Heartburn is extremely common. Sixty million Americans experience at least one episode every month and some studies report that more than 15 million Americans have symptoms every day. If you’re one of the many people who live with the discomfort of heartburn, there’s good news. You can find ways to treat and prevent the condition—it’s all about understanding your triggers.
We spoke with Akiva J. Marcus, MD, PhD, a gastroenterologist at the Digestive Disease Center of the Palm Beaches Congress, part of JFK Medical Center in West Palm Beach, Florida, to learn how to put out the fire you may be feeling.
Heartburn explained
Heartburn is aptly named. “A lot of people think that heartburn is discomfort in the upper abdomen, or they’ll say they have heartburn while pointing to their belly,” says Marcus. “But heartburn is when your heart, or your chest, literally feels like it’s burning.” Heartburn is usually associated with something called acid reflux, which is when stomach acid flows backward (reflux) into the esophagus, the tube that connects the throat and the stomach.
During normal digestion, a ring of muscle at the bottom of the esophagus called the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and then quickly tightens to prevent backflow into the esophagus. If the LES malfunctions, contents from the stomach, including food and corrosive digestive juices, can rise back into the esophagus. While the stomach lining is acid-resistant, the esophagus lining is not. When acid refluxes, it can get inflamed or irritated, causing a burning sensation.
Heartburn triggers
Anything that increases stomach acid or relaxes the LES can contribute to heartburn. Some common causes include:
Certain foods: Food triggers are different for everyone, but chocolate, coffee, alcohol, tomatoes and tomato-based foods, spicy foods and peppermint are common offenders for those with occasional heartburn. “Spaghetti sauce is the classic one,” says Marcus. Evidence is mixed regarding whether eliminating these foods can prevent heartburn, but your doctor may suggest cutting out one or more to see if symptoms improve.
Heartburn is also associated with fatty foods (including those with healthy fat like avocados) because they take longer to digest. “The longer food sits in your stomach, the greater the risk for reflux,” says Marcus. “The worst thing is eating a fatty meal and then going to bed. You lie down, and the contents of your stomach come right up—a lot of people wake up choking on acid.”
Large meals: A full stomach puts pressure on the sphincter muscle, making reflux more likely. Your stomach also responds to bigger portions of food by producing a large amount of acid at one time, increasing the risk of reflux.
Obesity: Excess weight increases abdominal pressure and forces acid up into the esophagus. In one study, people who were overweight or obese had a two- to three-fold increased risk of frequent reflux compared to people at a normal weight.
Smoking: Nicotine is thought to relax the LES by as much as 42 percent. Smoking also reduces the amount of saliva produced, which ordinarily helps neutralize stomach acid.
Change in position: Heartburn often gets worse when lying down or bending over, especially immediately after consuming a meal.
Medication: Taking anti-inflammatory painkillers can irritate the esophagus and thereby increase symptoms of heartburn. They can also promote acid reflux. Other medications that can have this effect include some blood pressure and heart medications, such as calcium channel blockers and nitroglycerin, and tricyclic antidepressants.
There are many other supplements and medications, both prescription and over-the-counter (OTC), that can may worsen the symptoms of heartburn. Even if you suspect a medication may be causing acid reflux, do not stop taking it. Instead, speak to your doctor, who can help you figure out if that is actually a trigger and the next steps you can take.
Pregnancy: Heartburn is a common occurrence during pregnancy, especially in the third trimester. Increased pressure on the stomach and intestines from a growing uterus can cause the reflux of food after meals. It’s also thought that an increase in the hormone progesterone causes the LES to relax more, allowing food to pass back through the esophagus.
When heartburn becomes frequent
Sometimes heartburn may be a symptom of a more severe problem like gastroesophageal reflux disease (GERD), which is the chronic form of acid reflux. If your acid reflux occurs more than twice a week for a few weeks, it may be due to GERD.
“It’s a disease where you have significant symptoms from acid reflux and/or evidence of damage to your esophagus,” says Marcus. Americans are no stranger to GERD either—it affects around 20 percent of the population.
In addition to burning or sharp chest pain, symptoms of GERD can include regurgitation (when food or stomach fluids flow back into your mouth), nausea, a recurring sour or bitter taste in your mouth, difficulty swallowing, sore throat, dry cough, bad breath, damage to tooth enamel, wheezing or repeatedly needing to clear your throat.
Treatment and prevention
For occasional acid reflux, OTC antacids like Mylanta, Rolaids, and Tums can provide quick relief by neutralizing excess stomach acid. They don’t, however, reduce acid production and only provide relief for a short amount of time. For that, there are other OTC options.
H-2-receptor blockers, like Tagamet HB, Pepcid AC, and Zantac, reduce acid production, while medications known as proton pump inhibitors (PPIs) block acid production for even longer to allow time for the esophagus to heal. Prilosec OTC, Prevacid 24 HR and Nexium are examples of PPIs. Prescription versions of H-2-receptor blockers and PPIs are also available, as are drugs that help strengthen the LES.
Lifestyle changes like losing weight, avoiding trigger foods and eating smaller meals can go a long way toward easing symptoms of heartburn or GERD. To keep stomach acid from escaping into your esophagus, experts also recommend remaining upright for three hours after eating. “You want to allow to gravity to work in your favor,” says Marcus.
For added insurance, prop up the head of your bed about six inches or insert a wedge between your mattress and box spring to elevate your body from the waist up. Don’t try the shortcut of sleeping on a few extra pillows. This actually makes reflux worse by bending you at the waist and compressing your stomach.
In more severe cases, surgery may be required to tighten the LES. For chronic heartburn or GERD, your healthcare provider can help you figure out the right combination of lifestyle changes and medication options.
When to see the doctor
"Patients should see the gastroenterologist not just for worsening symptoms but for a chronic symptoms, like chronic heartburn that continues for a long period of time," says Marcus. Over time, reoccurring heartburn or GERD can lead to serious health problems, such as inflammation of the esophagus (esophagitis), a narrowing of your esophagus (esophageal stricture), respiratory problems (caused when stomach acid gets into your lungs), ulcers of the esophagus and Barrett’s esophagus, a condition in which the cells lining the esophagus become abnormal. If you think you have GERD, it’s important to schedule a visit to your doctor.
Heartburn can also be a symptom of a peptic ulcer. “They’re very closely related because the esophagus and the stomach are attached to each other, so some symptoms can overlap,” says Marcus. While they may feel similar, heartburn and ulcers are very different conditions with varying causes, symptoms, prevention strategies, and treatments. If you’re experiencing burning in your stomach, pain that is eased by eating but causes discomfort a few hours later or a feeling of fullness, check with your doctor about the possibility of a peptic ulcer.
Other symptoms that should prompt a visit to your healthcare provider include:
- frequent vomiting
- vomit that contains blood or looks like coffee grounds
- black stool
- painful swallowing or trouble swallowing food
- weight loss
- coughing or wheezing
- worsening symptoms after treatment
If at any time you suspect your pain might actually be a heart attack, which can be mistaken for digestive problems, seek immediate medical attention.
Whether your heartburn is an infrequent nuisance or a chronic condition, a combination of lifestyle changes, preventive measures and guidance from a healthcare professional should help towards alleviating your pain.
