Basics of Heartburn and GERD

Despite its name, heartburn has nothing to do with the heart. It happens when your esophagus, the tube that goes from your throat to your stomach, gets irritated by acid that comes up from your stomach. That happens if a valve at the top of the stomach doesn’t work properly.

Most people have felt heartburn at one time or another. It's uncomfortable, but it’s usually not a serious health problem.

If it happens often, you may have a more serious condition called GERD. That stands for gastroesophageal reflux disease. Left untreated, GERD can sometimes lead to other problems, including:

• Inflammation and ulcers in the esophagus
• Hoarseness
• Lung disease
• Barrett's esophagus -- a change in the lining of the esophagus that makes you more likely to get esophageal cancer

Symptoms

You may have:

• A burning feeling in your chest just behind the breastbone that happens after you eat and lasts a few minutes to several hours
• Chest pain, especially after bending over, lying down, or eating
• Burning in the throat -- or a hot, sour, acidic, or salty-tasting fluid at the back of the throat
• Trouble swallowing
• Feeling of food "sticking" in the middle of your chest or throat

Causes

You are more likely to get heartburn if you:

• Eat large portions
• Eat certain foods, including onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoes or tomato-based products
• Drink citrus juices, alcohol, caffeinated drinks, and carbonated beverages
• Eat before bedtime
• Are overweight
• Smoke
• Wear tight-fitting clothing or belts
• Lie down or bend over after eating
• Are stressed out
• Are pregnant
• Have a hiatal hernia, meaning that part of your stomach bulges up into your chest
• Take certain medications, especially some antibiotics and NSAIDS, including aspirin
• Are constipated

What Can I Do to Feel Better?

Try these tips to help relieve, lessen, or prevent heartburn:

• Raise the head of your bed about 6 inches. This helps gravity keep your stomach's contents in your stomach. Don't sleep on piles of pillows. Doing so puts your body into a bent position that actually makes the condition worse. Instead, put blocks or bricks under the legs of the bed to raise it up.
• Eat meals at least 3 to 4 hours before lying down, and don't eat bedtime snacks.
• Eat smaller meals.
• Stay at a healthy weight.
• Limit fatty foods, chocolate, peppermint, coffee, tea, colas, and alcohol. All of these can relax the valve at the top of the esophagus.
• Limit tomatoes and citrus fruits or juices. These contain acid that can irritate the esophagus.
• Ask your doctor if you need to try an “elimination diet” to find other foods that bother you. On an elimination diet, you stop eating certain foods to find out if they cause a problem.
• Avoid constipation.
• If you smoke, stop. Smoking relaxes the valve that allows reflux.
• Wear loose belts and clothing.

Treatment

“Over the counter” or OTC medicines are ones you don’t need a prescription for. For heartburn, OTC medicines include:

Antacids. These medicines neutralize extra stomach acid to relieve heartburn, sour stomach, acid indigestion, and an upset stomach. Calcium carbonate and magnesium hydroxide can provide relief. Take them exactly how your doctor tells you to, or follow the directions on the label. Questions? Ask your doctor or a pharmacist. If you take antacid tablets, chew them well before you swallow them. Doing so will mean faster relief. If you accidentally take too much or use them too often, you can have side effects. They can include constipation, diarrhea, change in the color of bowel movements, and stomach cramps.

Acid Blockers. These drugs ease heartburn, acid indigestion, and sour stomach. They cut down on how much acid your stomach makes.

Follow the directions on the package, or follow your doctor’s instructions. When in doubt, ask your doctor or a pharmacist. Some of the over-the-counter heartburn drugs are also available by prescription. Check with your insurance company. The prescription may cost less than the over-the-counter. Side effects can include mild headache, dizziness, and diarrhea. These are usually temporary and will likely go away on their own. Examples of acid blockers include:

• Esomeprazole (Nexium)
• Famotidine (Pepcid AC), Zantac 360
• Lansoprazole (Prevacid)
• Nizatidine
• Omeprazole (Prilosec)
• Pantoprazole (Protonix)

When Should I See My Doctor?

Tell your doctor right away if you have confusion, chest tightness, bleeding, sore throat, fever, irregular heartbeat, weakness, or unusual fatigue.

Get immediate medical attention if you have any chest pain, pressure, or burning that doesn’t go away (even with medications and lifestyle changes). These can also be signs of a heart attack.

Also get medical help right away if you are vomiting blood or what looks like dark coffee grounds. See a doctor immediately if your stools are black, bloody, or a maroon color.

If your heartburn is severe and over-the-counter medicines don’t help, or if you have taken them for more than 2 weeks, call your doctor. Also see your doctor if you are losing weight without trying or having trouble swallowing. Your doctor can check to see what is causing the problem and what the best solution will be for you.

Will I Need Surgery?

You won’t need it if you have ordinary heartburn. It’s rare, but you may need an operation if:

• Other treatments haven’t helped.
• The muscle that controls the valve at the top of your stomach doesn’t work properly.
• You have cancer in your esophagus. Keep in mind that trouble swallowing, and not heartburn or GERD, is the most common symptom of this type of cancer.

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