Considering that a bellyache's usual cause is overeating, it's fitting there's such a smorgasbord of indigestion and heartburn remedies from which to choose.
Walk into any drugstore and you'll find dozens of ways to spell relief — from the old plop, plop, fizz, fizz standby to products promising to build a foam "raft" in the stomach to settle things down.
Narrowing your choice to one brand can lead to more decisionmaking. Often, there's regular, extra-strength, fast-acting, max, supreme or so-called complete versions to pick from. Liquid, tablets or gelcaps? Lemon flavor or cherry?
The good news is that consumers can't make a bad choice. Over-the-counter acid indigestion and heartburn remedies are among the safest and most effective medications out there, according to medical experts. Finding which one works best for you is a matter of knowing some indigestion basics.
"Overall, most of the differences between products are marketing differences," said Dr. John Haugen, a family practice physician at Park Nicollet Clinic in St. Louis Park, Minn. "If you follow the directions that come with the product, you're likely to get relief."
Something to keep in mind when picking a product is the physiology of indigestion — known medically as dyspepsia.
Symptoms include abdominal fullness, discomfort, burning, bloating or nausea. Heartburn is a burning sensation or sour taste in the back of the throat or behind the breastbone. Overindulging is a common cause of both.
The stomach's size is a key reason for this, said Dr. Jon Hallberg, a University of Minnesota family practice physician. The organ is a fairly small pouch, and it doesn't take much food to fill it.
Not surprisingly, a stomach bulging with food causes discomfort, Hallberg said. Certain foods — such as chocolate, tomato sauce, orange juice and alcohol — can change the chemical make-up of stomach contents. Indigestion's familiar burning pain results when stomach contents become too acidic.
Overindulging also can trigger heartburn, Hallberg said. When the stomach is too full, the sphincter that prevents acid from washing up the esophagus is stretched, compromising its ability to do its job.
Doctors call the phenomenon acid reflux. But the term heartburn better describes what acid in the esophagus — the tube that carries food from the mouth to the stomach — feels like.
If the stomach feels full from eating too much, there's not much to do other than wait for the stomach to process the food, said Dr. G. Richard Locke, a Mayo Clinic gastroenterologist. That can take a couple of hours.
Over-the-counter products can help when the stomach feels like it's burning or bloated, Locke said, or if heartburn has set in.
Physicians generally divide drugstore remedies into two groups:
Acid blockers. Zantac, Axid, Pepcid and Tagamet are the newest medications on the market. Formerly available only by prescription, these drugs prevent the stomach from producing digestive acids. They're sometimes known as H2 blockers.
Antacids. Maalox, Mylanta, Rolaids, Tums, Alka-Seltzer, Phillips Milk of Magnesia and Gaviscon all belong to this group. They work by neutralizing stomach acid. Compounds containing calcium, magnesium or aluminum are the usual ingredients. Alka-Seltzer contains baking soda and aspirin.
Physicians consider antacids quicker-acting than acid blockers, which can take up to 45 minutes to relieve stomach discomfort. But acid blockers have other important advantages, said Dr. Robert Ganz, a gastroenterologist with Minnesota Gastroenterology in Minneapolis.
They're more potent and longer acting — providing relief for up to eight hours. They can be used ahead of time to prevent stomach discomfort.
Acid blockers also are believed to have fewer side effects, Ganz said.
Physicians generally stop short of endorsing one product or brand over another. Many said they personally use acid blockers to treat or prevent persistent indigestion or heartburn, while calling on antacids for quick relief.
One of the newest products — Pepcid Complete — combines acid blockers and antacids. Physicians said consumers can get the same effect by combining both types of medicines on their own.
"It might be cheaper to do a shot of each if you've got both on hand," said Haugen.
Less-expensive, generic acid blockers are as effective as brand names, Locke said. The liquid form of these drugs is no more effective than tablets, acid blockers' usual form.
"An H2 blocker is an H2 blocker is an H2 blocker," Locke said.
Antacids also are similar to each other, physicians said. Liquids might be slightly faster in relieving discomfort, but their chalky taste can make them more difficult to swallow.
Extra-strength versions typically have more calcium, magnesium or aluminum in the product. They may contain simethicone, a product that helps reduce gassiness.
The extra helping of active ingredients might be beneficial, Locke said. Then again, it might not be necessary.
"Larger amounts of antacid will neutralize more acid in the stomach. In that respect they are 'better,' " he said. "However, for some people the smaller amount of antacid is all they need for symptom relief."
One product whose active ingredient stands out in the antacid group is Gaviscon.
It contains alginic acid, which forms a foamy substance in the stomach. Its manufacturer claims that this foam "raft" sits atop the stomach acid, forming a barrier that protects the stomach lining or the esophagus.
Some physicians believe it may be more effective for treating heartburn. Beyond that, physicians said, it's a matter of preference.
If consumers think gelcaps are easier to swallow, they should choose them. The same goes for medication flavorings.
Strategies to prevent indigestion and heartburn include eating less, eating more slowly and taking a walk after a meal to help the body digest food, Hallberg said.
Alternative practitioners offer similar recommendations. Chamomile tea, peppermint tea and papaya enzyme may help, said Pat Culliton, who specializes in traditional Chinese medicine at Hennepin County (Minn.) Medical Center's Alternative Medicine Clinic.
Ongoing heartburn and indigestion should be evaluated by a physician, Ganz said.
Stronger prescription medications are available and the stomach discomfort could indicate a more serious condition, such as a stomach ulcer, he said.
The American College of Gastroenterology also warns that heartburn and indigestion may be symptoms of a heart attack. Those with heart disease risk factors should consider this when heartburn or indigestion set in.