Heartburn: Everything you should know.
Heartburn is a digestive problem that occurs when stomach acid comes into contact with the lining of the esophagus, causing inflammation, irritation, burning, pain, and a variety of other symptoms, including tooth erosion.
Anyone may experience occasional heartburn,1 but if it occurs frequently or daily it may be the symptom of an underlying digestive disorder, most often gastroesophageal reflux disease (GERD). Treatment includes changes to your lifestyle and over-the-counter or prescription medications. Relief is available, and there are many ways you can prevent heartburn.
Most people experience the symptoms of heartburn occasionally, often after a large or spicy meal. It begins as a burning sensation in the upper abdomen behind the breastbone. The pain may travel from the diaphragm upward to the back of the throat and is often accompanied by a sour or bitter taste in the mouth. The pain is worse when you lie down or bend over. You may feel the sensation of food coming back into your mouth. The symptoms often occur after eating and can last for hours.
Nighttime heartburn is a common problem that can awaken you during the night or prevent sleeping. This can happen to such an extent as to affect your ability to work the next day.
If you find your heartburn persisting more frequently than a few times a week, contact your healthcare provider.
Chronic heartburn, which includes episodes that occur several times a week or several times a day, can lead to complications if left untreated.
The constant presence of stomach acid in the esophagus can lead to conditions such as Barrett’s esophagus, erosive esophagitis, esophageal strictures, and even esophageal cancer.
While lifestyle habits can worsen your heartburn symptoms, heartburn is a medical condition with biological causes. Heartburn happens when the lower esophageal sphincter (LES),5 which is located between the esophagus and stomach, is weakened or opens inappropriately. The stomach contents, including stomach acid, go up into the esophagus, an occurrence known as acid reflux. This results in heartburn.
Here are a few of the underlying causes of heartburn:
- Gastroesophageal reflux disease (GERD) is the main condition that displays the symptom of heartburn.
- Digestive motility disorders that slow stomach emptying can contribute to heartburn.
- Conditions linked to heartburn include hiatal hernia, asthma, and diabetes
- Pressure on the stomach can cause heartburn symptoms. This may be due to obesity, pregnancy, tight clothing, frequent bending over, or lifting
- Certain medications can cause heartburn symptoms, including some anti-anxiety medications, narcotics, steroids, antibiotics, and even aspirin.
Lifestyle risks that can trigger heartburn include eating large meals, eating shortly before bedtime, smoking, and stress.
Some types of food and drinks8 are more likely to trigger heartburn. Alcohol, fried foods, fatty foods, spicy foods, chocolate, peppermint, coffee, carbonated beverages, tomatoes, and citrus fruit are the most common irritants.
Before you begin self-medicating for frequent heartburn, you should see your doctor for an evaluation and diagnosis. It is an opportunity to get checked for more serious problems that could produce chest pain, such as angina or coronary artery disease. This is especially important if you have any of the risk factors for heart disease.
Other conditions that can be confused with heartburn include peptic ulcer disease, biliary tract disorders, esophageal motility disorders, and esophageal cancer. If your heartburn is diagnosed as being due to GERD, you can begin treatment that can reduce the risk of complications.
Treatment for heartburn begins with lifestyle and dietary modifications. Stop smoking, lose weight if you are overweight, limit alcohol, and avoid foods that trigger heartburn. You should eat smaller meals and not eat within two to three hours of bedtime. Elevating the head of your bed can help with nighttime heartburn.
If you have an occasional bout of heartburn, it is appropriate to use over-the-counter medications. Antacids neutralize stomach acid and can be used for quick relief when you feel heartburn beginning. They include Rolaids, Mylanta, Tums, or Gaviscon. They should not be used for more than two weeks. Pregnant women should avoid antacids that contain sodium bicarbonate or magnesium trisilicate.
Over-the-counter medications that take a couple of weeks to produce relief include H2 blockers and proton pump inhibitors (PPI). H2 blockers reduce stomach acid and include Axid (nizatidine), Pepcid (famotidine), Tagamet (cimetidine), and Zantac (ranitidine). Proton pump inhibitors (PPI) shut down stomach acid production and are taken for a two-week period. They include Nexium 24H (esomeprazole), Prilosec OTC (omeprazole), Prevacid 24H (lansoprazole), and Zegerid OTC (omeprazole/sodium bicarbonate).
If you have frequent episodes, you should see your doctor for screening and diagnosis to rule out other problems. You may be prescribed a more powerful H2 blocker or PPI.
If you’re dealing with mild or moderate heartburn, you may be able to make some diet and lifestyle changes to keep it from recurring. Here are a few suggestions to keep mild or moderate heartburn under control
- Stop smoking.
- Lose weight if you are overweight.
- Wear loose-fitting clothes.
- Eat frequent smaller meals instead of three larger ones.
- Eat slowly.
- Avoid food and drinks you know are your heartburn triggers.
- Chew gum and drink warm liquids after a meal.
- Don’t go to bed with a full stomach.
- Raise the head of your bed several inches.
- Stress can worsen heartburn. Learning relaxation techniques may help.
You will hear many myths about heartburn, but know that you can find relief. Keeping a heartburn diary can help you identify what triggers it most often for you and which lifestyle remedies and medications help best. Don’t delay in contacting your doctor if your heartburn is frequent and is keeping you from fully enjoying life.
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- Bansal A, Kahrilas PJ. Treatment of GERD complications (Barrett’s, peptic stricture) and extra-oesophageal syndromes. Best Pract Res Clin Gastroenterol. 2010;24(6):961-8.
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- Chen CH, Lin CL, Kao CH. Association between gastroesophageal reflux disease and coronary heart disease: A nationwide population-based analysis. Medicine (Baltimore). 2016;95(27):e4089.
- Kim D, Min YW, Park JG, et al. Influence of esophagectomy on the gastroesophageal reflux in patients with esophageal cancer. Dis Esophagus. 2017;30(12):1-7.
- Sandhu DS, Fass R. Current Trends in the Management of Gastroesophageal Reflux Disease. Gut Liver. 2018;12(1):7-16.
- Singh P, Terrell JM. Antacids. [Updated 2019 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526049/
- Richter JE. Review article: the management of heartburn in pregnancy. Aliment Pharmacol Ther. 2005;22(9):749-57.
- Smith KJ, O’brien SM, Smithers BM, et al. Interactions among smoking, obesity, and symptoms of acid reflux in Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev. 2005;14(11 Pt 1):2481-6.
- Herbella FA, Patti MG. Gastroesophageal Reflux Disease: From Pathophysiology to Treatment. World Journal of Gastroenterology : WJG. 2010;16(30):3745-3749. doi:10.3748/wjg.v16.i30.3745.