What Is Heartburn?
People experience heartburn in a variety of forms. Usually, heartburn is a burning chest pain located behind the breastbone. Often there is a sensation of food coming back into the mouth, accompanied by an acid or bitter taste. Typically, heartburn occurs after meals and is a common source of complaints of indigestion. Fried or fatty foods, tomato products, citrus fruits and juices, chocolate, and coffee often cause heartburn. Usually, the burning chest pain lasts for several minutes, sometimes up to 2 hours, and is often worse when lying flat or bending over. Heartburn is usually described as a burning sensation, although it may not be considered painful by some people. In addition, heartburn is neither brought on by exercise nor relieved with rest; most people obtain relief by standing upright or by taking an antacid.
How Common Is Heartburn?
Approximately 15 million people in the U.S. suffer daily from heartburn.
Although heartburn is a common malady in our society, it is rarely life-threatening. It can, however, limit an individual's daily activities and productivity. With proper understanding of the causes of heartburn and a rational approach to treatment, most people will find relief.
What Causes Heartburn?
The esophagus is the tube-like structure that connects the mouth to the stomach. At the point where the esophagus joins the stomach, the esophagus is kept closed by a specialized muscle called the lower esophageal sphincter (LES). When the LES valve weakens or relaxes when it shouldn't, stomach acid leaks upwards and irritates the esophagus lining.
Does Heartburn Equal Acid Reflux?
Acid reflux is the physical process when stomach contents and acid flow backward up into your esophagus.
Heartburn is the actual symptom or burning sensation you feel in your chest when that stomach acid irritates the lining of your esophagus.
Is Heartburn Caused by Hiatal Hernia?
Hiatal hernia is a condition in which a portion of the stomach slides up through the diaphragm and occupies a place in the chest cavity. In fact, the majority of people past the age of 50 have evidence of a hiatal hernia after certain maneuvers during x-ray examination. Heartburn is not caused by such a hernia but, rather, results from the incompetent valve described above.
What Can You Do About Heartburn?
Any chest pain (even burning) requires a medical evaluation. If acid reflux is suspected, certain specific steps may prevent symptoms of heartburn. Avoiding foods that cause symptoms may be of benefit. Although no studies proving that such modification relieves heartburn have been conducted, many physicians note that patients improve after they remove certain foods from their diets. In addition, decreasing the size or volume of a meal consumed can be helpful. Being overweight often contributes to symptoms, and many people find relief when their weight is below a certain point.
Cigarette smoking has been shown to decrease LES pressure dramatically. Therefore, reducing (or, preferably, stopping) smoking can be an important component of treatment.
Elevating the head of the bed on 6-inch blocks reduces heartburn by allowing the effect of gravity to minimize reflux of stomach contents into the esophagus at night. Antacids taken on a regular basis will neutralize the stomach acid and stop heartburn. Many patients have discovered that nonprescription antacids provide temporary or partial relief. An antacid combined with a foaming agent such as alginic acid can help some patients. These compounds are believed to form a foam barrier on the top of the gastric pool.
It should be recognized that there can be side effects from long-term use of antacids. These effects can include diarrhea, altered calcium metabolism, and magnesium retention. Magnesium retention can be serious for patients with kidney disease. As with other symptoms, if prolonged use of nonprescription antacids becomes necessary, a physician should be consulted.
What If Symptoms Persist?
People with severe acid reflux or with symptoms unresponsive to the measures described above may need more complete diagnostic evaluation. Usually an upper gastrointestinal (GI) series will be performed during the early phase of evaluation. An upper GI series is a special x-ray test that shows the esophagus, stomach, and duodenum. While this test provides limited information about possible acid reflux, it is performed to rule out other possible diagnoses such as peptic ulcer or to rule out complications such as esophageal ulcer.
A variety of tests and procedures are currently used to evaluate further the patient with heartburn. It is fair to say that the ideal test has not been developed and that no test is 100 percent accurate.
Endoscopy is an important procedure in heartburn patients. By looking through a small tube placed into the esophagus, the physician may see inflammation of the tissue lining the esophagus (esophagitis).
Biopsy (removal of a small sample of tissue) of the lining of the esophagus may be helpful if the findings of the endoscopy are negative or questionable.
Esophageal pH monitoring can be performed when a thin probe or tiny wireless capsule measures acid levels inside the esophagus over 24 hours.
Pressure measurements of the esophagus (esophageal manometric studies) occasionally help to identify critically low pressure in the LES.
What Medical Therapies Are Available?
Once the diagnosis of acid reflux has been confirmed, the physician may prescribe one of a number of new medications available to treat this problem. Many studies have indicated that these drugs are effective in the short-term treatment of acute reflux symptoms.
Other approaches to medical therapy include the use of drugs to increase the LES pressure.
Can Heartburn Require Surgery?
A few people may need surgery because of poor response to medical treatment. Surgical procedures intended to produce an effective LES have been developed in recent years. However, surgery should not be considered until all other measures have been tried.
What Are the Complications of Long-Term Heartburn?
Although heartburn itself does not cause complications, the acid reflux with which it is associated can occasionally result in serious complications. Gastrointestinal blood loss from damage to the esophagus can cause anemia, which occasionally may be severe. Scarring of the lower esophagus may result in narrowing of the opening of the esophagus (stricture), which can seriously interfere with swallowing. Reflux may be a cause of recurrent wheezing and other lung symptoms.
Note: The materials presented in this section are for general information and do not substitute for medical advice. Patients have the right to receive accurate, easily understood information about their health plans, professionals, and facilities, and to a choice of health care providers sufficient to ensure access to appropriate high-quality health care.