It’s back—that unpleasant burning sensation deep in your chest. Was it the sausage stuffing at dinner that did you in—or the cheesecake and coffee that ended your meal? Heartburn (often accompanied by gastroesophageal reflux or acid reflux) can certainly ruin a good time.
On any day of the week, more than 15 million Americans experience heartburn, sometimes along with acid reflux, which occurs when stomach acids flow back into the esophagus. Food usually triggers the pain, but some people find that exercising or bending over sets off heartburn. A stressful lifestyle can aggravate the condition.
Chances are, you’ve had an episode yourself, so you know that heartburn’s symptoms can be debilitating: a searing pain in the lower breastbone that may radiate toward your neck, a sour or bitter taste in your mouth and a feeling that you’re about to regurgitate. Heartburn can put a snag in your social plans, wreck a good night’s sleep and zap your productivity at work.
Heartburn usually isn’t serious. Self-care measures—such as improving your diet or losing weight—often resolve the problem. Over-the-counter medications can provide quick relief.
But if you experience heartburn or acid reflux more than twice a week, or your discomfort is severe or awakens you at night, you may have gastroesophageal reflux disease (GERD), a medical condition that needs to be treated. Symptoms of GERD include:
- persistent acid regurgitation, with or without heartburn
- sore throat or hoarseness
- difficulty swallowing
- chest pain
- coughing or wheezing
Left untreated, GERD can cause serious complications such as ulcers, bleeding and narrowing of the esophagus. Ten to 15 percent of people with GERD may go on to develop a serious condition called Barrett’s esophagus, which involves changes to the lining of the lower esophagus. When this happens, the risk for developing esophageal cancer increases.
Keeping track of the foods or circumstances that trigger your discomfort can help you avoid future episodes. You can also curb heartburn and acid reflux by making these lifestyle changes:
- Lose weight if you need to. Carrying excess pounds puts pressure on your stomach and diaphragm, forcing the muscle at the bottom of your esophagus to open and acids to flow upward.
- Stop smoking. Smoking stimulates acid production and inhibits saliva, which protects the esophagus lining.
- Improve your diet. Limit foods that trigger your heartburn, such as fatty foods, tomato products or chocolate. Control your portion sizes and eat smaller meals more often.
- Elevate the head of your bed. Use blocks or try foam wedges (available at drugstores and medical supply stores) to raise your mattress so stomach acid stays put. A 4- to 6-inch incline works well.
- Let your food digest. Avoid exercising, lying down or bending over soon after eating.
- Wear clothes that fit comfortably. Avoid tight belts and clothes that put pressure on your stomach.
- Talk to your doctor about your medications. Some antidepressants, antibiotics, sedatives and other prescription medications may contribute to heartburn. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can also cause heartburn.
When your symptoms fail to improve with lifestyle changes, your doctor may suggest one of the following over-the-counter medications:
- Antacids neutralize stomach acid. They’re good for rapid—but short-term—relief.
- H-2-receptor blockers reduce stomach acid. These work slowly but have longer-lasting effects.
- Proton pump inhibitors (PPIs) shut down active acid pumps in the stomach.
Prescription options include stronger H-2-receptor blockers or PPIs and prokinetic agents that help your stomach empty more rapidly.
When medications don’t bring relief, your doctor may order tests. A barium X-ray can reveal a hiatal hernia, a growth or esophageal narrowing. An endoscopy can help your doctor detect ulcers or inflammations. Ambulatory acid (pH) probe tests measure the amount and frequency of acid reflux.
Surgical procedures and less-invasive measures that tighten the muscle at the bottom of the esophagus to prevent reflux are available for patients with extreme cases of GERD that don’t respond to medication and lifestyle changes.