato sauce, chocolate and mint-flavored candy or gum — can cause heartburn, as can eating large meals, Cryer said. Being pregnant or overweight (putting extra pressure on the stomach) and taking GLP-1 drugs (which delay stomach emptying) also increase the risk.

Over-the-counter medications including antacids (like Tums and Rolaids), H2 blockers (like Pepcid and Zantac 360), proton pump inhibitors (like Nexium and Prilosec) and alginate medications (like Gaviscon) can be effective at treating heartburn, Cryer said. But these drug classes work in different ways, he said. Here’s how to find the right one for you.

How They Work

Antacids like Tums and Rolaids work by “instantly neutralizing” stomach acid, which masks burning and pain, said Dr. Sumona Bhattacharya, a gastroenterologist and assistant professor of medicine at the George Washington University School of Medicine.

These medications are best for when you need “rapid relief” for mild, infrequent symptoms, Cryer said, like light burning in the chest or throat after a glass of wine. Since the drugs neutralize stomach acid, they’re most effective when taken after symptoms start, he added. But they won’t reduce stomach acid production.

For that, you’ll need a histamine-2 receptor antagonist, known as an H2 blocker, or a proton pump inhibitor, often called a PPI.

When you eat, your stomach produces an immune chemical called histamine, which stimulates cells in the stomach lining to produce acid, said Dr. Craig C. Reed, a gastroenterologist at UNC Health in North Carolina. H2 blockers like Pepcid and Zantac 360 attach to histamine receptors, hindering the cells’ acid production, he said.

H2 blockers are most effective for more intense burning and pain that happen once or twice a week, Cryer said. They can be taken daily to prevent heartburn, he said, or as needed after the symptoms develop, and they can take up to an hour to kick in.

Proton pump inhibitors like Nexium and Prilosec block an enzyme — called the proton pump — in the stomach cells that secrete acid, Reed said. People with chronic heartburn can benefit most from PPIs, since they can be taken daily to prevent symptoms, he added. The drugs are most effective when taken on an empty stomach.

Another type of heartburn medication is made from alginates — compounds derived from seaweed — which form a physical, gel-like barrier between the stomach and esophagus, preventing stomach acid from passing through. Some alginate medications, like Gaviscon, also contain an antacid.

Alginates are recommended for people with regurgitation — the feeling that contents of the stomach are coming up into your throat, Cryer said. They can be used alongside the three other medication classes.

When to See a Doctor

Most people can tolerate over-the-counter heartburn medications well, Cryer said. However, long-term use of PPIs can raise the risk of certain conditions, including vitamin B-12 deficiency, osteoporosis or a severe intestinal infection caused by the bacterium C. diff.

If you need to take one of these medications for more than 10 consecutive days, see a gastroenterologist, Cryer said. Also, Bhattacharya added, see a doctor if you get heartburn more than a few days a week.

Heartburn accompanied by difficulty swallowing or unintended weight loss especially warrants a trip to the doctor, she said. That could signal a more serious condition like gastroesophageal reflux disease, or GERD, which is a chronic, more severe form of acid reflux, or esophagitis, an inflammation of the esophagus lining, which may require different treatment.

For severe heartburn, doctors can prescribe stronger doses of PPIs or H2 blockers, Cryer said.

If over-the-counter or prescription heartburn medications don’t work, certain surgeries are an option, Reed said. One, called fundoplication, involves wrapping the top part of the stomach around the lower part of the esophagus to strengthen the barrier between them.

To prevent heartburn before it starts, avoid foods and beverages that you know may set it off, Reed said. It’s also helpful to elevate your head while sleeping and to refrain from lying down immediately after eating. If you smoke or drink, cut back on both; and if you’re overweight, losing weight also can potentially prevent heartburn, Reed said.

What’s unlikely to work are herbal remedies like chamomile tea, ginger or licorice extract, Cryer said — scientists don’t have strong evidence that they help with heartburn. And those remedies shouldn’t replace proven therapies like medications, he said.

This article originally appeared in The New York Times.

© 2026 The New York Times Company