Heartburn (Acid Reflux, GERD): Causes and Remedies

Heartburn is a burning sensation in the middle of the chest behind the breastbone and in the middle of the abdomen. It occurs when acid and other contents of the stomach travel up the esophagus and irritate the tissues. A faulty stomach valve allows acid and stomach contents to escape and cause the burning sensation. Approximately 60 million Americans suffer from the condition at least once a month. Approximately 15 million Americans suffer from it daily. Eating spicy foods and overeating are common triggers of the symptom. Indigestion is another name for heartburn.

When you swallow food, it travels down the esophagus and passes through a muscular ring known as the lower esophageal sphincter (LES). This structure opens to allow food to pass into the stomach. It is supposed to remain closed to keep stomach contents where they belong. If the valve is weak or damaged in some way, it may open and allow stomach contents and acid to travel back up, or reflux, into the esophagus. Acid reflux produces a burning sensation.

In some people, the lower esophageal sphincter relaxes at the wrong time or becomes weakened. This allows stomach contents to escape and travel up the esophagus. This causes burning, irritation, and pain. Surprisingly, not everyone who has acid reflux experiences a burning sensation. Other times, burning in the area of the chest and abdomen is caused by a condition other than reflux. Sometimes chest pain may occur due to a heart attack or other serious conditions. Acid reflux is the main symptom of gastroesophageal reflux disease (GERD), but GERD is associated with other symptoms like nausea, dry cough, hoarseness, sore throat, trouble swallowing, and a feeling of a lump in the throat. See your doctor if you experience pain, burning, or irritation in your chest or abdomen.

Gastroesophageal reflux disease (GERD) is a condition whose main symptom (burning or chest discomfort) is caused by acid reflux. This reflux causes burning in the chest, typically after eating. An attack may last for up to several hours. Lying down and bending over may make symptoms worse. Severe reflux may cause additional symptoms including trouble swallowing, a feeling that something is stuck in the throat or chest, or a sour taste in the back of the throat. Reflux can trigger shortness of breath, asthma attacks, and a chronic cough. Chest pain caused by reflux may mimic chest pain that occurs during a heart attack. If you are unsure about reflux vs cardiac chest pain, see your doctor. A doctor can usually diagnose reflux easily by asking a patient to describe his or her symptoms.

Anyone at any age can get heartburn, but certain factors make it more likely to get the condition. Risk factors may weaken or damage the LES. Other factors may affect the amount of stomach acid that is produced. Those at increased risk for the condition include pregnant women, those who are overweight or obese, and those who smoke or who are exposed to secondhand smoke. Certain medications increase the risk. Even wearing clothes that are too tight may increase the risk of reflux.

Occasional heartburn usually is not a cause for concern, but severe, ongoing acid reflux can be dangerous. Severe heartburn that occurs at least twice per week may indicate GERD which needs to be treated. Chronic GERD can cause ulcers, scarring, and inflammation in the esophagus. It can also change cells that line the esophagus. This is known as Barrett's esophagus and it increases the risk of developing esophageal cancer.

Nighttime heartburn may be particularly dangerous. Waking up with a sour taste in the mouth, coughing, or sore throat may indicate nighttime acid reflux. Not only does it disturb sleep, but the esophagus may sustain more damage. That's because when you are lying down for several hours, acid has a lot of time to linger in the esophagus and damage the tissue. When we are awake, we swallow saliva throughout the day. Saliva helps neutralize stomach acid. We naturally swallow less saliva when we sleep, so stomach acid is not neutralized.

There's a lot you can do to prevent heartburn symptoms at home. Eat small meals to avoid overeating. Do not eat within 3 to 4 hours of your bedtime. Give yourself plenty of time to digest so stomach contents cannot back up into your esophagus at night. Do not eat late at night. You want to go to bed with your stomach empty. If you eat before bed, acid and food may travel up the esophagus when you lie down and cause burning. Raise the head of your bed by approximately 6 to 8 inches. This allows gravity to work to your advantage and helps stomach contents to remain where they belong.

The types of food you eat may cause digestive discomfort. If you are prone to acid reflux, avoid eating spicy foods, acidic foods, and other foods that trigger reflux because they relax the LES. Known trigger foods include tomatoes, garlic, citrus fruits, onions, chocolate, peppermint, and fatty foods. Avoiding drinking alcohol. You may be able to tolerate normally spicy dishes by toning down the heat in the dish. Choose milder versions of your favorite spicy dishes that are less likely to provoke your symptoms.

Just as foods can provoke heartburn symptoms, so can drinking certain beverages. Tomatoes and citrus fruits may provoke reflux, so can juices make from these foods. Do not drink tomato juice, orange juice, or grapefruit juice. Other beverages that may bring on reflux include tea, coffee, alcohol, and sodas and carbonated beverages. Everyone is different. Some people may be able to consume these beverages without a problem but some people may find drinking them brings on symptoms. Others may be able to consume these beverages in moderation without affecting their condition. Experiment a bit and do what's right for you.

Getting adequate physical activity is necessary to maintain your overall health, but the types of activities you engage in may affect your acid reflux symptoms. Exercises that increase abdominal pressure may force stomach contents back up into the esophagus. Yoga poses that invert the body, like downward dog and headstands may provoke symptoms. Abdominal exercises, like crunches, also increase intra-abdominal pressure and may give you reflux. Exercise is great. Just make sure to choose exercise that keeps the contents of your stomach where it belongs.

People spend approximately one-third of their lives sleeping. Nighttime reflux is particularly dangerous because stomach acid may come into contact with the esophagus for many hours at night while sleeping, damaging and eroding the tissue. Sleep in a way that makes gravity work for you and keeps stomach acid in its place. Put wooden planks under the head of your mattress to raise your head by about 6 to 8 inches. Other good ways to raise your head include sleeping on a wedge pillow or sleeping with multiple pillows under your head. You may also notice that sleeping on your left side is better for preventing reflux than sleeping on your right side.

Lifestyle changes can have surprising effects on acid reflux symptoms. The clothing you wear may influence your symptoms. Tight-fitting clothing puts pressure on the abdomen and may force acid and food in your stomach up into your esophagus. Avoid wearing tight pants, belts, shapewear, and constraining clothing that puts pressure on your abdomen. Wear loose-fitting pants, shirts, and other types of clothing to give yourself ample room to encourage proper digestive function. These styles may help prevent reflux, too.

Approximately 30% to 50% of women complain of heartburn during pregnancy. The symptoms tend to be worse during the second and third trimesters when the woman's abdomen grows the largest. Increased intra-abdominal pressure and changing hormones during pregnancy up the risk of heartburn and acid reflux. Some women may achieve relief from their symptoms by making certain lifestyle changes. This includes eating several small meals per day instead of three large main meals. Pregnant women should not eat fried food or spicy foods. Pregnant ladies should not lie down immediately after eating. While several over-the-counter medications are available for the treatment of heartburn symptoms, pregnant women should consult with their doctors before taking medication to make sure it is safe for the fetus.

Antacids are medications that neutralize stomach acid. They are one type of over-the-counter treatment to alleviate the burning feeling. Rolaids, Maalox, and Mylanta are a few kinds of OTC antacids. Antacids are a good option if you have occasional heartburn and mild symptoms and discomfort. Take these medications as directed and do not exceed the recommended dose. Do not overuse antacids or take more than is directed on the label as this may result in side effects including constipation or diarrhea. If you suffer from severe heartburn or longstanding heartburn, antacids may not be the appropriate treatment choice.

H2 blockers are another treatment option for heartburn relief. They are available over-the-counter and by prescription. As their name suggests, the block the production of stomach acid. H2 blockers should be taken 30 minutes prior to meals to be most effective. Some doctors may recommend taking both H2 blockers and antacids to control symptoms. Another benefit of H2 blockers is that they help heal the esophagus, reversing damage done by stomach acid. Examples of H2 blockers include ranitidine (Zantac), cimetidine (Tagamet), nizatidine (Axid), and famotidine (Pepcid).

Proton pump inhibitors are medications that decrease the amount of stomach acid that the stomach produces. They are more effective for providing heartburn relief than H2 blockers. They also work better to help heal the esophagus. Both over-the-counter and prescription versions of these medications are available. They need to be taken on an empty stomach. Examples of PPIs include lansoprazole (Prevacid), pantoprazole (Protonix), esomeprazole (Nexium), omeprazole (Prilosec, Zegerid), and Rabeprazole (AcipHex). PPIs should not be taken long-term nor in high doses because this is associated with an increased risk of fractures of the wrists, spine, and hips.

The type of heartburn treatment that is right for you depends on a variety of factors. The frequency and severity of your symptoms are important considerations. Some medications provide relief from current symptoms while other medications are designed to prevent symptoms before they start. If you are unsure of which heartburn treatment to take, have a discussion with your doctor. Your physician can evaluate your condition and take into account any additional medical conditions you have and medications you may be taking and make an appropriate treatment recommendation.