Overview
Heartburn is a burning pain or discomfort felt behind the breastbone. It occurs when stomach acid backs up into the esophagus. It is also commonly known as "reflux."
Occasional heartburn is common and generally harmless. However, heartburn more than twice a week may be a sign of gastroesophageal reflux disease (GERD).
Symptoms
- Burning sensation behind the breastbone
- Chest pain worsened by lying down or bending over
- Bitter or sour taste in the mouth
- Lump sensation in the throat
- Hoarse voice
- Chronic cough
- Difficulty swallowing
- Onset after meals
- Symptoms waking you from sleep at night
Heartburn can be confused with symptoms of a heart attack. If heartburn is accompanied by chest tightness, pain radiating to the arm/jaw, or cold sweat, call emergency services immediately.
Causes
Relaxation of the lower esophageal sphincter causes stomach acid to escape into the esophagus.
Triggers
- Foods: Chocolate, mint, spicy, fatty, fried foods, onion, garlic, tomato
- Beverages: Coffee, tea, alcohol, carbonated drinks, citrus juices
- Overeating
- Eating before bed
- Tight clothing
- Smoking
- Pregnancy
- Excess weight
- Hiatal hernia
- Some medications: Aspirin, NSAIDs, some blood pressure medications
- Stress and anxiety
Risk Factors
- Obesity
- Pregnancy
- Smoking
- Tight clothing
- Hiatal hernia
- Habit of eating late
- Stress
Complications (If Untreated)
- Esophagitis (inflammation of the esophagus)
- Narrowing of the esophagus
- Barrett's esophagus (precursor to cancer)
- Esophageal cancer (long-term risk)
- Asthma, chronic cough
- Dental enamel erosion
- Sleep disturbances
When to See a Doctor
- If heartburn occurs more than twice a week
- If it does not respond to over-the-counter medications
- If you have difficulty swallowing
- Unexplained weight loss
- Bloody or black vomiting/stools
- New onset of symptoms after age 50
- Loss of appetite and severe abdominal pain
Diagnosis and Treatment
Diagnosis: Based on symptoms. Endoscopy or 24-hour pH monitoring may be performed when needed.
Treatment:
1. Over-the-counter medications:
- Antacids (quick temporary relief)
- H2 blockers (famotidine)
2. Prescription medications:
- Proton pump inhibitors (PPIs): omeprazole, pantoprazole
- High-dose H2 blockers
- Alginate-containing medications
3. Lifestyle changes (most important)
Prevention
- Lose excess weight
- Avoid trigger foods
- Eat small, frequent meals
- Finish meals at least 3 hours before lying down
- Raise the head of the bed by 15-20 cm
- Do not wear tight clothing
- Quit smoking
- Limit alcohol and caffeine
- Do not lie down immediately after eating
- Manage your stress
- Try sleeping on the left side (right-side sleeping increases reflux)