Heartburn

Description

Heartburn is a burning sensation in your chest, just behind your breastbone. The pain is often worse after eating, at night or when lying down or bending over.

Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own with lifestyle changes and medications without prescription.

Heartburn that is more frequent or interferes with your daily routine may be a symptom of a more serious condition that requires medical attention.

Symptoms

The symptoms of heartburn are:

  • A burning pain in the chest that usually occurs after eating and may occur at night
  • Pain that gets worse when lying down or bending over
  • A bitter or acidic taste in the mouth

When to see a doctor

Chest pain may be a symptom of a heart attack. Seek help immediately if you have severe chest pain or pressure, especially when combined with pain in the arm or jaw, or difficulty breathing.

Make an appointment with your health care provider if:

  • Heartburn occurs more than twice a week
  • Symptoms persist despite the use of medication without a prescription
  • You have trouble swallowing
  • You have persistent nausea or vomiting
  • You have loss of weight because of poor appetite or difficulty eating

Causes

Heartburn occurs when acid from the stomach backs up into the tube that carries food from the mouth to the stomach (esophagus).

Normally, when food is ingested, a band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into the stomach. Then, the muscle is tensed again.

If the lower esophageal sphincter is not functioning as it should, the acid of the stomach can flow back into the esophagus (acid reflux) and cause heartburn. The acid backup can be worse when bending or lying down.

Risk factors

Certain foods and drinks can trigger heartburn in some people, including:

  • Spicy foods
  • Onions
  • Citrus products
  • Tomato products such as tomato sauce
  • Fatty or fried foods
  • Mint
  • Chocolate
  • Alcohol, sodas, coffee or other drinks with caffeine
  • Large or high-fat foods

Being overweight or pregnant may also increase your risk of heartburn.

Complications

Heartburn that occurs frequently and interferes with your routine is considered gastroesophageal reflux disease (GERD). gastroesophageal reflux disease (GERD) treatment may require the prescription of medication, and, occasionally, surgery or other procedures. GERD can seriously damage your esophagus, or lead to precancerous changes in the esophagus called Barrett's esophagus.

Heartburn

Diagnosis

To determine if your heartburn is a symptom of gastro-esophageal reflux disease (GERD), your doctor may recommend:

  • X-ray to see the shape and condition of your esophagus and stomach.
  • Endoscopy, to see the esophagus with a tiny camera to check for irregularities. A sample of tissue (biopsy) may be taken for the analysis.
  • Ambulatory acid probe tests, to identify when, and for how long, stomach acid backs up into the esophagus. An acid monitor that is placed in the esophagus connects to a small computer that you wear around the waist or on a strap over his shoulder.
  • Esophageal motility test, to measure the movement and pressure in the esophagus.

Treatment

Many otc medications may help relieve heartburn. The options include:

  • Antacids, which help to neutralize the acid of the stomach. Antacids can provide quick relief. But you can not cure an esophagus damaged by stomach acid.
  • H2 blockers, which can reduce the acid in the stomach. H2 blockers do not act as quickly as antacids, but they can provide longer relief. Examples include cimetidine (Tagamet HB), and famotidine (Pepcid AC).
  • Proton pump inhibitors, which may also reduce the stomach acid. Examples include esomeprazole (Nexium 24HR), lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC).

If the-counter treatments do not work or that depend on them often, talk to your health care provider. You may need to take prescription medications and further testing.

Self-care

Lifestyle changes can help relieve heartburn:

  • Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into the esophagus.
  • Avoid clothes tightly, which puts pressure on the abdomen and the lower esophageal sphincter.
  • Avoid foods that trigger heartburn.
  • Avoid lying down after a meal. Wait 2 to 3 hours.
  • Avoid late meals.
  • Elevate the head of your bed if you regularly experience heartburn at night or while trying to sleep. If that is not possible, insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows is not generally effective.
  • Avoid tobacco and alcohol. Both smoking and drinking alcohol decreases the lower esophageal sphincter is the ability to function properly.
  • Avoid large meals. Instead of eating many small meals during the day.

Preparing for your appointment

You may be referred to a doctor who specializes in disorders of the digestive system (gastroenterologist).

What you can do

  • Be aware of any pre-appointment restrictions, such as not eating solid foods on the day before your appointment.
  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of all your medications, vitamins and supplements.
  • Write down your key medical information, including other conditions.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Ask a relative or friend to accompany you, to help you remember what the doctor says.
  • Write questions to ask their doctor.

Questions to ask your doctor

  • What is the most likely cause of my symptoms?
  • Is my condition likely temporary or chronic?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available?
  • Should I remove or add food to my diet?
  • I have other health conditions. How can I best manage these conditions?

In addition to the questions that you've prepared to ask your doctor, do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor may ask you a series of questions. Be prepared to respond to them can make the time to go over points you want to spend more time. You may ask:

  • When did you first begin to experience the symptoms, and how severe are they?
  • The symptoms been continuous or occasional?
  • What, if anything, seems to improve or worsen your symptoms? Are worse after meals or lying down?
  • Make your symptoms you awake at night?
  • Does food or the cream of material to reach an agreement in the back of your throat?
  • Do you experience nausea or vomiting?
  • Do you have difficulty swallowing?
  • Have you lost or gained weight?

What you can do in the meantime

Try to lifestyle changes to control your symptoms until you see your doctor. For example, avoid foods that trigger heartburn and avoid eating at least two hours before bedtime.

Symptoms and treatment of Heartburn