Do you have heartburn after taking antibiotics? You aren’t alone. It’s common for people to have heartburn when taking antibiotics.
Antibiotics are prescribed for the treatment of bacterial infections. Their role is to kill bacteria or inhibit bacterial growth. Unfortunately, antibiotics do not differentiate between good and bad bacteria. We have good bacteria in our digestive system that aid in digestion and keep bad bacteria in check. When the good bacteria are missing, digestive issues occur.
Antibiotics contribute to heartburn symptoms and worsen gastroesophageal reflux disease (GERD) by eradicating good bacteria and by directly irritating the esophagus.
Common digestive side effects of antibiotics are:1
Antibiotics Heartburn Caused by Esophageal Irritation
Antibiotics are one of many caustic pills that cause esophagitis. The more caustic the antibiotic greater the risk of irritation.
What is esophagitis? Esophagitis is the inflammation of the esophagus, the tube that carries food from the mouth to the stomach. Common causes of esophagitis are acid reflux, medications, and infections affecting the esophagus. The irritation caused by esophagitis can be painful and make swallowing difficult.
Esophagitis is commonly caused by antibiotics accounting for close to half of all reported cases of pill-induced esophagitis. Doxycycline, tetracycline, and clindamycin are a few of many that make up a long list of antibiotics that cause esophagitis.
Causes of Antibiotic Pill-Induced Esophagitis
Numerous issues can lead to esophagitis through extended contact with antibiotic pills.2
The causticity of antibiotic pills can cause injury if pills remain in contact with the lining of the esophagus.
Poor posture can cause pills to get stuck in the esophagus.
Conditions or medication that lead to decreased amounts of saliva causing dry mouth can cause pills to get stuck in the esophagus when swallowed.
Number of Pills Swallowed
Taking a number of pills at the same time can cause them to get stuck in the esophagus.
Antibiotic Pill Size
Larger antibiotic pills can potentially get stuck when swallowing.
Lack of Water
Not drinking enough water when swallowing pills can cause them to get stuck in the esophagus.
Esophageal Motility Disorder
Esophageal motility disorders make swallowing both solids and liquids difficult.
Repeated exposure to refluxed acid in patients with GERD can form a ring of scar tissue called an esophageal stricture. Esophageal strictures make swallowing difficult allowing the prolonged contact of antibiotic pills with the lining of the esophagus.
Cardiomegaly is the enlargement of the heart. When the left atrium is enlarged, it can compress the esophagus causing swallowing issues.
Elderly patients are more likely to develop pill-induced esophagitis. As we age, increased physical ailments require medications many of which are caustic or cause acid reflux by promoting the relaxation of the lower esophageal sphincter (LES). The LES is a ring of muscle at the base of the esophagus that needs to close tightly to prevent stomach acid from refluxing into the esophagus to cause heartburn.
The muscles weaken with age. This includes the muscle in the esophagus and LES. The weakening of these muscles can make swallowing pills more difficult and lend to the reflux of medication.
Stomach acid also decreases with age. Low stomach acid lengthens digestion time in the elderly. The longer antibiotics remain in the stomach the greater the risk of refluxing these caustic medications.
How to Avoid Antibiotic Pill-Induced Esophagitis
To avoid antibiotic pill-induced esophagitis, patients should:
- Swallow pills when sitting upright or preferably while standing.
- Swallow pills one at a time.
- Swallow pills with 4 to 8 ounces of water.
- Remain in an upright position for two hours after swallowing pills.
- Ask your doctor or pharmacist if there is a liquid form of the antibiotic you’re prescribed.
- Ask your doctor or pharmacist if the antibiotic pill can be crushed and mixed with water to make swallowing easier.
- Ask your doctor or pharmacist if the antibiotic can be taken with food without limiting its effectiveness.
- Ask your doctor if a less caustic antibiotic is available for treatment.
- Ask your doctor if a sublingual, intrarectal, subcutaneous, or intravenous, forms of antibiotics are available for treatment.
- The elderly should increase stomach acid to improve the digestion time of antibiotics.
- The mucosal membrane lining the esophagus and stomach can be bolstered with mucilage for added protection against esophagitis. Mucilage is a substance produced by plants and is found in aloe vera, licorice (use DGL form), slippery elm, and marshmallow root.
Patients who are at risk of a recurrence of antibiotic pill-induced esophagitis or the development of chronic esophagitis from taking antibiotic pills are those who have esophageal issues that restrict swallowing, the elderly, those whose health condition prohibits swallowing pills with an adequate amount of water, and those who are unable to sit up.
Antibiotics Heartburn Caused by the Loss of Good Gut Bacteria
Antibiotics are used to kill off bad bacteria that are causing illness, but they also kill off good bacteria in the digestive system. These good bacteria aid the digestive process. When good bacteria is missing, we can suffer from digestive issues like acid reflux and heartburn.
How Good Gut Bacteria Loss from Antibiotic Use Causes Heartburn
How can the lack of good bacteria from the use of antibiotics lead to acid reflux symptoms like heartburn? When good bacteria in the digestive system are killed by antibiotics, an overgrowth of bad bacteria can lead to excessive gas, bloating, belching, reduced stomach acid, and constipation. All of which can lead to heartburn.
Antibiotics Heartburn from Gas and Bloating
Bad bacteria produce hydrogen and methane gas causing an increase in abdominal pressure. This increase in abdominal pressure will weaken the lower esophageal sphincter (LES) prohibiting it from closing tightly enough to keep stomach acid from refluxing into the esophagus. The LES is a ring of muscle at the base of the esophagus that opens as food travels to the stomach and closes to keep acid reflux from occurring.
The gas produced by bad bacteria not only causes abdominal pressure. It can lead to belching. Belching will help lower abdominal pressure, but it can also force stomach acid through the LES into the esophagus.
Antibiotics Heartburn from Reduced Stomach Acid
An overgrowth of bad bacteria in the digestive system will cause a reduction in stomach acid. This initially sounds great to those suffering from acid reflux symptoms like heartburn, however, stomach acid actually triggers the LES to close. If the LES doesn’t close tightly enough, acid reflux can occur. For many people, heartburn isn’t from too much acid. It’s a lack of acid. Our stomachs are designed to handle stomach acid. The stomach has a lining that protects against it. The problem is when acid refluxes into the esophagus. The lining of the esophagus doesn’t have the same protective lining as the stomach.
Constipation After Discontinuation of Antibiotics Can Lead to Heartburn
Antibiotics not only cause heartburn during their use but can also lead to heartburn after use. Not only can excessive gas, bloating, belching, and reduced stomach acid continue after antibiotics are discontinued constipation can occur.
Diarrhea may be experienced during the use of antibiotics. Constipation can be experienced after the discontinuation of antibiotics. Without good bacteria to keep the bad bacteria under control, bad bacteria will impair the digestive process causing it to slow by preventing the synthesis of digestive enzymes needed to break down proteins into amino acids and the absorption of nutrients. The increase in abdominal pressure due to constipation can prevent the LES from closing properly leading to acid reflux and heartburn.
Treat Antibiotics Heartburn Caused by Loss of Good Bacteria with Probiotics
Probiotics are good bacteria that need to be ingested to rebalance gut bacteria after discontinuation of antibiotics. The reintroduction of these good bacteria will improve digestive function and reduce acid reflux symptoms like heartburn.
Use of probiotics during antibiotic treatment may help restore stomach acid and alleviate gas, bloating, and belching even though antibiotics will continue to kill these good bacteria.
Probiotics rebalance digestive function after antibiotic use and thus reduce the instance of heartburn by:
- Preventing the overgrowth of bad bacteria which produce gas leading to bloating and belching.
- Preventing constipation by eliminating bad bacteria that cause slow, inefficient digestion.
- Promoting optimal stomach acid levels. Stomach acid helps the LES close properly, kills harmful bacteria, improves absorption of nutrients, and reduces the instance of constipation.
- Improving food and nutrient absorption by helping break down food for easier digestion thus reducing the possibility of constipation. Improved nutrient absorption also provides the digestive system needed nutrients for proper function.
- Maintaining muscle activity which moves material through the digestive tract.
- Preventing leaky gut and helping with antibody production which boosts the immune system. A healthy immune system also helps protect against bad bacteria overgrowth.
How to Treat Antibiotics Heartburn from the Loss of Good Bacteria with Probiotics
Fermented foods and probiotic supplements can be used to reintroduce good bacteria into the digestive system after use of antibiotics. Fermented foods and beverages like buttermilk, kefir, kimchee, kombucha, miso, sauerkraut, sour cream, and yogurt are the best sources of probiotics, but avoid pasteurized versions of these. Good bacteria is killed off in the pasteurization process. Consume probiotic foods that are unpasteurized.
Though cultured dairy products are great sources of probiotics, avoid these when first reintroducing probiotics and when you have heartburn. Dairy products contain lactose, a sugar on which the bad bacteria will feed. Dairy products can also increase heartburn symptoms. Initially, dairy products can make heartburn feel better, but they will prompt the stomach to produce more acid for breaking down calcium, fat, and protein found in these foods. The additional acid can cause heartburn symptoms to rebound.
If you can’t find unpasteurized, probiotic foods, you can always make your own at home. Lacto-fermented foods are quite simple to make. A great guide for making these foods is The Art of Fermentation by Sandor Ellix Katz.
Good Bacteria Must Be Fed
Good bacteria or probiotics need a food source called prebiotics. Prebiotics are nondigestible carbohydrates found in foods like barley, oats, flax, wheat, beets, carrots, garlic, leeks, legumes, onion, artichokes, asparagus, and radishes. They can also be found in supplement form.
Avoid or keep sugar, processed foods, animal fats, and animal protein to a minimum. These food promote bad bacteria growth.
9 Things to Remember When Taking Antibiotics:
- Don’t take antibiotics unless they are really needed. Too many people abuse antibiotics.
- Antibiotics will likely cause heartburn.
- Mucosal supplementation in the form of mucilage (aloe vera, licorice (use DGL form), slippery elm, and marshmallow root) is available for protecting the lining of the esophagus and stomach from the causticity of antibiotic medications.
- Take pills while in an upright position, with 4 to 8 ounces of water, and remain upright for 2 or more hours.
- Taking antibiotics with food may reduce stomach irritation.
- Antibiotics kill off needed good bacteria in the digestive system.
- Rebuilding good bacteria after getting off antibiotics is essential for digestive health.
- The general tips for avoiding heartburn can help during antibiotic use.
- Heartburn medicine can affect the absorption and effectiveness of some medications. Speak with your doctor before taking acid reducers for heartburn symptoms.
1) “Side effects – Antibiotics.” National Health Service, UK, September 6, 2016.
2) J. Walter Kikendall, MD. “Pill-Induced Esophagitis.” National Center for Biotechnology Information, U.S. National Library of Medicine, Gastroenterol Hepatol (NY), April 2007.