Heartburn

Heartburn Treatment

Nearly everyone will experience occasional heartburn at some point in their lifetimes, and this is typically no cause for concern. There are many over-the-counter heartburn treatments and diet and lifestyle changes that ease symptoms. However, if heartburn is more frequent or is severe, it may be indicative of a different gastrointestinal problem, such as acid reflux or gastroesophageal reflux disease (GERD).

What Is Heartburn?

Heartburn is typically a burning sensation or pain in the chest that may or may not move up through the neck and throat. It can last from several minutes to several hours. The burning sensation that you feel is stomach acid escaping from the stomach into the esophagus. The amount of acid may vary, depending on whether it is occasional heartburn or symptomatic of another disease, such as GERD.

At the bottom of the esophagus is a muscle called the lower esophageal sphincter (LES). After food or liquid moves through the esophagus, a properly functioning LES closes. However, sometimes the LES opens and closes or is completely open. The stomach contents escape into the esophagus. Heartburn occurs when the stomach acid temporarily inflames the esophagus.

What Are the Symptoms of Heartburn?

Heartburn symptoms can look slightly different in every patient, depending on the severity of the heartburn and how far the stomach acid has traveled. Common heartburn symptoms include:

• A burning pain or feeling in the chest
• Difficulty swallowing (dysphagia)
• A bitter, sour, or hot taste in the back of the throat
• Pain in the chest when lying down or bending over

Regurgitation (food and liquid coming back up into the mouth) can also occur with heartburn, particularly when the underlying cause is acid reflux or GERD.

Common Causes of Heartburn

The cause of heartburn is stomach acid in the esophagus. However, many outside factors can cause this to occur. Other than acid reflux and GERD, these can contribute to heartburn:

• Pregnancy
• Hiatal hernia (when the stomach pushes into the chest)
• Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin
• The foods you eat and eating habits 

Many cases of occasional heartburn are caused by poor eating habits or the foods you eat. If you struggle with occasional bouts of heartburn, you can try diet and lifestyle changes as heartburn treatment. Some foods and beverages you may want to avoid to prevent heartburn include:

• Alcohol
• Citrus fruits and juices 
• Tomatoes and tomato products
• Spicy foods
• Caffeine 
• Onions
• HIgh-fat foods
• Carbonated beverages

You also may want to make changes in your eating and lifestyle habits. This would include changes such as eating smaller meals, quitting smoking if you’re a smoker, and losing weight (if overweight). You should also avoid eating right before you lie down, as this can trigger heartburn.

When to Seek Medical Help for Heartburn

Chest pain can sometimes be mistaken for heartburn when the pain is attributed to a heart attack instead. If you have severe chest pressure or pain, seek emergency help immediately.

For heartburn and heartburn symptoms, you should consult a gastroenterologist if:

• You have heartburn episodes more than twice a week/
• You still have symptoms, even after using over-the-counter heartburn treatment or diet and lifestyle changes.
• You have dysphagia (difficulty swallowing).
• Heartburn is accompanied by nausea and vomiting. 
• You have unintended weight loss. 

Your GI doctor will likely want to rule out acid reflux or GERD, so they may run some diagnostics in order to provide heartburn treatment. Your gastroenterologist will ask you about your symptoms and medical history as well. Some of these tests could include:

• X-rays. These can give insight into the condition of the stomach and esophagus.
• Endoscopy. During this procedure, you’ll be given light sedation, and a thin, flexible tube will be placed into your throat and down through your esophagus. At the end of the tube is a tiny camera so the physician can examine your esophagus. While you’ll need someone to drive you home, this procedure has very few side effects other than a potential sore throat.
• Acid monitor testing. A small monitor is placed in your esophagus, which connects to a receiver. This shows when stomach acid backs up and for how long.
• Esophageal motility testing. This measures the pressure and movement in the esophagus.

Heartburn treatment will depend upon the testing, however, there are common medications used to treat heartburn, acid reflux, and GERD, as defined by the Food and Drug Administration (FDA). These drugs can be both over-the-counter and prescription, and your gastroenterologist will direct you which one is right for you.

• Antacids. These medications help change the heartburn-causing stomach acid. Common OTC antacids include Mylanta® (aluminum hydroxide, magnesium hydroxide, and simethicone), Rolaids® (calcium carbonate), and TUMS® (calcium carbonate).
• Proton pump inhibitors (PPIs). PPIs work by reducing the amount of acid in the stomach. These are often prescribed but are also available over the counter. These include:
  • Lansoprazole (Prevacid®)
  • Esomeprazole (NEXIUM®)
  • Omeprazole magnesium (Prilosec®)
  • omeprazole and sodium bicarbonate (Zegerid®)
• Histamine-2 blockers (H2 blockers). These medications also work toward reducing acid in the stomach. In cases of GERD, PPIs and H2 blockers are often prescribed together. These commonly include:
  • Cimetidine (Tagamet®)
  • Famotidine (Pepcid®)
  • Nizatidine (Axid®)

It’s important to remember that if you’re taking antacids, PPIs, or H2 blockers over the counter and your symptoms are not lessening, it’s time to schedule a consultation with a gastroenterologist for heartburn treatment.