Heartburn

Introduction

The symptoms of heartburn are hard to ignore. You've just eaten a big meal and leaned back in your favorite chair. As you begin to relax, your chest starts to hurt so much it feels like it's on fire.

Heartburn is common, and an occasional episode is generally nothing to worry about. However, many people battle heartburn — a burning sensation in the food pipe (esophagus), just below or behind the breastbone — regularly, even daily. Frequent heartburn can be a serious problem, and it deserves medical attention. Frequent or constant heartburn is the most common symptom of gastroesophageal reflux disease (GERD) — a disease in which stomach acid or, occasionally, bile flows back (refluxes) into your esophagus.

Most people can manage the discomfort of heartburn with lifestyle modifications and over-the-counter medications. But if heartburn is severe, these remedies may offer only temporary or partial relief.

Risk factors

Conditions that cause difficulty with digestion can increase the risk of heartburn. These include:

• Obesity. Excess weight puts extra pressure on your stomach and diaphragm — the large muscle that separates your chest and abdomen — forcing open the lower esophageal sphincter and allowing stomach acids to back up into your esophagus. Eating very large meals or meals high in fat may cause similar effects.
• Hiatal hernia. If this protrusion of part of your stomach into your lower chest is large, it can worsen heartburn by further weakening the lower esophageal sphincter muscle.
• Pregnancy. Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower esophageal sphincter.
• Asthma. Doctors aren't certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering regurgitation of stomach acid into your esophagus. Some asthma medications that widen (dilate) airways may also relax the lower esophageal sphincter and allow reflux. Or it's possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your esophagus and pharynx, damaging lung airways.
• Diabetes. One of the many complications of diabetes is gastroparesis, a disorder in which your stomach takes too long to empty. If left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn.
• Gastric outlet obstruction. This is a partial blockage caused by scarring, an ulcer or a growth near the valve (pylorus) in the stomach that controls the flow of food into the small intestine. It can keep this valve from working properly or can obstruct the release of food from the stomach. Food doesn't empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus. This usually causes more signs and symptoms than just heartburn, such as abdominal pain, difficulty eating, weight loss, nausea and vomiting. If you experience any of these signs and symptoms, consult your doctor.
• Delayed stomach emptying. In addition to diabetes or an ulcer, abnormal nerve or muscle functions can delay emptying of your stomach, causing acid backup into the esophagus. Medications may also lead to delayed stomach emptying. These include narcotics, some antidepressants and antihistamines.
• Connective tissue disorders. Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should, allowing acid reflux.
• Zollinger-Ellison syndrome. One of the complications of this rare disorder is that your stomach produces extremely high amounts of acid, increasing the risk of acid reflux.

Self-care

You may eliminate or reduce the frequency of heartburn by making the following lifestyle changes:

• Control your weight. Being overweight is one of the strongest risk factors for heartburn. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
• Eat smaller meals. This reduces pressure on the lower esophageal sphincter, helping to prevent the valve from opening and acid from washing back into your esophagus.
• Loosen your belt. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
• Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, tomatoes, caffeine and nicotine may make heartburn worse.
• Avoid stooping or bending. Tying your shoes is OK. Bending over for longer periods to weed your garden isn't, especially soon after eating.
• Don't lie down soon after a meal. Wait at least two to three hours after eating before going to bed, and don't lie down right after eating.
• Raise the head of your bed. An elevation of about six to nine inches puts gravity to work for you. You can do this by placing wooden or cement blocks under the feet of your bed at the head end. If it's not possible to elevate your bed, you can insert a foam wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head only by using pillows is not a good alternative. If you need to raise the head of your bed most nights, talk to your doctor because it may indicate GERD and require stronger medication and evaluation.
• Don't smoke. Smoking may increase stomach acid. The swallowing of air during smoking may also aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of esophageal cancer.