Heartburn: What to do when the burn becomes a burden

A large meal followed by a nap, a spicy new recipe, or wearing tight-fitting clothing may cause infrequent heartburn, or the sensation of acid coming up into the throat, for some people. But when the burning pain happens frequently or disrupts normal activities, it's time to talk to your health care provider about heartburn.

Heartburn cause

A burning sensation, or pain or discomfort behind your breastbone, is known as heartburn. When stomach acid backs up into the esophagus, the tube that carries food from your mouth to your stomach, heartburn occurs.

Normally, when you swallow, a band of muscle around the bottom part of the esophagus relaxes to allow food and liquid to move into the stomach. After eating or drinking, the muscle tightens again. If the muscles weaken or relax abnormally, stomach acid can flow back up into the esophagus, known as acid reflux, and cause heartburn.

Some medications or conditions, such as central obesity, which is an excess accumulation of fat in the abdominal area, may affect the way the muscle tightens and allow for more acid to flow up into the esophagus.

The lining of the esophagus is sensitive to acid because is not protected like the lining in the stomach. Typically, people who experience heartburn are affected when the acid from the stomach goes where it should not be or is not cleared from the food pipe in a timely manner.

Symptoms also can develop if the protective mechanism of the lining of the gut is weakened, which may happen from use of over-the-counter medications such as nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen.

Heartburn symptoms

Heartburn symptoms, such as a burning pain in the chest, usually occurs after eating or at night. You may notice pain increases when lying down or bending over.

People can experience different types of symptoms related to heartburn, including:

• Epigastric pain
  This is a burning sensation directly under the ribcage.
• Globus sensation
  This is a feeling of a lump or fullness in the throat, dry cough or clearing the throat repeatedly.
• Water brash
  This is hyper-salivation, or excess amount of saliva, which can cause halitosis, or bad breath, and increase risk of cavities.
• Difficulty swallowing
  This could be caused by acid exposure over a prolonged time period.

If heartburn and acid reflux happen more two or more times per week, and it interferes with daily activities, it is typically considered to be gastroesophageal reflux disease, or GERD. Your health care provider can diagnose GERD by evaluating symptoms or performing tests.

Heartburn treatment

Just as people experience different symptoms of heartburn, different treatment options can relieve symptoms.

Over-the-counter medications can relieve heartburn symptoms. Consider these types of medications:

• Antacids
  These medications provide quick relief to neutralize stomach acid, but they cannot heal an inflamed esophagus. Examples include Milk of Magnesia, Mylanta and Rolaids.
• H-2-receptor antagonists, or H2RAs
  These types of medications do not act as quickly as antacids, but they may provide longer relief. Examples include famotidine (Pepcid), Tagamet and ranitidine (Zantac).
• Proton pump inhibitors, or PPIs
  These medications can reduce stomach acid for up to 24 hours. Examples include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC).

If over-the-counter treatments do not work or are needed continually, it is important to see your health care provider. Prescriptions or other treatment options may be an option.

Lifestyle modifications also can relieve heartburn symptoms. Consider these lifestyle modifications:

• Maintain a healthy weight.
  Excess weight puts pressure on your abdomen, pushing up your stomach and causing acid to back up into the esophagus.
• Avoid tight-fitting clothing.
  This can put pressure on your abdomen and muscle around the bottom of the esophagus.
• Avoid laying down after a meal.
  Wait at least three hours after a meal to lie down.
• Avoid a late meal.
  Plan the timing of meals to allow two to four hours before going to bed.
• Eat smaller meals more frequently.
  Avoid eating large meals that cause the stomach to expand.
• Elevate the head of your bed.
  If you experience heartburn at night or while sleeping raise the head of your bed 4 to 6 inches. This can be done by putting blocks under the legs at the head of the bed or by inserting a wedge between the mattress and box spring to elevate your body above the waist. Adding more pillows usually isn't effective as it can increase pressure on the stomach.
• Avoid smoking.
  Try not to be around tobacco smoke.
• Limit alcohol consumption.
  Drinking alcohol can irritate the esophagus and stomach.
• Avoid nonsteroidal anti-inflammatory drugs.
  Avoid these medications unless recommended by your health care provider. Examples include aspirin, ibuprofen or naproxen.
• Avoid foods that trigger heartburn.
  Foods that trigger your heartburn may be different than others. Keep a journal to note what foods cause an increase in symptoms. Foods that are known to cause symptoms include spearmint, peppermint, tomatoes and tomato-based products, citrus fruits, caffeine, carbonated drinks, high fat foods, and spicy foods.

Heartburn and acid reflux can affect people of all ages due to stress, lifestyle and other factors. When symptoms of heartburn become a burden, talk with your health care provider about the best way to control your symptoms.

Harika Balagoni, M.B.B.S., specializes in gastroenterology and hepatology, including digestive care, in La Crosse, Wisconsin.