Heartburn

Heartburn can be relieved and cured for many people with lifestyle changes.

Heartburn is a sensation of burning in the chest caused by stomach acid backing up into the esophagus (food pipe). The burning is usually in the central part of the chest, just behind the sternum (breast bone). The burning can worsen or can be brought on by lying flat or on the right side. Pregnancy tends to aggravate heartburn.

Many people experience heartburn and there are a large number of over-the-counter (OTC) medications and home remedies available to treat heartburn.

In most cases, you will not need to see a healthcare professional, except if the symptoms are frequent (several times a week), severe, or increasing in severity.

If heartburn is severe or the pain is accompanied by additional symptoms such as shortness of breath, or radiation into your arms or neck, you will need to see a doctor to distinguish these symptoms from more serious medical conditions such as a heart attack.

GERD (Gastroesophageal reflux disease) can be considered a chronic and more serious form of reflux with heartburn as the major symptom; however, there may be other symptoms or no symptoms at all.

If your heartburn symptoms occur more than twice a week you should see your healthcare professional to make sure no serious problems are present.

The esophagus (the tube that connects your mouth to the stomach) has a tight band of muscles at the lower end (lower esophageal sphincter [LES]) that closes after the food enters the stomach and prevents the stomach contents from reentering the esophagus. If this sphincter weakens or relaxes at the wrong time, stomach acid can back up into the esophagus, causing heartburn and its complications.

What triggers heartburn symptoms?

Certain foods and drinks have been recognized to trigger heartburn.

Foods and drinks that cause heartburn include the following:

• Alcohol: Alcohol can relax the lower esophageal sphincter.
• Coffee (including decaf) and orange or other acidic juices: Some of these beverages can worsen or trigger heartburn.
• Carbonated beverages
• Fatty foods, fried foods, and some acidic foods (oranges, grapefruits, tomatoes), as well as spicy foods, can cause heartburn.
• Chocolate

Every person reacts somewhat differently to specific food groups. To track what foods worsen your symptoms, keep a food journal. In this journal, you should keep track of what you eat, the time you ate, any activity that worsened or made the heartburn better, and indicate which days you have heartburn symptoms. Over time, you will be able to correlate the offending foods with heartburn events.

Print this table below and take it with you to your next doctor's appointment to discuss possible causes of heartburn you may be experiencing.

Besides certain foods, several other factors may trigger heartburn. They include:

• Overeating
• Sleeping or lying down right after a meal
• Smoking
• Rigorous exercise especially after a meal
• Obesity or being overweight
• Hiatal hernia (a condition in which the stomach bulges up into the chest through an opening in the diaphragm, the muscle that separates the two areas)
• Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), blood pressure medications, and medications used to treat asthma, heart diseases, anxiety, depression, and cancer
• Stress and anxiety

Can multivitamins cause heartburn?

Multivitamins, especially the ones containing zinc, iron, or calcium, can aggravate the symptoms of GERD including heartburn.

To avoid heartburn caused by multivitamins:

• Avoid taking multivitamins on an empty stomach
• Take multivitamins with food
• Do not take multivitamins right before exercise
• Try the easy-to-digest forms of multivitamins, such as chewable tablets, powders, and dissolvable forms
• Avoid mega doses of multivitamins, such as the once-a-month or once-a-week dose
• Take smaller daily doses of multivitamins
• Try meeting your daily nutrient needs through a diet

The usual symptom of heartburn is a burning sensation in the chest. It can be accompanied by the following:

• A sour taste at the back of the throat
• Regurgitation of food
• A feeling of food being stuck in the throat
• Burning in the chest
• Coughing
• Hoarseness

A person needs to be evaluated by a healthcare professional for heart disease as soon as possible if he or she has heartburn symptoms that are accompanied by the following:

• Shortness of breath
• Radiation to the arms or neck
• Dizziness or cold sweat

Acid reflux or GERD

Picture of GERD (gastroesophageal reflux disease, heartburn)

Heartburn is usually not a cause for concern. However, if the pain is persistent, it could be a sign of something more serious.

Consult your doctor immediately if you experience the following:

• Symptoms that worsen or become more frequent (more than once a week for 6 months or longer)
• Chest tightness or pressure
• Shortness of breath or difficulty breathing
• Dizziness or lightheadedness
• Cold sweats
• Heart palpitations
• Unexplained weight loss
• Symptoms that are not relieved with antacids
• Symptoms interfere with your daily activities or sleep
• Severe abdominal pain
• Bloating or abdominal distention
• Uncontrolled hiccups
• Difficulty swallowing
• Persistent cough
• Lump in the throat
• Fever
• Nausea and vomiting
• Diarrhea
• Blood in stools or black, tarry stools
• Blood in vomit
• Jaundice (yellowing of the skin or eyes)

Often all that a healthcare professional requires is a thorough history and physical to make the preliminary diagnosis of heartburn.

To evaluate if there is any damage and how severe your heartburn is, the doctor may suggest some of the following tests:

• Endoscopy: A flexible scope is passed down the esophagus to examine the esophagus as well as the stomach. Biopsies can be taken if indicated. This lets the doctor see if there is any obvious damage and also eliminates other reasons for the patient's symptoms (foreign body, malignancy).
• Upper GI series (upper GI series): After drinking a liquid that coats the inside of the digestive tract, X-rays are taken. These X-rays will show the outline of the digestive system.
• Ambulatory pH testing: This test measures the acidity in the esophagus via a small tube that goes through the nose into the stomach.

There are many over-the-counter and prescription medications available. These fall into three major categories:

1. Medications that neutralize stomach acid (antacids): Antacids (Mylanta, Maalox, Rolaids, Tums) provide quick relief because they decrease the acid. These medications don't heal existing damage to your esophagus nor prevent future episodes of heartburn.
2. Medications that reduce the production of acid: These medications are named after the receptor they block (H-2 blockers) and are available as over-the-counter as well as prescription medications. Their symptom relief tends to last longer than antacids, but it also takes longer for them to start working. They are available in several brands and formulations (ranitidine [Zantac], nizatidine [Axid], cimetidine [Tagamet], and famotidine [Pepcid]). Depending on the strength they are available over-the-counter and by prescription.
3. Medications that block acid production: Proton pump inhibitors (for example, omeprazole [Prilosec], and lansoprazole [Prevacid]) block the production of acid. This then allows the healing of the damaged esophagus.

Note: You should make your healthcare professional aware if you take these medications on a chronic basis as there can be interactions with other medications and frequent use will alert your doctor to the severity of symptoms.

Laparoscopic surgical procedures are available to treat heartburn. This option is usually only chosen if lifestyle changes and medications have not helped. There also are endoscopic treatments for treating heartburn that don't require surgery, but endoscopic procedures are less commonly used than surgery.

Making changes to your diet is a great way to help ease heartburn. You can start by avoiding foods that are likely to worsen your symptoms and then add in other nutritious foods. There are no specific diets for acid reflux, but these top 10 heartburn foods might help:

• Oatmeal
  • High-fiber foods keep you feeling full for longer. This can stop you from overeating, which might trigger heartburn. Fiber-rich diets have also been linked to lower acid reflux risk. Eating whole grains like oatmeal and whole-grain rice can help.
• Sweet potatoes
  • Root vegetables like sweet potatoes are great sources of fiber and complex carbohydrates. Try roasting, grilling, or broiling sweet potatoes with other root vegetables like beets and carrots. Roasting brings out sweeter flavors and avoids frying, which can trigger heartburn. Make sure to leave out the garlic and onions, which can be irritating.
• Ginger
  • Ginger is well known for its soothing digestive effects. It can help with gas, nausea, and bloating, and it's anti-inflammatory, which can help soothe an irritated digestive system. If you normally enjoy coffee, try switching to ginger tea. You can add a slice of fresh ginger to a mug of hot water.
• Melons
  • Fruits are part of a healthy diet, but citrus fruits can trigger heartburn. Instead, focus on eating watery fruits like watermelon, cantaloupe, and honeydew. Extra water can help dilute stomach acid and ease your symptoms.
• Chicken broth
  • If your throat is sore and irritated from acid reflux, you might need to eat soft and watery foods for a while. Broth-based soups and chicken broth can be soothing and the extra water can dilute stomach acid. Make sure it's not too hot so it doesn't burn your sore throat.
• Fennel
  • Fennel is a low-acid vegetable and is known for its anti-inflammatory and soothing digestive effects. Traditional cultures often eat fennel or drink fennel tea for nausea, gas, stomachaches, and gastritis, or inflammation in the stomach lining. It's sweet and crunchy with a mild licorice taste and is rich in fiber.
• Non-fat milk
  • People often say you should drink milk if you have heartburn, but it's important to pay attention to the fat content in milk and dairy products. Fatty foods take longer to digest and can delay stomach emptying, which can trigger acid reflux.
  • At the same time, non-fat milk can act as a temporary barrier between your stomach lining and your stomach acid. This can ease your symptoms right away. Make sure to drink non-fat milk and dairy products.
• Fresh herbs
  • Spicy foods can trigger heartburn, but heartburn doesn't mean you have to sacrifice taste. While eating bland meals can help if you have a lot of irritation, you can try using fresh herbs instead of hot spices. These can add plenty of flavor to your meal without bothering your stomach. Try parsley, basil, or rosemary.
• Olive oil
  • Since fatty foods can trigger heartburn, it's important to avoid a high-fat diet and switch to healthier fats. Animal fats like lard and butter are high in saturated fats. Swap these for plant-based fats like olive, sunflower, or avocado oil.
• Lean meats
  • Meat is also high in saturated fat. Switching to lean meats can help lower the amount of fat you're eating and help heartburn. Poultry and fish are also great options and good sources of protein.

Heartburn can be treated with lifestyle changes and medications (over-the-counter and prescription). In rare cases, surgical procedures are available to help with severe and chronic heartburn (GERD).

There are several ways to treat and avoid heartburn with lifestyle changes.

• Lose weight and maintain your ideal weight. Excess weight increases the pressure on the stomach, increasing the chance of acid reflux into the esophagus.
• Quit smoking. Smoking interferes with the proper functioning of the lower esophageal sphincter.
• Avoid foods that aggravate heartburn and replace them with healthy foods. Avoid foods that trigger heartburn (see previously). Consider keeping a food journal to alert you to foods that make your heartburn worse. Decrease the amount of food you eat.
• Elevate the head of the bed. If you are experiencing heartburn at night, elevating the head of the bed will decrease reflux.

Pregnancy tends to aggravate heartburn because the lower esophageal sphincter (LES) is weakened during pregnancy. This weakened (LES) resolves after the delivery of the baby. Pregnancy also distorts the organs in the abdomen and the increased abdominal pressure from the growing fetus causes heartburn. These changes promote the reflux of acid and heartburn.

Approximately 17% to 45% of women who become pregnant will suffer from heartburn.

Unfortunately, there are no clear studies on the safety of heartburn medications on the growing fetus, and researchers are not going to test these drugs on pregnant women to evaluate how safe they are for the developing fetus, so the only option is to test these drugs on pregnant animals. There is no evidence that most of the acid-neutralizing or suppressing drugs are harmful to the fetus although nonabsorbable medications are preferred.

Management of heartburn during pregnancy consists of many of the same home remedies and lifestyle changes for a person with heartburn who is not pregnant (see the previous section on home remedies and lifestyle changes).

Occasional heartburn is usually not a cause for concern and can be managed with lifestyle changes and over-the-counter medications. However, frequent heartburn that occurs every day may be a sign of something more serious.

The most common complication of heartburn is esophagitis, or the inflammation of the food pipe. This can cause constant burning pain, making it hard to swallow or eat. Without treatment, this can also lead to ulcers, bleeding, or both.

In less than 2% of esophagitis cases from people with GERD, a condition called Barrett's esophagus can develop. This causes premalignant changes in the cells lining the esophagus. Two to 5% of people with Barrett's esophagus end up getting cancer. If you have severe esophagitis, take medications regularly to keep acid down.

If you're using antacids to treat your acid reflux, overuse can lead to diarrhea or constipation. Try to pick antacids that have both magnesium hydroxide and aluminum hydroxide to avoid this. One causes diarrhea and the other causes constipation, so they work against each other.

The first step, as it is so often, is basic lifestyle changes. Stop smoking, lose weight, and watch what you eat (sounds familiar?).

If these interventions do not fully alleviate heartburn symptoms, then the addition of medications that decrease heartburn or prevent it together, under the guidance of your healthcare professional, should allow you to control heartburn.