Heartburn

Heartburn is that painful, burning sensation you sometimes feel in your chest. It happens most often at night, after you eat or when you lie down or bend over.

Despite its name, heartburn isn’t really in your heart. Instead, the burning sensation occurs when stomach acid bubbles up into your esophagus, the tube you use to swallow food. Your esophagus runs through your chest near your heart.

You can manage occasional heartburn with lifestyle changes or over-the-counter medications. If you experience heartburn regularly, you may have gastroesophageal reflux disease (GERD), which requires specialized treatment.

Most episodes of heartburn last from a few minutes to a few hours. Your symptoms typically disappear once your stomach finishes digesting your last meal.

Whether you have occasional or frequent heartburn, you may experience these symptoms:

• Bitter, acidic taste in your mouth
• Burning pain in your chest that may spread to your throat (usually after eating or later at night)
• Burping
• Nausea
• Pain that gets worse when you lie down or bend over
• Regurgitation (some food coming back up your esophagus)

Some less common heartburn symptoms include:

• Asthma that gets worse
• Bloating
• Cough that lingers
• Difficulty swallowing
• Hiccups
• Laryngitis (losing your voice)
• Sore throat

Most people can manage heartburn on their own. But if your symptoms get worse, our providers can help. Make an appointment if you experience:

• Difficulty swallowing
• Heartburn more than twice a week
• Nausea or vomiting
• Symptoms that linger after using over-the-counter medications
• Weight loss due to difficulty eating or poor appetite

It’s normal for heartburn to cause some chest pain. But that discomfort can also be a sign of a heart attack. Get medical attention right away if your chest pain or pressure is severe — especially if your arm or jaw hurts or if you have trouble breathing.

Heartburn is the feeling caused by acid reflux. This condition happens when the acid your stomach produces during digestion backs up into your esophagus. When the muscle that separates your esophagus from your stomach relaxes, stomach acid burns the lining of the tube.

Several things can cause the muscle between your esophagus and stomach to relax, including:

• Acidic foods like chocolate, citrus fruits, coffee or tomato sauce
• Extra pressure on your abdomen (body weight, pregnancy or tighter clothing)
• Hiatal hernia (when your stomach pushes through the muscles of your diaphragm)
• Heavy meals that stretch your stomach and digest slowly
• Indigestion and gas
• Inhaling smoke
• Lying down right after eating
• Medications like birth control pills, blood pressure medicine, ibuprofen or iron supplements

Acid reflux causes most episodes of heartburn. But other conditions can also cause the same burning feeling. These include:

• Esophageal ulcers. These sores develop in the lining of your esophagus. Acid reflux may create these ulcers, but taking too much aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) can also cause them.
• Esophagitis. GERD, fungal infections, viruses or certain medications can cause severe inflammation in your esophagus.
• Functional heartburn. Some disorders change how your brain interprets sensations from your digestive system. It feels like regular heartburn but without acid reflux.
• Reflux hypersensitivity. Overactive nerves create a burning sensation in your esophagus. Acid reflux is not involved.

Our providers can usually diagnose heartburn based on the symptoms you describe. If your heartburn is mild and infrequent, they may not need to evaluate you further. However, if you get heartburn all the time, they may suggest you see a gastroenterologist. These providers specialize in treating the organs that make up your digestive system, and they can run additional tests to detect any damage to your esophagus.

These tests may include:

• Esophageal pH test. An implanted wireless capsule measures the pH (acid level) in your esophagus over time. A receiver you wear on your waistband collects the measurements. You can share the measurements and any symptoms you record with your provider.
• Upper endoscopy. This test uses a long tube with a small, lighted camera at the end to examine your gastrointestinal tract. After giving you medication to make you comfortable, our providers gently slide the endoscope down your throat. Then, they check your esophagus, stomach and top of your small intestines for damage.

Most people can treat heartburn with over-the-counter medications. Our providers frequently recommend:

• Antacids. These medications neutralize your stomach acid, so it does less damage to your esophagus. They can also reduce gas and relieve constipation.
• Alginates. These naturally occurring sugars are found in seaweed. They float on top of your stomach acid, preventing it from getting into your esophagus.

Some lifestyle changes can also improve your condition. These healthy behaviors include:

• Avoid trigger foods. Stay away from the foods that make your heartburn worse.
• Don’t eat before bed. Avoid eating too close to bedtime. Wait three to five hours after eating to lie down.
• Eat small meals. Eat several smaller meals during the day. Your stomach produces less acid when it contains less food.
• Loosen your belt or waistband. Too much pressure on your abdomen increases your heartburn risk.
• Lose weight. Maintaining a healthy weight can also lower your heartburn risk by reducing pressure on your esophagus.
• Quit smoking. Smoking weakens the muscle between your esophagus and stomach, making it easier for stomach acid to flow into your esophagus.
• Sleep on your left side. Lying on your left side keeps your esophageal muscle above the contents of your stomach. This position makes it harder for stomach acid to escape and back into your esophagus.

You may need prescription medication if over-the-counter medicines or lifestyle changes don’t help. Our providers may recommend the following:

• Antibiotics or antivirals. These medications can fight infections that cause heartburn.
• Histamine receptor antagonists (H2 blockers). Some H2 blockers are prescription-only. They block histamines, the chemicals in your body that trigger the production of stomach acid.
• Proton pump inhibitors. Our providers may suggest this medication if you have severe heartburn or significant damage to your esophagus. These acid blockers are 90 percent effective at reducing acid production. They also help your esophagus heal faster, especially if you have esophageal ulcers.
• Steroids. These prescription medications reduce inflammation in your esophagus.

If your heartburn still doesn’t improve, our providers may recommend a procedure. Depending on your condition, they may suggest:

• Hernia repair surgery. If a hiatal hernia causes your heartburn, this procedure can fix the problem.
• LINX device. In a minimally invasive procedure, our providers implant a ring of magnets to keep the passage between your esophagus and your stomach closed.
• Nissen fundoplication. This procedure tightens the muscle between your esophagus and your stomach.
• Transoral incisionless fundoplication. This technique tightens the muscle between your esophagus and stomach without surgery.

If your heartburn is severe and goes on long enough, it may cause significant damage to your esophagus. Over time, you can develop long-term complications like:

• Esophageal cancer. Inflammation in your esophagus can trigger cellular changes that lead to cancer.
• Esophageal strictures (narrowing). Over time, inflamed esophageal tissue can become scar tissue. The scar tissue narrows your esophagus, making it harder to swallow.
• Intestinal metaplasia. Sometimes, inflamed esophageal tissue becomes more like the lining of your intestines. As a result, you can develop Barrett’s esophagus, a precancerous condition.