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Heartburn is a burning sensation in the middle of the chest
behind the breastbone and in the middle of the abdomen.
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What Is Heartburn?
Heartburn is a burning
sensation in the middle of the chest behind the breastbone and in the middle of
the abdomen. It occurs when acid and other contents of the stomach travel up
the esophagus and irritate the tissues. A faulty stomach valve allows acid and
stomach contents to escape and cause the burning sensation. Approximately 60
million Americans suffer from the condition at least once a month.
Approximately 15 million Americans suffer from it daily. Eating spicy foods and
overeating are common triggers of the symptom. Indigestion is another name for
heartburn.
The Lower Esophageal Sphincter
When you
swallow food, it travels down the esophagus and passes through a muscular ring
known as the lower esophageal sphincter (LES). This structure opens to allow
food to pass into the stomach. It is supposed to remain closed to keep stomach
contents where they belong. If the valve is weak or damaged in some way, it may
open and allow stomach contents and acid to travel back up, or reflux, into the
esophagus. Acid reflux produces a burning sensation.
What Causes the Valve to Malfunction?
In some people,
the lower esophageal sphincter relaxes at the wrong time or becomes weakened.
This allows stomach contents to escape and travel up the esophagus. This causes
burning, irritation, and pain. Surprisingly, not everyone who has acid reflux
experiences a burning sensation. Other times, burning in the area of the chest
and abdomen is caused by a condition other than reflux. Sometimes chest pain
may occur due to a heart attack or other serious conditions. Acid reflux is the
main symptom of gastroesophageal reflux disease (GERD), but GERD is associated
with other symptoms like nausea, dry cough, hoarseness, sore throat, trouble
swallowing, and a feeling of a lump in the throat. See your doctor if you
experience pain, burning, or irritation in your chest or abdomen.
What Are GERD Symptoms?
Gastroesophageal
reflux disease (GERD) is a condition whose main symptom (burning or chest
discomfort) is caused by acid reflux. This reflux causes burning in the chest,
typically after eating. An attack may last for up to several hours. Lying down
and bending over may make symptoms worse. Severe reflux may cause additional
symptoms including trouble swallowing, a feeling that something is stuck in the
throat or chest, or a sour taste in the back of the throat. Reflux can trigger
shortness of breath, asthma attacks, and a chronic cough. Chest pain caused by
reflux may mimic chest pain that occurs during a heart attack. A doctor can
usually diagnose reflux easily by asking a patient to describe his or her
symptoms.
Who Gets Heartburn?
Anyone at any
age can get heartburn, but certain factors make it more likely to get the
condition. Risk factors may weaken or damage the LES. Other factors may affect
the amount of stomach acid that is produced. Those at increased risk for the
condition include pregnant women, those who are overweight or obese, and those
who smoke or who are exposed to secondhand smoke. Certain medications increase
the risk. Even wearing clothes that are too tight may increase the risk of
reflux.
Do You Have GERD or Something Else?
Occasional
heartburn usually is not a cause for concern, but severe, ongoing acid reflux
can be dangerous. Severe heartburn that occurs at least twice per week may
indicate GERD which needs to be treated. Chronic GERD can cause ulcers,
scarring, and inflammation in the esophagus. It can also change cells that line
the esophagus. This is known as Barrett's esophagus and it increases the risk
of developing esophageal cancer.
Do You Have Nighttime Symptoms?
Nighttime
heartburn may be particularly dangerous. Waking up with a sour taste in the
mouth, coughing, or sore throat may indicate nighttime acid reflux. Not only
does it disturb sleep, but the esophagus may sustain more damage. That's
because when you are lying down for several hours, acid has a lot of time to
linger in the esophagus and damage the tissue. When we are awake, we swallow
saliva throughout the day. Saliva helps neutralize stomach acid. We naturally
swallow less saliva when we sleep, so stomach acid is not neutralized.
Heartburn Home Remedies
There's a lot
you can do to prevent heartburn symptoms at home. Eat small meals to avoid
overeating. Do not eat within 3 to 4 hours of your bedtime. Give yourself
plenty of time to digest so stomach contents cannot back up into your esophagus
at night. Do not eat late at night. You want to go to bed with your stomach
empty. If you eat before bed, acid and food may travel up the esophagus when
you lie down and cause burning. Raise the head of your bed by approximately 6
to 8 inches. This allows gravity to work to your advantage and helps stomach
contents to remain where they belong.
Make Dietary Changes
The types of
food you eat may cause digestive discomfort. If you are prone to acid reflux,
avoid eating spicy foods, acidic foods, and other foods that trigger reflux
because they relax the LES. Known trigger foods include tomatoes, garlic,
citrus fruits, onions, chocolate, peppermint, and fatty foods. Avoiding drinking
alcohol. You may be able to tolerate normally spicy dishes by toning down the
heat in the dish. Choose milder versions of your favorite spicy dishes that are
less likely to provoke your symptoms.
Choose Beverages Wisely
Just as foods
can provoke heartburn symptoms, so can drinking certain beverages. Tomatoes and
citrus fruits may provoke reflux, so can juices make from these foods. Do not
drink tomato juice, orange juice, or grapefruit juice. Other beverages that may
bring on reflux include tea, coffee, alcohol, and sodas and carbonated
beverages. Everyone is different. Some people may be able to consume these
beverages without a problem but some people may find drinking them brings on
symptoms. Others may be able to consume these beverages in moderation without
affecting their condition. Experiment a bit and do what's right for you.
Be Smart about Exercise
Getting
adequate physical activity is necessary to maintain your overall health, but
the types of activities you engage in may affect your acid reflux symptoms.
Exercises that increase abdominal pressure may force stomach contents back up
into the esophagus. Yoga poses that invert the body, like downward dog and
headstands may provoke symptoms. Abdominal exercises, like crunches, also
increase intra-abdominal pressure and may give you reflux. Exercise is great.
Just make sure to choose exercise that keeps the contents of your stomach where
it belongs.
Make Gravity Work for You
People spend
approximately one-third of their lives sleeping. Nighttime reflux is
particularly dangerous because stomach acid may come into contact with the
esophagus for many hours at night while sleeping, damaging and eroding the
tissue. Sleep in a way that makes gravity work for you and keeps stomach acid
in its place. Put wooden planks under the head of your mattress to raise your
head by about 6 to 8 inches. Other good ways to raise your head include
sleeping on a wedge pillow or sleeping with multiple pillows under your head.
You may also notice that sleeping on your left side is better for preventing
reflux than sleeping on your right side.
What You Wear Matters, Too
Lifestyle
changes can have surprising effects on acid reflux symptoms. The clothing you
wear may influence your symptoms. Tight-fitting clothing puts pressure on the
abdomen and may force acid and food in your stomach up into your esophagus.
Avoid wearing tight pants, belts, shapewear, and constraining clothing that
puts pressure on your abdomen. Wear loose-fitting pants, shirts, and other
types of clothing to give yourself ample room to encourage proper digestive
function. These styles may help prevent reflux, too.
Manage Symptoms During Pregnancy
Approximately
30% to 50% of women complain of heartburn during pregnancy. The symptoms tend
to be worse during the second and third trimesters when the woman's abdomen
grows the largest. Increased intra-abdominal pressure and changing hormones
during pregnancy up the risk of heartburn and acid reflux. Some women may
achieve relief from their symptoms by making certain lifestyle changes. This
includes eating several small meals per day instead of three large main meals.
Pregnant women should not eat fried food or spicy foods. Pregnant ladies should
not lie down immediately after eating. While several over-the-counter
medications are available for the treatment of heartburn symptoms, pregnant
women should consult with their doctors before taking medication to make sure
it is safe for the fetus.
Antacids for Heartburn Relief
Antacids are
medications that neutralize stomach acid. They are one type of over-the-counter
treatment to alleviate the burning feeling. Rolaids, Maalox, and Mylanta are a
few kinds of OTC antacids. Antacids are a good option if you have occasional
heartburn and mild symptoms and discomfort. Take these medications as directed
and do not exceed the recommended dose. Do not overuse antacids or take more
than is directed on the label as this may result in side effects including
constipation or diarrhea. If you suffer from severe heartburn or longstanding
heartburn, antacids may not be the appropriate treatment choice.
What Are H2 Blockers?
H2 blockers are
another treatment option for heartburn relief. They are available
over-the-counter and by prescription. As their name suggests, the block the
production of stomach acid. H2 blockers should be taken 30 minutes prior to
meals to be most effective. Some doctors may recommend taking both H2 blockers and
antacids to control symptoms. Another benefit of H2 blockers is that they help
heal the esophagus, reversing damage done by stomach acid. Examples of H2
blockers include ranitidine (Zantac), cimetidine (Tagamet), nizatidine (Axid),
and famotidine (Pepcid).
What Are Proton Pump Inhibitors (PPIs)?
Proton pump
inhibitors are medications that decrease the amount of stomach acid that the
stomach produces. They are more effective for providing heartburn relief than
H2 blockers. They also work better to help heal the esophagus. Both
over-the-counter and prescription versions of these medications are available.
They need to be taken on an empty stomach. Examples of PPIs include
lansoprazole (Prevacid), pantoprazole (Protonix), esomeprazole (Nexium),
omeprazole (Prilosec, Zegerid), and Rabeprazole (AcipHex). PPIs should not be
taken long-term nor in high doses because this is associated with an increased
risk of fractures of the wrists, spine, and hips.
Which Heartburn Treatment Is Right for You?
The type of
heartburn treatment that is right for you depends on a variety of factors. The
frequency and severity of your symptoms are important considerations. Some
medications provide relief from current symptoms while other medications are
designed to prevent symptoms before they start. If you are unsure of which
heartburn treatment to take, have a discussion with your doctor. Your physician
can evaluate your condition and take into account any additional medical
conditions you have and medications you may be taking and make an appropriate
treatment recommendation.
Reviewed by Charles Patrick Davis, MD,
PhD on Friday, January 12, 2018
Heartburn (Acid Reflux,
GERD): Causes and Remedies
This tool does not
provide medical advic
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