Heartburn

What is heartburn?

Heartburn is a burning pain or warmth in your chest or throat when acids in your stomach flow back into your esophagus. (The esophagus is the tube that carries food from your throat to your stomach.) This backward movement of stomach acid is called reflux. The acid can burn and irritate the esophagus, throat, and vocal cords.

Everyone has heartburn once in a while. It usually happens after eating, especially after eating spicy foods, or from bending over soon after eating.

If you have heartburn often, starting treatment will usually relieve the symptoms in a few days. However, the symptoms may come back from time to time, especially if you gain weight.

If you have heartburn every day, you may have a condition called gastroesophageal reflux disease (GERD). It is important to get treatment for GERD because without treatment, GERD can damage the lining of the esophagus. You may have bleeding or ulcers. Scar tissue can form that narrows the esophagus, making it hard to swallow. Some people with GERD develop Barrett’s esophagus, which is a change in the lining of the esophagus. There is a small risk that Barrett's can lead to cancer.

Heartburn can sometimes make asthma worse. If you have asthma, preventing or controlling heartburn may help control your asthma symptoms.

What is the cause?

Normally, when you swallow, food and liquids flow down the esophagus. There is a ring of muscle around the lower end of this food pipe. This ring, called a sphincter, opens up and lets the food go into your stomach. Normally, it then closes and keeps stomach contents from going back into the esophagus. If the sphincter is weak or too relaxed, it doesn’t stay closed all of the way and stomach acid and food can flow back into the esophagus. Because the esophagus does not have the protective lining that the stomach has, the acid irritates it and can cause pain.

The sphincter muscle sometimes does not work properly if:

• You are overweight.
• You are pregnant.
• You have a hiatal hernia (a condition in which part of the stomach pokes through the diaphragm into the chest).
• You eat too much.
• You lie down soon after eating.
• You wear tight clothes that push on your stomach.

Foods that may make heartburn worse are:

• foods high in fat
• sugar
• chocolate
• peppermint and other mint flavorings
• onions and garlic
• citrus foods and juices
• tomato-based foods
• spicy foods
• caffeine drinks, such as coffee and tea
• carbonated drinks, such as colas
• alcohol

Heartburn can also be made worse by:

• taking certain medicines, such as aspirin or ibuprofen
• smoking cigarettes
• taking medicines with too little water, causing them to get stuck in the esophagus

Anyone can have an occasional attack of heartburn from overeating or eating foods that are irritating. Most of the time heartburn is mild and lasts for a short time. There is usually not a problem when heartburn occurs just once in a while.

You should see your healthcare provider if:

• You have heartburn nearly every day for 2 weeks.
• The heartburn comes back when the antacid wears off.
• Heartburn wakes you up at night.

What are the symptoms?

Symptoms of heartburn may include:

• burning pain or warmth in your chest or throat, usually close to the bottom of the breastbone (the main symptom)
• bitter or sour taste in your mouth
• belching
• a feeling of bloating or fullness in the stomach
• frequent unexplained dry cough
• wheezing, shortness of breath, and chest tightness (symptoms that are similar to asthma symptoms)

These symptoms tend to happen after large meals and especially with activity such as bending or lifting after meals. Heartburn usually occurs 30 to 60 minutes after you eat and may be severe. Tight clothing may make the symptoms worse. You may have symptoms when you lie down too soon after eating. You may feel better when you sit upright. The pain may spread to your neck, jaw, arms, and back. It may be hard to tell it from a heart attack. Get emergency care if your heartburn does not get better within 15 minutes after treatment or if you have chest discomfort (pressure, fullness, squeezing or pain) that goes away and comes back or chest discomfort that goes to your arms, neck, jaw, or back. These symptoms may be signs of a heart attack.

Heartburn is very common during the last few months of pregnancy. The weight of the baby pushes on the stomach and can cause the sphincter to let acid flow back into the esophagus.

How is it diagnosed?

Your healthcare provider will ask about your symptoms. Depending on your symptoms, you may have an exam. Usually heartburn can be diagnosed from your medical history. If there is any question about the diagnosis, you may have the following tests to check for ulcers or other problems that might cause your symptoms:

• barium swallow X-ray exam of the esophagus
• complete upper GI (gastrointestinal) barium X-ray study of the esophagus, stomach, and upper intestine
• endoscopy (a way for your provider to look at your esophagus and stomach with a scope)

How is it treated?

The goal of treatment is to control reflux and have fewer symptoms of heartburn. Your healthcare may recommend some lifestyle changes and antacids. If this doesn’t relieve your symptoms, your healthcare provider may recommend prescription medicine and may check you for GERD.

If you have GERD, prescription medicines can help decrease stomach acid or help the stomach empty. Medicine for GERD may be taken once or twice a day, or only as needed. Ask your provider how often you are to take it. If you are on medicine for a long time, your provider may try lowering the dose to see if it still controls your symptoms. In some cases when medicine doesn’t help, surgery may be needed.

How can I take care of myself and help prevent heartburn?

To feel better and prevent problems:

• Follow your healthcare provider’s treatment plan. Carefully follow your provider’s instructions for taking your medicines. Ask your healthcare provider what you should do if your treatment isn’t helping or your symptoms get worse. Keep your follow-up appointments with your provider.
• Take nonprescription antacids after meals and at bedtime, according to your provider’s recommendation.
• Take medicines with plenty of liquid. Swallowing medicine without enough liquid can irritate the esophagus.
• Try not to put a lot of pressure on the sphincter muscle. Eat smaller, more frequent meals and wear clothing that is loose around your belly.
• If you find that certain foods or drinks seem to cause your symptoms or make them worse, avoid those foods.
• Lose weight if you are overweight. Extra weight puts pressure on your stomach. This can cause stomach contents to push up into your esophagus.

It may also help if you:

• Avoid vigorous activity after meals.
• Sit up during meals and wait at least an hour after eating before you lie down. It’s best to not eat for 2 to 3 hours before you go to bed.
• If heartburn bothers your sleep, raise the head of your bed 6 to 8 inches by putting the frame on wood blocks. If you cannot raise the frame of the bed, try placing a foam wedge under the head of your mattress. Sleeping on your left side may also help. Just using extra pillows will not help.
• Chew sugarless gum after meals. Some studies have shown that this decreases reflux.
• Don't smoke. Smoking can increase stomach acid. The air you swallow while smoking may also increase the pressure in your belly. This can cause stomach contents to push up into your esophagus. Smoking also increases the risk for cancer of the esophagus.
• Do things to help your mood and emotions. If you start to feel depressed or anxious, talk to your provider about your feelings.

Ask your healthcare provider:

• how and when you will hear your test results
• how long it will take to recover from this illness
• what activities you should avoid and when you can return to your normal activities
• how to take care of yourself at home
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.