Heartburn

What is heartburn?

Heartburn is a common problem. Despite its name, it has nothing to do with the heart.

When you have heartburn often, you may have a condition called gastroesophageal reflux disease, or GERD. It is important to get treatment for frequent heartburn, because a small percentage of people with GERD will develop changes in the lining of the esophagus called Barrett's esophagus. These changes can lead to cancer of the esophagus.

How does it occur?

At the bottom of the esophagus there is a ring of muscle called a sphincter. It acts like a valve. When you swallow food, the sphincter opens to let the food pass into the stomach. The ring then closes to keep the stomach contents from going back into the esophagus. If the sphincter is weak or too relaxed, stomach acid and food flow backward into the esophagus. Because the esophagus does not have the protective lining that the stomach has, the acid causes 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 protrudes 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
• onions
• citrus foods such as orange juice
• tomato-based foods
• spicy foods
• coffee and other drinks with caffeine, such as tea and 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 attack of heartburn from overeating or eating foods that are high in acid. 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?

The main symptom of heartburn is a burning pain in the lower chest, usually close to the bottom of the breastbone. Other symptoms you may have are:

• acid or sour taste in your mouth
• belching
• a feeling of bloating or fullness in the stomach.

These symptoms tend to happen after very large meals and especially with activity such as bending or lifting after meals. The symptoms may be made worse by lying down or by wearing tight clothing.

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?

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 study 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?

To help reduce the symptoms of heartburn you can:

• Try not to put a lot of pressure on the sphincter muscle. Eating light meals and wearing loose clothing will help.
• Lose weight if you are overweight.
• Take nonprescription antacids (tablets or liquid) after meals and at bedtime.
• Raise the head of your bed or use more than one pillow so your head is higher than your stomach. This may allow gravity to help keep food from backing up.
• If you find that certain foods or drinks seem to cause your symptoms or make them worse, avoid those foods.

If the simple measures described above do not relieve the symptoms, your healthcare provider may prescribe medicine. The prescription medicines help reduce stomach acid. They also help stomach emptying. A very few people who are not helped with medicines may need surgery.

Get emergency care if the following symptoms occur with the heartburn and do not go away within 15 minutes of treatment for heartburn: shortness of breath; sweating; lightheadedness, weakness; or pain in the chest, jaw, arm, or back.

How long will the effects last?

Heartburn symptoms are usually relieved by treatment in just a few hours or less. If you are having heartburn every day, 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.

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

How can I help prevent heartburn?

The best prevention is to:

• Keep a healthy weight. Lose weight if you are overweight.
• Sleep with your head elevated at least 4 to 6 inches. (It's usually most comfortable to put the head of your bed on blocks.)

It may also help if you: