The term “heartburn” refers to the burning sensation that you (and millions) feel in your chest behind the breastbone (sternum). Along with this feeling, you may also feel a sour (or bitter) taste in your throat and mouth. This sensation usually occurs or worsens after eating or lying down. It usually lasts from a few minutes up to hours. But, despite the name, it doesn’t affect your heart.
Heartburn is a fairly common symptom that millions all over the world experience. You may be one of these millions who know how it is an unpleasant feeling.
Heartburn isn’t a disease; it’s a symptom that indicates a problem with stomach acid. Generally, it is just discomfort, and most people can control it by modifying their lifestyle and over-the-counter (OTC) medications. But, frequent and prolonged heartburn may indicate more severe diseases, such as GERD (gastroesophageal reflux disease). Also, people with heart disease or who are at risk of heart attack should pay attention to this feeling because it is similar to the symptoms of a heart attack.
Management of heartburn depends on its cause. Generally, OTC medications can relieve it. If they failed, your doctor would prescribe other drugs and order further investigations to reach the underlying cause. Lifestyle modifications are essential for the management plan for heartburn that corrects many of its triggers.
- Now, let’s dig into the details of this common condition. It’s usually occasional, but you should know when to worry about this feeling and see your doctor.
First, to understand how and why heartburn occurs, you should understand the physiology of stomach acid and how it can lead to heartburn.
Stomach acid
You eat your food through the mouth, and then it travels through the esophagus to reach the stomach. The esophagus is a long tube that connects the mouth and stomach. At its lower end, there is a valve called the lower esophageal sphincter (LES). It allows the food to reach the stomach and then closes to keep the stomach contents down.
Then, the stomach secretes a potent acid (HCL) to begin food digestion. Your stomach can naturally tolerate this acid without getting injured because its wall includes cells that secrete a protective mucous layer.
But, your esophagus isn’t the same; it doesn’t have protection against stomach acid. The stomach acidic mixture damages its unprotected wall and causes inflammation. When the LES can’t close properly (due to any cause), the stomach contents -including the acid- goes back into the esophagus. This condition is acid reflux, which causes heartburn.
What can cause and trigger acid reflux and heartburn?
Many people experience heartburn, but there are no certain causes for this problem. But, some medical conditions and other risk factors may put you at high risk, as follows:
Obesity and overweight
It increases the intra-abdominal pressure, which affects the contraction power of LES and predisposes to reflux. Obesity also raises the risk of GERD.
Pregnancy
Like obesity, pregnancy increases intra-abdominal pressure and predisposes to reflux. Also, during pregnancy, the progesterone hormone may relax the LES and cause reflux. Thus, heartburn is common among pregnant women, especially during the third trimester.
Hiatal hernia
It occurs when a part of the stomach passes to the chest (instead of the abdomen) through the diaphragm. It may affect the LES function and causes reflux. Hiatal hernia only causes heartburn when the LES fails to close well.
Certain medications, such as ibuprofen, aspirin, anti-inflammatory drugs, and some antihypertensive medications, may increase the risk of heartburn.
Smoking affects the LES and predisposes to reflux. Stopping smoking reduces the risk of heartburn by about three times more than smokers.
Heartburn is also related to your lifestyle and eating habits, like which food you eat, how much, and when. Some foods and drinks may trigger heartburn, such as:
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- Spicy foods
- Citrus fruits and juice
- Tomato and tomato-based products
- Onion and peppermint
- High-fat and fried foods
- Alcohol and coffee
- Carbonated and caffeinated beverages
- Chocolate
Also, eating large meals and eating close to bedtime raises the risk of heartburn. Also, lifestyle habits, like high-stress levels and anxiety, increase the risk.
Your doctor should consider these risk factors and triggers during the management of heartburn regardless of its underlying cause.
Complications of heartburn
Recurrent and long-term heartburn may not be simple and easy to control as occasional heartburn. It usually indicates GERD that requires prescription medications or even surgery.
Ignored recurrent heartburn means continuous irritation and inflammation of the lining wall of the esophagus, which may lead to ulcers and bleeding. These ulcers may heal with scars and cause esophageal strictures and narrowing.
Continuous irritation of the esophagus by acid reflux may change its lining cells because they can’t tolerate the acid, which is Barret’s esophagus.
Changing the cell type is metaplasia, and it’s a precancerous condition. Thus, Barret’s esophagus puts you at a higher risk of esophageal cancer.
Also, long-term heartburn may impact your quality of life.
When should you see your doctor due to heartburn?
Occasional heartburn is usually easy to control by over-the-counter medications and doesn’t require contacting a specialist. But, it isn’t always simple in this way.
As we said, heartburn may be a sign of heart attack. Thus, contact your doctor if you feel heartburn with other heart attack symptoms, such as dyspnea and pain in the arms or jaw, or at risk of heart attacks, such as older people, smokers, diabetics, or those with hypertension or heart disease.
Also, recurrent and persistent heartburn may lead to dangerous complications in the esophagus, including cancer.
Call your doctor if:
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- Your heartburn doesn’t go away.
- You take OTC medications for more than two weeks without improvement.
- Your heartburn becomes more severe and frequent (more than twice per week).
- You feel difficult or painful to swallow.
- You have persistent hoarseness or wheezing.
- You have nausea and vomiting.
- You have unexpected weight loss or poor appetite (it may indicate cancer).
- Your heartburn interferes with your daily activities.
How can your doctor manage heartburn?
As we said, heartburn is common and usually occasional. Occasional heartburn is easy to control with OTC medications and healthy lifestyle modifications. But, more frequent and severe heartburn -which may be due to GERD- requires the prescription of more potent medicines and even may require surgery. Also, complications of long-term and frequent heartburn may require surgical intervention.
● OTC medications for heartburn include:
Antacids (like Gaviscon, Maalox, Rolaids, and Tum):
Antacids neutralize the stomach acid and provide quick relief for heartburn. They also help in relieving indigestion, stomach upset, and gases. They can’t heal ulcers or damage that the stomach acid caused. You can take them after eating, at bedtime, or on need.
Some antacids may lead to diarrhea, constipation, or stomach cramps. Avoid overdose and overuse of antacids because it may lead to serious side effects. Contact your doctor if there is no improvement with prolonged use or if there are side effects.
H2 receptors blockers (or acid blockers), such as Tagamet:
These medications act by reducing stomach acid production. They don’t provide quick relief as antacids but provide more prolonged relief. Take these medicines regularly as your healthcare provider recommends, even if your symptoms get better.
Acid blockers may cause headaches, dizziness, or diarrhea. Contact your doctor if you feel serious side effects, like confusion, fatigue, sore throat, chest tightness, or irregular heartbeats.
● Prescription medications for heartburn:
If the OTC medications failed to relieve your heartburn, your doctor might prescribe other medicines, such as:
Prescription-stronger acid blockers (like Zantac and Pepcid):
They block acid production and treat heartburn, esophagitis, GERD, and peptic ulcers. Follow your doctor’s prescription.
Proton pump inhibitors (like Nexium and Prilosec):
They also block the production of stomach acid but with a more potent effect.
Your doctor will choose the best drug for you, depending on your condition, and tell you how and when to take them. Your doctor may prescribe antacid with other medications to provide quick relief until their effect starts.
Surgery may be an option when you have GERD, stricture, Barret’s esophagus, severe or atypical symptoms, or when intensive medical therapy can’t control your condition.
Is heartburn preventable, and what is the role of your lifestyle in management?
Some healthy lifestyle changes can prevent heartburn or promote its management plan, such as:
- Avoid certain foods that make your condition worse.
- Avoid alcohol and smoking.
- Avoid overeating (eat smaller and frequent meals).
- Avoid eating immediately (within 3 or 4 hours) before bed.
- Raise the head of your bed.
- Keep a healthy weight.
- Avoid tight clothes and belts around your waist.
Talk to your doctor about habits you should change to get a better lifestyle and fewer heartburns.
Finally, heartburn is a common problem, but it’s usually simple and easy to control. Talk to your doctor if there is a sign of an underlying problem or if the simple ways can’t improve this sensation. Follow a healthy lifestyle to prevent heartburn and manage it more effectively.