Heartburn occurs when gastric juices from the stomach flow up into the esophagus (tube from the mouth to the stomach).
Food travels down the esophagus to the stomach. The connection between the esophagus and stomach opens to let food enter the stomach. Normally it closes as soon as the food enters the stomach. With heartburn, the opening does not close tightly. Stomach acid flows into the esophagus (called acid reflux), causing the burning sensation. Other causes include diseases that interfere with food passing through the esophagus or cause excess acid production.
Exercise immediately after eating (especially jogging or running)
Smoking
Alcohol use
Chocolate
Carbonated beverages, caffeinated beverages, and decaffeinated coffee
High-fat or high-carbohydrate foods and spicy foods
Certain medications, including anti-cholinergics, calcium channel blocking agents, theophylline, NSAIDs, quinidine, tetracycline, potassium and iron supplements, anti-osteoporosis agent alendronate
Prior surgery for heartburn, including gastric reflux surgery and vagotomy
Heartburn symptoms usually occur after overeating or lying down after a big meal. They may last for a few minutes or a few hours. The severity of symptoms depends on the reason the opening does not close, the amount of acid entering the esophagus, and how much the saliva is available to neutralize it.
Symptoms include:
Burning feeling that starts in the lower chest and may move up the throat
Feeling that food is coming back up
Sour or bitter taste in the throat
Pain that increases when bending over, lying down, exercising, or lifting heavy objects
Other symptoms and complications of reflux include:
Sleep apnea (stopping breathing repeatedly throughout the night)
If reflux persists, the acid can damage the esophagus. Symptoms of esophageal damage include:
Bleeding and ulcers in the esophagus
Difficulty swallowing
Vomiting blood
Black or tarry stools
Inflammation and scarring of the esophagus
Barrett's esophagus (pre-cancerous condition of the esophagus)
Dental problems (due to the effect of the stomach acid on the tooth's enamel)
Diagnosis
Heartburn can feel like the pain associated with a heart attack. Never assume that chest pain is heartburn or ingestion. Seek medical care if you're not sure.
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
Upper GI Series – a series of x-rays of the upper digestive system taken after drinking a barium solution
24-hour pH Monitoring – a probe placed in the esophagus to keep track of the level of acidity in the lower esophagus. This is done over a 24-hour period.
Manometry – a test that measures muscle pressures in the lower esophagus
Endoscopy – looking at the esophagus and stomach through a thin, lighted tube that is passed down the throat
Biopsy – removing a small sample of esophageal tissue to measure the amount of acid or pressure in the esophagus
Treatment
Treatment aims to decrease the number of episodes of heartburn and its complications. Therapies focus on stopping the flow of acid back into the esophagus and neutralizing or decreasing production of stomach acid.
Treatment may include:
Medication
Medications may include:
Over-the-counter antacids, which neutralize stomach acid. They work quickly but can cause problems with long-term use. Examples include Maalox, Tums, Rolaids, and Mylanta.
Over-the-counter H2-blocker drugs, which stop the stomach from producing as much acid. These include Tagamet, Pepcid, and Zantac.
Prescription drugs that suppress acid production or reduce the chance of acid entering the esophagus. These are called proton-pump inhibitors and include omeprazole and lansoprazole.
Medications that coat and protect the lining of the stomach (sucralfate)
Medications that improve muscle tone in the lower esophageal sphincter (reglan)
Lifestyle Changes
Lifestyle changes may include:
Keep a food diary of what you eat and what the reaction is. Make gradual changes to your diet and record the results.
Avoid foods that provoke symptoms, such as:
High fat foods
Spicy foods
Onions
Chocolate
Peppermint
Citrus fruits
Tomatoes
Peppers
Alcohol
Coffee
Carbonated drinks
Try eating smaller portions, since large meals increase the chance of heartburn.
Allow at least two or three hours between meals and bed or naptime. This allows the stomach to partially empty before you lie down.
Losing weight may help decrease symptoms.
Don't smoke cigarettes. Cigarette smoking relaxes the muscle, allowing stomach acid into the esophagus.
Avoid belts and clothing that are too tight.
Elevate head of bed 6-8 inches.
Surgery
If symptoms are severe enough and patients can't tolerate the medications, surgery may be an option:
Fundoplication – the doctor wraps the stomach around the esophagus to create pressure on the muscle at the opening to the stomach.
Prevention
Several lifestyle changes can help prevent heartburn. Suggestions include:
Avoid overeating.
Sit up for two to three hours after eating.
Avoid wearing clothing or belts that are too tight.
Do not smoke.
Avoid drinking beverages that contain alcohol or caffeine.
Modify diet to avoid foods that increase heartburn.
Chew sugarless gum for about 30 minutes after a meal. This will increase saliva flow, which can neutralize stomach acids in the esophagus.
Obtain and maintain a healthy weight.
Learn and practice stress-management techniques.
Resources:
American College of Gastroenterology
http://www.acg.gi.org/
American Gastroenterological Association
http://www.gastro.org/
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov
SOURCES:
America Academy of Family Physicians
American College of Gastroenterology
American Gastroenterological Association
Conn's Current Therapy 2001, 53rd ed. W. B. Saunders Company, 2001.
National Institute of Diabetes and Digestive and Kidney Diseases
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
