Heartburn and Gastroesophageal Reflux Disease (GERD)
Despite its name, heartburn has nothing to do with the heart (although some of the symptoms are similar to a heart attack). Heartburn is an irritation of the esophagus caused by acid that refluxes (comes up) from the stomach. Heartburn is also a symptom of more serious gastroesophageal reflux disease, or GERD.
When swallowing, food passes down the throat and through the esophagus to the stomach. Normally, a muscular valve called the lower esophageal sphincter (LES) opens to allow food into the stomach (or to permit belching); then it closes again. Then the stomach releases strong acids to help break down the food. But if the lower esophageal sphincter opens too often or does not close tight enough, stomach acid can reflux or seep back into the esophagus, damaging it and causing the burning sensation we know as heartburn.
Not only can stomach acid in the esophagus cause heartburn, but it can also cause ulcers, strictures (narrowing) of the esophagus, and cancer of the esophagus.
Most people have felt heartburn at one time or another. In fact, the American Gastroenterological Association reports that more than 60 million Americans experience heartburn/GERD symptoms at least once each month. Though uncomfortable, heartburn does not usually pose a serious health problem for most people.
However, if heartburn symptoms occur frequently and persistently, it may be a sign of a more serious problem, such as GERD. GERD is a chronic reflux of acid into the esophagus. Left untreated, GERD can cause a host of complications, including esophagitis, esophageal ulcers, hoarseness, chronic pulmonary disease, and Barrett's esophagus (a change in the lining of the esophagus that increases the risk of developing cancer of the esophagus).
Symptoms of heartburn include:
- A burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few minutes to several hours
- Chest pain, especially after bending over, lying down, or eating
- Burning in the throat -- or hot, sour, acidic, or salty-tasting fluid at the back of the throat
- Difficulty swallowing
- Feeling of food "sticking" in the middle of the chest or throat
Reporting these symptoms to your doctor is usually all that is needed for a diagnosis of heartburn. However, your doctor may perform special tests such as endoscopy or pH monitoring to determine the severity of your problem or to monitor your treatment.
Various lifestyle and dietary factors can contribute to heartburn by relaxing the lower esophageal sphincter and allowing it to open, increasing the amount of acid in the stomach, increasing stomach pressure, or by making the esophagus more sensitive to harsh acids. These factors include:
- Eating large portions
- Eating certain foods, including onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoes or tomato-based products
- Drinking certain beverages, including citrus juices, alcohol, caffeinated drinks, and carbonated drinks
- Eating before bedtime
- Being overweight
- Wearing tight-fitting clothing or belts
- Lying down or bending over, especially after eating