LeRoy Hodges, M.D.
At least 40 million Americans suffer from heartburn. Most have only mild or occasional symptoms. However, about 15 million need medication on a daily basis to control that burning sensation.
What is heartburn?
The feeling varies from person to person, but most people complain about a burning sensation in the chest, near the level of the heart. Occasionally, the pain is lower, near the bottom of the breastbone or sternum. Real heartburn has nothing to do with the heart, but the location of the pain often requires that we make sure the heart is not involved.
The accepted medical term for the problem that causes heartburn is gastroesophageal reflux disease (GERD). It’s also commonly referred to as acid reflux.
What causes heartburn?
Quite simply, acid reflux refers to acid from the stomach flowing backwards up into the esophagus, also known as the swallowing tube.
As most people know, the stomach makes acid to help digest our food. The lining of the stomach is built to withstand the effects of acid. The acid is supposed to travel downstream into the small intestine along with the food being digested and absorbed. Therefore, the first part of the small intestine, known as the duodenum, also handles acid quite well.
Unfortunately, the lining of the esophagus is not made to withstand acid. For most people, this is not a problem. Normally, a valve at the end of the esophagus prevents acid from refluxing, or flowing upstream, into the esophagus. When this valve fails, heartburn often results. Another factor for some people may be the presence of a hiatal hernia. This occurs when the opening in the diaphragm where the esophagus passes from the chest into the belly becomes enlarged, allowing part of the stomach to slide up into the chest. This interferes with the function of the valve at the beginning of the stomach, leading to acid reflux and heartburn.
What are symptoms of heartburn?
Heartburn, and a number of other complications of acid reflux, can vary from mild to severe, disabling pain. Other symptoms are usually associated with damage and scarring caused by the acid. These might include ulcers of the esophagus from the acid, causing worsening pain. Sometimes scarring occurs, which can actually partially block the esophagus, causing difficulty swallowing. Some people actually have food get completely stuck on the way down, requiring removal by their doctor.
Are there long-term risks?
Rarely, acid reflux can cause changes in the lining of the esophagus that are actually precancerous. This does not mean that cancer will occur. However, it does mean that some people end up with a higher chance of cancer than the average.
In the end result, the main question is, “When should I see my doctor?”
Clearly, most people with heartburn don’t need a doctor to help them. These are the people with mild, rare symptoms that are easily controlled with occasional over-the-counter medications.
However, if you or a loved one has recurring, frequent heartburn, especially when it is not getting better with the usual over-the-counter medications, you should consider seeing your doctor. Most importantly, if you are having trouble swallowing, having pain with swallowing or having food get stuck on the way down, seeing your doctor is essential. While cancer in this area is uncommon, if it occurs, finding it right away is the key to the cure.
Most people have benign acid reflux that is easily treated with medication. Often the medication can be temporary until the irritation is healed. For some people, long-term medication is needed. Rarely, an operation to prevent acid reflux is necessary.