"It almost feels like there's a volcano and you're on fire."

That's how Eric Palatnik used to describe his heartburn. His occasional bouts of acid reflux became more frequent and severe with age.

"On your worst nights with acid reflux, the only way I could actually get relief was to actually sleep sitting up," he said.

To treat heartburn, more and more people are turning to a class of drugs called proton pump inhibitors, or PPIs.

The biggest seller by far is the heavily advertised prescription drug Nexium. With a $240-a-month price tag, 2008 sales of Nexium reached nearly $5 billion.

It's the second most commonly prescribed brand-name drug in the United States.

"PPIs can be effective, particularly if you suffer from acid reflux or GERD. But they're often over-prescribed, unnecessary, and expensive," said Consumer Reports' Dr. John Santa.

If your doctor suggests a PPI, Consumer Reports Best Buy Drugs said several over-the-counter alternatives can work just as well and save you thousands of dollars a year.

They include generic omeprazole, Prilosec OTC and new Prevacid 24HR.

"But before you start taking any heartburn medication more than just occasionally, talk to your doctor about changing diet and lifestyle and see if that helps," Santa said.

That's how Palatnik got his heartburn under control.

"The dietary changes that I've made include cutting out caffeine, chocolate, tomatoes, red sauce, citrus," said Palatnik.

For occasional heartburn, Consumer Reports said before considering a PPI medication, try an antacid like Rolaids or TUMS, or an H2 blocker, such as Pepcid or Zantac.