Q: What Causes Heartburn And How Can I Ease It?

Heartburn, (also called acid reflux) is the burning symptom you feel when acid from the stomach splashes back up from the stomach into the esophagus, the muscular tube which food travels down to the stomach after  it’s swallowed.  At the bottom of the esophagus is a muscular ring (called a sphincter), which relaxes to allow food to pass into the stomach, then closes tight to prevent food and acid from backing up into the esophagus. If it doesn’t tighten enough, acid reflux occurs. Two things especially contribute to the problem: overeating, and excessive pressure on the stomach, often from obesity, pregnancy or constipation.

Heartburn symptoms are similar for most people: a burning feeling in the chest, just behind the breastbone that occurs after eating and lasts a few minutes to several hours.  There may be burning in the throat – or hot, sour, acidic, or salty-tasting fluid at the back of the throat, and difficulty swallowing. Heartburn may cause chronic cough, sore throat, or chronic hoarseness. Chest pain may occur, especially after bending over, lying down, or eating.

Heartburn triggers differ from person to person. Eating a heavy meal, then laying down (especially on your back), or bending over can cause reflux. So can snacking before bedtime, using aspirin or ibuprofen, muscle relaxers, some blood pressure medications, and exercise.Some foods relax the sphincter, including: foods containing tomatos, such as spaghetti, or pizza, citrus fruits, garlic, onions, chocolate cake, coffee, alcohol, carbonated beverages, spicy foods (especially curry and hot pepper), and mint.

Some lifestyle changes can help prevent heartburn. Place 6 – 9 inch blocks to elevate the head of the bed, with the entire bed at a slant. If you smoke, quit. Lose weight, if you’re overweight. Don’t overeat. Eat high protein, low fat meals. Avoid tight clothes and belts. Avoid alcohol, caffiene, and carbonation. Avoid foods and other things that you know cause you symptoms.

Antacids that you can buy over-the-counter (OTC) weaken the acid your stomach produces. They can give fast, short-term relief. If you take too much, however, you can get constipation or diarrhea. Look for antacids that contain both magnesium hydroxide and aluminum. One causes diarrhea, the other causes constipation; each balances the other’s effect. H2 blockers, which decrease acid production, are also OTC. Some brand names are Pepcid and Zantac.

If lifestyle changes and OTC medications don’t help your symptoms, see your doctor. The doctor may suggest prescription medication or do some testing. Tests may include X-rays, checking for acid in the esophagus, or using a scope to look directly at the stomach and check for H. pylori, bacteria that cause ulcers. Chronic irritation of the lining of the esophagus can lead to scarring, narrowing, and difficulty swallowing. Cells damaged by the chronic inflammation can develop cancer.

Chest pain with severe heartburn, and chest pain caused by a heart attack, can be so difficult to distinguish, especially in women, that sophisticated medical testing is needed to determine whether or not the pain is a heart attack. The similar symptoms also occur in similar types of people – older and overweight.

Signs more typical of heartburn include:

A sharp, burning sensation just below the breastbone or ribs, which does not usually radiate to the shoulders, neck or arms, but it can occur.
Pain occurs after meals, when lying on the back, bending over, exercising, or with anxiety.
Symptoms respond quickly to antacids.
A cold sweat is rare.

Signs more typical of angina (chest pain from coronary artery disease) or a heart attack include:

Fullness, tightnesss, dull pressure or pain in the center of the chest
Sudden chest pain or pressure
Dizziness or lightheadedness
Pain may spread to the shoulders, neck, jaw, or arms
Shortness of breath
Often, a cold sweat

If you have pain for more than a few minutes, that doesn’t get better fast with antacids, or have warning signs of a heart attack, get to a hospital or see your doctor right away! Don’t assume that unexplained chest pain is heartburn.

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