Heartburn

Heartburn refers to the symptoms you feel when acids in your stomach flow backward into the esophagus. The esophagus is the tube that carries food from your throat to your stomach.

Heartburn is a common problem. Despite its name, it has nothing to do with the heart. Heartburn that happens often is called gastroesophageal reflux disease, or GERD.

At the bottom of the esophagus is a ringlike muscle called the lower esophageal sphincter. It acts like a valve. When you swallow food, this muscular ring opens to let the food pass into the stomach. The ring then closes to prevent the stomach contents from going back into the esophagus. When this sphincter muscle is not working properly, 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.
• 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
• onions
• citrus foods such as orange juice
• tomato-based foods
• spicy foods
• coffee
• alcohol.

Heartburn can also be made worse by:

• taking certain medicines, such as aspirin
• smoking cigarettes.

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. Your health care provider should be seen if the heartburn occurs several times a week, comes back when the antacid wears off, or wakes you up at night.

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 and the sensation of bloating or fullness of the stomach.

These symptoms tend to occur 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 muscle to allow acid to flow back into the esophagus.

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 procedure in which a thin flexible tube with a tiny camera is placed in your mouth and down into your stomach so your provider can see your esophagus and stomach.

To help reduce the symptoms of heartburn you can:

• Try not to put a lot of pressure on the sphincter muscle. Eating light meals, wearing loose clothing, and losing any excess weight will help.
• Take nonprescription antacids (tablets or liquid) after meals and at bedtime.
• Avoid the substances likely to make symptoms worse, such as spicy foods, tomatoes, coffee, and orange juice.
• 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 reduce your symptoms.

If the simple measures described above do not relieve the symptoms, your health care 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.

Seek 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; weakness; or arm, back, or chest pain.

Heartburn symptoms are usually relieved by treatment in just a few days. However, the symptoms may recur from time to time, especially if you gain weight or increase your use of nicotine, alcohol, or caffeine, or if you eat more spicy foods.

The best prevention is to:

• Lose weight if you are overweight.
• Avoid foods and other substances that seem to cause heartburn.

It also helps if you:

• Do not eat for 2 to 3 hours before you go to bed.
• Eat smaller, more frequent meals.
• Avoid tight clothes and belts.
• Don't smoke.
• Sleep with your head elevated at least 4 inches.