Heartburn, also known as acid indigestion is a feeling of burning in the central chest just behind the sternum (breast bone) or upper central abdomen, caused by stomach acid refluxing back into the oesophagus (food pipe). The burning can worsen or can be brought on by lying flat or on the right side.
Heartburn is actually a symptom of GERD (gastroesophageal reflux disease). If you have heartburn more than twice a week, you may have GERD. But you can have GERD without having heartburn.
What are the Symptoms of Heartburn?
Despite its name, heartburn has nothing to do with the heart. Some of the symptoms, however, are similar to those of a heart attack or heart disease.
The usual symptom of heartburn is a burning sensation in the chest. Typical features of heartburn include:
Starts as a burning sensation in the upper abdomen and moves up into the chest
Usually occurs after eating or while lying down or bending over
May awaken you from sleep, especially if you have eaten within two hours of going to bed
Is usually relieved by antacids
It may be accompanied by:
a sour taste in your mouth — especially when you're lying down,
a feeling of food being stuck in the throat,
stomach pain in the upper abdomen,
persistent sore throat,
regurgitation of foods or liquids with a taste of acid in the throat, and
persistent hoarseness or laryngitis.
How is Heartburn Diagnosed?
Heartburn is a common complaint, though it can be confused with other chest-related illnesses, including:
chest wall pain.
Oftentimes, all that a health-care professional requires is a thorough history and physical examination to make the preliminary diagnosis of heartburn. To evaluate if there is any damage and how severe your heartburn is, the doctor may suggest some of the following tests:
Endoscopy: A flexible scope is passed down the oesophagus to examine the oesophagus as well as the stomach. Biopsies can be taken if indicated. This lets the doctor see if there is any obvious damage, and also eliminate other reasons for the patient's symptoms (foreign body, malignancy).
Upper GI series (upper GI series): After drinking a liquid that coats the inside of the digestive tract, X-rays are taken. These X-rays will show the outline of the digestive system.
Ambulatory pH testing: This test measures the acidity in the oesophagus via a small tube that goes through the nose into the stomach.
Many people experience heartburn and there are a large number of over-the-counter (OTC) medications and home remedies available to treat heartburn or the symptoms of heartburn. In rare cases, surgical procedures are available to help with severe and chronic heartburn (GERD).
In most cases you will not need to see a health-care professional, except if the symptoms are frequent (several times a week) or severe.
If heartburn is severe or the pain is accompanied with additional symptoms such as shortness of breath, radiation into your arms or neck, dizziness or cold sweat, you will need to see a doctor to distinguish these symptoms from more serious medical conditions such as a heart attack.
If your heartburn symptoms occur more than twice a week you should see your health-care professional to make sure no serious problems are present.
Heartburn is not without complications. If ignored, recurrent irritation and inflammation of the oesophagus can lead to ulcers, which are small areas of tissue breakdown. These can cause serious bleeding.
As well, scarring and stricture are other significant complications of GERD. Changes in the type of cells lining the oesophagus may result from acid reflux, causing a condition known as Barrett's oesophagus, which is associated with an increased risk of oesophageal cancer.
The prognosis for the large majority of people with heartburn is very good. Many people require no treatment or only treatment with OTC's. A small number of people will develop complications and their prognosis will vary from good to a more guarded.
Some common foods that we eat and drink, stimulate increased stomach acid secretion setting the stage for heartburn. Over-the-counter medications also may precipitate heartburn.
Examples of these irritants include:
aspirin (Bayer, etc.),
ibuprofen (Motrin, Advil, Nuprin, etc.),
naproxen (Naprosyn, Aleve),
tomato products, such as ketchup,
This is not a complete list of all the offending agents; people can learn from experience what foods, drinks and over-the-counter medications give them heartburn symptoms and then avoid them.
Smoking and the consumption of high-fat content foods tend to affect function of the lower oesophageal sphincter (LES), causing it to relax from the stomach and allow acid to reflux into the oesophagus.
A hiatal hernia where a portion of the stomach lies within the chest instead of the in abdomen, can affect the way the LES works and is a risk factor for reflux. Hiatal hernias by themselves cause no symptoms. It is only when the LES fails that heartburn occurs.
Pregnancy can cause increased pressure within the abdominal cavity and affect LES function and predispose it to reflux. Approximately 17% to 45% of women who become pregnant will suffer from heartburn.
Obesity may also cause increased pressure in the abdomen, and thus reflux in the same way.
Primary diseases of the oesophagus can also present with heartburn as a symptom. These include, among others, scleroderma and sarcoidosis.
How can Heartburn be Prevented?
The first step, as it is so often, is basic lifestyle changes.
Lifestyle changes include:
Eat smaller, more frequent meals.
Eat high-protein, low-fat meals.
Avoid lying down after a meal. Wait at least three hours.
Avoid late meals.
Avoid alcohol, aspirin, ibuprofen, and caffeine.
Stay away from cigarette smoke.
Chew gum to help neutralize acid.
Wear loose clothing. Avoid tight-fitting clothing and tight belts, which puts pressure on your abdomen and the lower oesophageal sphincter.
Practice proper posture.
Elevate the head of the bed (or use two or three pillows) to allow gravity to keep acid in the stomach and avoid acid reflux. You can place 6- to 9-inch blocks under the legs at the head of your bed to raise it.
Weight loss/keeping ideal weight: Excess weight increases the pressure on the stomach, increasing the chance of acid reflux into the oesophagus.
Avoid foods that trigger heartburn. Consider keeping a food journal to alert you to foods that make your heartburn worse.
Mix a teaspoon of baking soda into a glass of water
If these interventions do not fully alleviate heartburn symptoms, then the addition of medications that decrease heartburn or prevent it all together, under the guidance of your health-care professional, should allow you to control heartburn.