Heartburn


WHAT IS HEARTBURN?

Patients experiencing heartburn often report a burning sensation in their chest, just behind the breastbone. Pain often peaks after eating, in the evening hours, or when lying down or bending over. And while occasional bouts of heartburn are quite common, when pain interferes with your everyday life, a more serious condition may be to blame – and medical care may be required.

If heartburn only causes mild discomfort, simple lifestyle changes or over-the-counter medication are often effective solutions. There’s no need to suffer in silence, so contact your local GI specialist today!

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CAUSE

male with heartburn, stomach pains, tummy acheHeartburn occurs when stomach acid backs up into the esophagus, the tube that transports food to your stomach. When your digestive system is functioning as it should, a band of muscle at the esophagus’s base (lower esophageal sphincter) relaxes to allow food into the stomach, then retightens. 

But if the muscles malfunction, stomach acid is free to flow back up into the esophagus, causing heartburn. Bending forward or lying down makes it even easier for the acid to flow, which is why acid reflux symptoms are often worse in these scenarios.

HEARTBURN & GERD

Acid reflux causes heartburn, as explained above. Frequent or constant reflux can lead to GERD, causing a more chronic issue as opposed to occasional discomfort.

FOODS + SUBSTANCES TO AVOID WITH HEARTBURN

Certain foods and drinks can trigger heartburn, including:

  • Spicy foods
  • Citrus products (ex. orange juice, grapefruit juice)
  • Tomato products (ex. ketchup, pasta sauce)
  • Fatty or fried foods
  • Onions
  • Peppermint
  • Chocolate
  • Alcohol
  • Carbonated beverages
  • Coffee (or other caffeinated drinks)
  • Large or high-fat meals
  • Tobacco

FOODS TO EASE HEARTBURN

These foods may help keep uncomfortable symptoms at bay:

  • Whole grains (ex. brown rice, oatmeal, and whole-grain bread)
  • Ginger
  • Fruits and vegetables (ex. sweet potatoes, carrots, broccoli, green beans, and more)
  • Lean protein (ex. chicken, seafood, tofu, and egg whites)
  • Legumes (beans)
  • Nuts and seeds (ex. almonds, peanuts, chia, pomegranate, and flaxseeds)
  • Healthy fats (ex. avocado, olive oil, walnuts, and soy products)
  • Yogurt 

RISK FACTORS 

Occasional heartburn affects many Americans, often triggered by a particular rich or acidic meal. The added abdominal pressure experienced during pregnancy can cause heartburn too.

Heartburn that occurs very regularly, though, is a symptom of GERD, or chronic acid reflux. About 20% of people in the U.S. suffer from GERD, especially those with certain risk factors – like obesity  (body mass index greater than 30), being overweight (BMI over 25), smoking, or exposure to secondhand smoke. 

SYMPTOMS

  • A burning pain in the chest that occurs after eating and at night.
  • Pain that worsens when lying down or bending over.
  • A bitter or acidic taste in the mouth.

If your heartburn stems from acid reflux, you may experience:

  • Burping
  • A sour taste in the mouth.
  • Nausea
  • Regurgitation of food.

Other unusual symptoms of acid reflux, include:

  • Stomach bloating and overfullness.
  • Hiccups
  • Chronic cough
  • Worsening asthma
  • Sore throat
  • Laryngitis
  • Difficulty swallowing or feeling like there’s a lump in your throat.
  • Chest pain similar to angina (non-cardiac chest pain).

COMPLICATIONS 

If heartburn prevents you from participating in your normal, daily activities, gastroesophageal reflux disease (GERD) is likely the culprit. Treatment options include prescription medication, surgery, or other medical procedures. Because prolonged GERD can damage the esophagus and even lead to precancerous changes (Barrett’s esophagus), it is crucial to see your gastroenterologist in Charleston.

WHEN TO SEE A DOCTOR

Keep in mind that chest pain may be indicative of a more serious condition, like a heart attack. If chest pain or pressure become severe, seek medical attention immediately. If you are also experiencing pain in the arm or jaw, or are having trouble breathing, call 911 right away.

While emergency care may not be needed for the following symptoms, we strongly recommend scheduling an appointment with local GI specialist:

  • Heartburn that occurs more than twice a week.
  • Symptoms that persist despite over-the-counter medications.
  • Difficulty swallowing.
  • Persistent nausea or vomiting.
  • Weight loss due to poor appetite or difficulty eating.

DIAGNOSTIC TEST 

Here at Charleston GI, our board-certified gastroenterologists may perform the following to reach a diagnosis:

  • X-ray: To check the condition of the esophagus and stomach.
  • Endoscopy: To view your esophagus from the inside and potentially collect a tissue sample.
  • Ambulatory acid probe tests: To determine when, and for how long, the stomach acid backs up into the esophagus.
  • Esophageal motility testing: To measure the movement and pressure in your esophagus.

TREATMENT

In many cases, non-prescription medications do the trick, with over-the-counter products like these effectively relieving heartburn:

  • Antacids: Neutralize stomach acid and provide quick relief.
  • H2 blockers: Reduce stomach acid, often delivering longer term relief.
  • Proton pump inhibitors: Reduce stomach acid to prevent back-up into the esophagus.

If non-prescription treatments just don’t cut it, consult a gastroenterologist near you. Prescription medication and further testing may be required.

PREVENTION

Lifestyle changes like these can help ease heartburn:

  • Maintain a healthy weight. 
  • Avoid tight apparel that puts unneeded pressure on the abdomen.  
  • Eliminate trigger foods from your diet.
  • Avoid lying down for about two to three hours after a meal. 
  • Don’t consume meals late in the evening. 
  • Elevate the head of your bed or insert a wedge between your mattress and box spring to elevate your body from the waist up. 
  • Quit smoking and avoid frequent alcohol use.
  • Opt for many small meals throughout the day instead of less frequent, larger ones.

PREPARING FOR AN APPOINTMENT ON HEARTBURN

Before visiting your local GI specialist, prepare by:

  • Checking pre-appointment restrictions, like eating solid food the day before your visit.
  • Detail your symptoms, including any that may seem unrelated.
  • List all your medications, including vitamins and supplements.
  • Record your key medical information, such as major surgeries or other conditions.
  • Make note of key personal information, like recent life changes or stressors.
  • Ask a relative or friend to go with you to help remember what the doctor says.
  • Write down questions to ask your doctor.

Common Questions to Ask Your Gastroenterologist

  • What's the most likely cause of my symptoms?
  • Is my condition likely temporary or chronic?
  • What kinds of diagnostic tests are needed? Will I need to do anything to prepare? 
  • What treatments are available?
  • Should I remove or add any foods to my diet?
  • I have other health conditions. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

WHAT TO EXPECT AT YOUR CHARLESTON GI APPOINTMENT 

Focused on providing a higher standard of caring, your gastroenterologist will first ask you some questions, including the following:

  • When did you first begin experiencing symptoms, and how severe are they?
  • Have your symptoms been continuous, or do they remain occasional?
  • What, if anything, seems to improve or worsen your symptoms? Are they worse after meals or lying down?
  • Do your symptoms wake you up at night?
  • Does food or sour material ever come up in the back of your throat?
  • Do you experience nausea or vomiting?
  • Do you have difficulty swallowing?
  • Have you lost or gained weight?

After you’ve thoroughly answered, your GI doctor will perform a physical exam. Further testing may be required as well to determine the root cause of your condition.

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FREQUENTLY ASKED QUESTIONS

How long does heartburn last?

Heartburn may last anywhere from a few minutes to a few hours. In many patients, symptoms subside when the last meal eaten passes out of your stomach – about two to five hours, depending on the meal.

What does heartburn feel like?

Heartburn feels like acid burning in your chest. Heartburn begins in the esophagus, but the burning sensation often radiates through your chest and sometimes into your throat. It may be mild or severe.

When does heartburn occur?

You may notice that heartburn worsens when:

  • Lying down
  • Bending over
  • Eating a late dinner.
  • Consuming rich, acidic, or spicy foods.

When should I seek medical care for heartburn?

See your GI doctor if:

  • You experience heartburn on a weekly basis.
  • You have atypical symptoms.
  • You struggle to swallow or consume adequate calories.
  • You’re over age 60.
  • You have chest pain that feels like angina (a chest pain that comes and goes, a tightening or squeezing feeling).
  • Your treatment plan isn’t working.

What changes can I make to manage heartburn?

To help prevent acid reflux:

  • Eat smaller meals throughout the day instead of larger, less frequent meals.
  • Loosen your waistband to avoid abdominal pressure.
  • Maintain a healthy weight.
  • Wait three to five hours after eating before lying down.
  • Try to sleep on your left side. This positions your lower esophageal sphincter in an air pocket above your stomach contents. Lying on your back or your right side submerges the valve.
  • Avoid trigger foods. Pay attention to which foods and drinks make your heartburn worse.
  • Quit smoking. Heartburn is just one of many reasons to quit smoking. Your provider can help.

How alike are heartburn and heart attack symptoms?

Heartburn, angina, and heart attack may feel very similar. Even seasoned medical professionals can’t always distinguish one from the other based solely on your medical history or a physical exam. If chest pain sends you to the emergency room, tests will likely be performed right away to rule out a heart attack. 

What's the best thing to do if I have chest pain and aren’t sure what's causing it?

If you have persistent chest pain and you aren't certain that it’s heartburn, call 911 or seek emergency medical care immediately. If you do not seek medical attention during the event, be sure to contact your health care provider as soon as you can. Pain may be a warning sign or an indicator of a more serious issue.

What common signs and symptoms are more often associated with a heart attack than heartburn?

A "textbook" heart attack is defined by sudden, crushing chest pain and difficulty breathing, often triggered by exertion. But this is not always the case. Signs and symptoms vary greatly from one patient to the next, but the most common include the following:

  • Pressure, tightness, pain, or a squeezing/aching sensation in the chest or arms.
  • Pain that spreads to the neck, jaw or back.
  • Nausea, indigestion, heartburn, or abdominal pain.
  • Shortness of breath.
  • Cold sweat
  • Fatigue
  • Lightheadedness or sudden, unexplained dizziness.

Note: The most common symptom of heart attack for both men and women is chest pain. Women are more likely to experience some of the other symptoms, though. Heart attacks are more common among those with high blood pressure, diabetes, or high cholesterol. Smokers and overweight or obese people also face a higher risk.

Are there additional digestive symptoms that cause chest pain?

A muscle spasm in your esophagus may cause chest pain that feels very similar to a heart attack. A gallbladder attack may also cause pain that spreads to your chest. With gallbladder disease, however, you may experience nausea and an intense, persistent ache in the upper middle or upper right abdomen – especially after eating a rich, fatty meal. Again, if you are not sure that’s causing your chest pain, it’s better to be safe than sorry! Seek medical attention immediately.

I’ve never had an issue with heartburn before, why is it happening now?

If heartburn is relatively new, and you haven’t recently made any dietary or lifestyle changes, it may be caused by one of these: 

  • Aging: Heartburn may develop or worsen over time as the muscles weaken, including the one at the base of your esophagus.  
  • Weight gain: Even gradual weight gain can cause symptoms to arise suddenly, especially once you’ve reached a certain weight threshold.
  • Medications: If you’ve recently changed or added new medications, ask your GI physician if they could be causing acid reflux.

Is heartburn always caused by acid reflux?

Heartburn is usually caused by acid reflux, but symptoms may mimic those of certain GI conditions, like these:

  • Esophageal ulcers: Sores caused by erosion of the GI tract lining, often due to overuse of NSAIDs, like aspirin and ibuprofen.
  • Esophagitis: Severe esophageal inflammation caused by GERD, viruses, fungal infections, an allergic reaction, or certain medications. 
  • Functional heartburn: Failure of the nervous system to properly convey sensations from your digestive system to your brain. 
  • Reflux hypersensitivity: Caused by non-acid reflux, often due to overactive nerves.

Is heartburn a serious condition?

Occasional heartburn is uncomfortable but is not a cause for concern. In fact, some amount of acid reflux is perfectly normal. If it happens regularly though, your esophagus lining may not have enough time to heal in between, and damage may result.

When your esophagus lining is consistently injured, it can lead to long-term complications, like:

  • Esophageal strictures: When tissue is constantly inflamed, it may begin to replace itself with scar tissue, resulting in a narrower opening and trouble swallowing.
  • Intestinal metaplasia:  Sometimes instead of scarring, the tissues change to look more like the intestinal lining. This precancerous condition is called Barrett’s esophagus. 
  • Esophageal cancer: While few people actually develop esophageal cancer, studies show a link between persistent inflammation (esophagitis) and cellular changes that can cause cancer. 

Acid reflux may also reveal other digestive system concerns, like gastritis or stomach ulcers. That’s why it’s important to schedule an appointment with a gastroenterologist near you. Contact Charleston GI today – no referral needed!


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