Heartburn—Overview
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Definition
Heartburn is a burning sensation in the lower chest. Heartburn can be caused by different conditions, but most often it is related to gastroesophageal reflux disease (GERD).

Treatment may depend on the cause of your heartburn. In most cases, heartburn can be treated with medications, lifestyle changes, or surgery.

Heartburn

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Causes
Heartburn is caused by stomach acid that moves up into the esophagus. A muscle at the top of the stomach allows food to enter the stomach. This muscle also closes to prevent food and acid from moving back up into the esophagus. Certain conditions can keep this muscle from closing completely, which allows acid to flow out. This causes heartburn.

Risk Factors
Factors that increase your chance of heartburn include:

  • Obesity
  • Smoking
  • Exercising or strenuous activity immediately after eating
  • Lying down, bending over, or straining after eating
  • Pregancy
  • Prior surgery for heartburn such as vagotomy
  • Diabetes
  • Scleroderma
  • Certain nervous system disorders
  • In-dwelling nasogastric tube
Foods and beverages associated with heartburn include:

  • Alcohol use, especially in excess
  • Caffeinated products
  • Citrus fruits
  • Chocolate
  • Fried foods
  • Spicy foods
  • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
Medications and supplements associated wtih heartburn include:

  • Anticholinergics
  • Calcium channel blockers
  • Theophylline, bronchial inhalers, and other asthma medications
  • Nitrates
  • Sildenafil
  • Bisphosphonates
Symptoms
Heartburn symptoms usually occur after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

Common heartburn symptoms may include:

  • Burning feeling that starts in the lower chest and moves up the throat
  • Feeling that food is coming back up
  • Sour or bitter taste in the throat
Other symptoms and complications of reflux include:

  • Sore throat
  • Hoarseness
  • Chronic cough
  • Feeling of a lump in the throat
  • Asthma
  • Waking up with a sensation of choking
  • Difficulty swallowing
If reflux persists, the acid can damage the esophagus. Symptoms of esophageal damage include:

  • Bleeding and ulcers in the esophagus
  • Vomiting blood
  • Black or tarry stools
  • Inflammation and scarring of the esophagus
  • Barrett's esophagus— precancerous condition that can lead to esophageal cancer
  • Dental problems, which may occur because of the effect of stomach acid on tooth enamel
When Should I Call My Doctor?
It is common to experience heartburn occasionally. If you have heartburn at least two times a week, make an appointment to see your doctor. Call your doctor if you have any symptoms of heartburn complications.

When Should I Call for Medical Help Immediately?
Heartburn and chest pain due to a heart attack can feel similar. Get medical help right away if you have:

  • Squeezing or chest pressure
  • Pain in the left shoulder, left arm, or jaw
  • Trouble breathing
  • Sweating, clammy skin
  • Nausea
  • Weakness
  • Lightheadedness
  • Pain that starts during activity or stress
If you are not sure of the cause of any pain in your chest, call for emergency help right away.

Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may be able to make a diagnosis based on your symptoms. Your doctor may also take images of your esophagus or stomach with an upper GI series . A sample of your esophagus may be taken and sent for examination. This is often done during an endoscopy.

Other tests may include:

  • 24-hour pH (acid) monitoring
  • Manometry to test muscle strength in the lower esophagus
Treatment
Talk to your doctor about the best treatment plan for you. Treatment will depend on what is causing your heartburn. Treatment may focus on preventing heartburn from occuring or repairing damage causing the heartburn.

Lifestyle Changes
To help decrease the indicidence of heartburn:

  • Keep a food diary of what you eat and what the reaction is. Make gradual changes to your diet and record the results.
  • Avoid foods that trigger heartburn symptoms.
  • Eat smaller portions.
  • Allow at least 2-3 hours between meals and lying down, and exercise.
  • Lose weight .
  • Quit smoking.
  • Avoid belts and clothing that are too tight. This may increase pressure on the abdomen.
  • Elevate head of bed 6-8 inches.
Medication
Medication may help relieve symptoms and repair any damage to the esophagus. Many prescription heartburn medications are available over-the-counter. Your doctor may recommend the following.

  • Proton-pump inhibitors block acid production in the stomach
  • H-2 blockers decrease the amount of acid secreted by the stomach
  • Antacids neutralize stomach acid
Procedures
If symptoms are severe and you cannot tolerate medication, surgery may be an option.

The most common surgery for heartburn is fundoplication . The doctor wraps the stomach around the esophagus. This creates pressure on the muscle at the opening to the stomach.

Endoscopic Procedures
An advantage of endoscopic techniques is that they do not involve incisions in the skin. Instead, the doctor inserts a lighted device called an endoscope through the mouth and down the esophagus. The doctor can perform one of a variety of procedures with this scope to decreases the backward flow of stomach acid into the esophagus.

If surgery or endoscopy is successful, you may no longer need heartburn medication.

Prevention
There are no current guidelines to prevent heartburn.




RESOURCES:
Gastro.org—American Gastroenterological Association

National Institute of Diabetes and Digestive and Kidney Diseases

CANADIAN RESOURCES
Canadian Institute for Health Information


References:
Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 25, 2013. Accessed April 26, 2013.

Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd. Updated April 30, 2012. Accessed April 26, 2013.

Heartburn. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/heartburn.html. Updated July 2010. Accessed April 26, 2013.

Understanding Heartburn and Reflux Disease. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/heartburn-gerd. Updated April 25, 2010. Accessed April 26, 2013.

Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp. Updated March 22, 2013. Accessed April 26. 2013.

9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168:1798-1804.

3/1/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Maalox Total Relief and Maalox liquid products: medication use errors. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm200672.htm. Published February 17, 2010. Accessed April 26, 2013.

4/25/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Shimamoto T, Yamamichi N. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: a cross-sectional study of 8,013 healthy subjects in Japan. PLoS One. 2013;8(6):e65996.

Last Reviewed March 2014



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