Heartburn

What Is Heartburn?

Heartburn is actually a symptom of another condition and not a disease itself. The disease that causes heartburn is gastroesophageal reflux disease (GERD). GERD is the more-serious form of gastroesophageal reflux (GER), a common condition where contents of the stomach—digestive juices, or acids—rise up into the esophagus due the opening or incomplete closure of the lower esophageal sphincter (LES). The LES is the muscle that keeps the contents of the stomach out of the esophagus and airway. When GER persists and occurs more than twice a week, it is considered GERD.

Although the causes of GERD and subsequently heartburn aren’t clear for every individual, there are several common factors among those affected. One factor is that the LES relaxes when the esophagus is active and allows stomach acids to rise up into the esophagus and airway, causing heartburn. Another cause may be a hiatal hernia, an abnormality where part of the stomach and the LES move above the diaphragm; because the diaphragm helps the LES keep acid from rising up, the interference of a hiatal hernia can allow for GERD and heartburn.

GERD and accompanying heartburn not only cause discomfort but, when not properly treated, can lead to serious health problems. Stomach acid that rises up into the esophagus, or is refluxed, can cause inflammation in the esophagus, which can lead to bleeding or ulcers (known as esophagitis). Refluxed stomach acid can also scar the esophagus, causing strictures (narrowing) that interfere with swallowing. Barrett’s esophagus is also a risk of untreated GERD—this condition is marked by abnormal cells in the esophageal lining, which can lead to esophageal cancer.

Symptoms
GERD may cause frequent heartburn, also known as acid indigestion. When you experience heartburn, you’ll feel a burning-type pain in the lower part of your mid-chest, behind the breast bone, and in the mid-abdomen. Sometimes, however, GERD does not cause heartburn—this is especially true in children under the age of 12. In such cases, GERD may cause a dry cough, asthma symptoms, or trouble swallowing.

Who’s at Risk?
GERD and heartburn can affect anyone, regardless of age, gender, or medical history. There are, however, certain lifestyle and dietary factors that can increase your risk. Those who are obese, smoke, or are pregnant may be more likely to experience heartburn. More risk factors—and how to limit your risk—are described later under Prevention and Lifestyle Changes and Management Tips.

GERD and heartburn in children
Children may also suffer from GERD and heartburn. Spitting up or vomiting caused by GER can be normal among babies, and many outgrow this by age one. If GER continues past age one, however, it may be GERD and cause symptoms including heartburn, repeated regurgitation, nausea, coughing, laryngitis, and respiratory problems. Your healthcare provider can help you address GERD in your child. Strategies to manage or avoid GERD in children include burping infants several times during feeding and keeping them upright for 30 minutes after they eat; older children may benefit from eating frequent, small meals and avoiding foods like chocolate, caffeinated beverages, acidic foods (oranges and tomatoes), fried or spicy foods, and peppermint.

Diagnosis
If you experience heartburn twice a week or more, you may have GERD and should consult your healthcare provider. As well, you should see you doctor if you have been using antacids (over-the-counter medicines to control acid reflux) for more than two weeks. Patients with persistent heartburn may be referred to a gastroenterologist, a specialist in diseases affecting the stomach and intestines.

Treatment
Depending on the severity of your heartburn, your healthcare provider or a gastroenterologist may recommend lifestyle changes to manage your symptoms. These are described later in Lifestyle Changes and Management Tips.

Medication
In addition to lifestyle changes, heartburn and GERD are often treated with medication, both over-the-counter and prescription. Even though many of the medications for heartburn and GERD are available without a prescription, you should always consult your doctor before taking these or any other medicine. And be aware that these drugs may be associated with side effects, so consult your doctor if you experience symptoms including diarrhea, constipation, upset stomach, vomiting, loss of appetite, and other digestive issues. The following is a list of medications your doctor may recommend or prescribe, sometimes alone and sometimes in combination:

  • Antacids. These over-the-counter drugs include Alka-Seltzer®, Maalox®, Mylanta®, Rolaids®, and Tums®. Antacids work by reducing or neutralizing acidity in the stomach.
  • Gaviscon®. This over-the-counter drug also neutralizes stomach acid by creating a foam barrier over contents of the stomach to keep acid from refluxing.
  • H2 blockers. Examples of H2 blockers include Tagamet-HB®, Pepcid-AC®, Axid AR®, and Zantac 75®. H2 blockers reduce the amount of acid in the stomach by blocking histamine2, an important producer of acid. They are available in prescription and non-prescription strength.
  • Proton pump inhibitors. This group of drugs, which includes Nexium® (esomeprazole), Prevacid® (lansoprazole), Prilosec® (omeprazole), and others, also reduce stomach acidity by blocking its production. To do so, proton pump inhibitors inhibit the proton pump, a system in the stomach. Proton pump inhibitors are available by prescription, and Prilosec is also available in over-the-counter strength.
  • Prokinetics. These prescription medicines—including Urecholine® (bethanechol) and Reglan® (metoclopramide)—help strengthen the LES and make the stomach empty faster. Prokinetics are, however, associated with frequent side effects, such as fatigue, depression, anxiety, and problems with physical movement.

Surgery
Medication and lifestyle changes are often the first line of defense in treating GERD and heartburn, but when they don’t bring relief, surgery is an option.

  • Fundoplication. This is the most common surgery for GERD. By wrapping the upper part of the stomach around the LES, the sphincter is strengthened and better able to prevent stomach acid from refluxing. Fundoplication can be performed with a laparoscope (where instruments and a camera are inserted through small incisions in the abdomen), which is less invasive than standard (open or Nissen’s) fundoplication and allows for shorter hospitals stays and quicker recovery.
  • Endoscopic surgery. These techniques use an endoscope—an instrument inserted directly into an organ (in this case, the esophagus), which is used to examine that organ. Long-term effects of endoscopic surgery are not known. Techniques include the Bard EndoCinch system, NDO Plicator, and the Stretta system. Each is intended to strengthen the LES.

Prevention
Certain behaviors and foods may increase your risk of developing GERD and heartburn. Obesity and smoking are risk factors, and pregnant women should know that they may also experience GERD. If you suffer from any degree or frequency of heartburn, consider avoiding the following foods, as controlling symptoms through dietary choices may keep GERD from worsening:

  • Spicy foods
  • Mint flavors
  • Tomato-based foods
  • Garlic and onions
  • Citrus fruits
  • Caffeinated or alcoholic beverages
  • Chocolate

Lifestyle Changes and Management Tips
In addition to avoiding the foods listed above, lifestyle changes can also help you prevent GERD from occurring or manage your symptoms. If you smoke, quitting may improve GERD and heartburn as well as a number of health issues and may reduce your risk of certain cancers. If you’re overweight or obese, losing weight may also help. Try eating smaller, frequent meals, wearing loose-fitting closes, and try not to lie down for three hours after a meal. Some people also find that raising their head in bed by 6 to 8 inches (using wood blocks) also helps control heartburn.

Resources

American College of Gastroenterology

American Gastroenterological Association

International Foundation for Functional Gastrointestinal Disorders

Source

Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD). National Digestive Diseases Information Clearinghouse Web site (a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health). http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm. Accessed April 2010.

CONDITIONS OF THE GI TRACT