Heartburn 101

Got a burning, burping feeling in your chest? Learn what causes it, how you can manage it, and when to see your doctor.

From the WebMD Archives

There was a time when it didn’t take much to set off Sara Perlman-Smith’s heartburn. Spicy foods, alcohol, even a foul mood could send a burning wave rushing up her throat. "I could feel the acid in my esophagus," she recalls. "It was just a consistent burning pain in my chest."

Then there was the constant burping. "A lot of times that would make me feel a little better," says Perlman-Smith, 38, a stay-at-home mom in Hallsville, Mo. "But a lot of the time if it was a really bad episode, I’d just be burping up acid."

The burning and belching she describes are signs of heartburn -- a condition that’s triggered when a valve (called the lower esophageal sphincter) between your esophagus and stomach malfunctions, letting stomach acids slip out and take a wrong-way route back up your esophagus.

As the acid burns its way northward, it brings serious discomfort. "The pain radiates upward from the middle of the chest toward the neck," says Frank Marrero, MD, a staff physician in the Cleveland Clinic’s Swallowing Center. Sometimes that acid can make it all the way into your mouth.

What Triggers Heartburn?

You’d expect to feel the burn after downing a grande enchilada with extra jalapeños, but some other heartburn triggers might surprise you. Steer clear of these if you’re prone to heartburn:

  • Pain relievers. They can ease your headache, but one side effect of taking nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen is heartburn.
  • Skinny jeans. Those tight jeans might look great in the mirror, but any clothes that put the squeeze on your abdomen can worsen the burn.
  • After-dinner mints. Peppermint relaxes the muscles of the digestive system -- great if you have an upset stomach -- but it also can relax the muscle that keeps acid in your stomach. Heartburn sufferers will want to get their fresh breath elsewhere.
  • Salt. One study found that people who used extra table salt daily were 70% more likely to have heartburn. It’s another reason (along with high blood pressure) to pass on the salt.
  • Lighting up. If cancer, heart disease, lung disease, and wrinkles aren't enough to convince smokers to stop, here’s another: Tobacco weakens the lower esophageal sphincter.

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Lifestyle Remedies for Heartburn

Heartburn can be a real pain, but you can help prevent it by making some simple changes to your routine. First, watch what you eat. Having more food in your stomach keeps more acid moving into your esophagus. Instead of gorging, graze on smaller portions of food throughout the day. Avoid the most notorious heartburn triggers: chocolate, caffeine, citrus fruits, and tomatoes.

Watch the fat in your meals, too, because both consuming high-fat foods and being overweight can cause heartburn. "If you have extra weight in your belly, basically what you’re doing is putting pressure on the stomach," Marrero says. That added pressure pushes more stomach acid up into your esophagus.

Nighttime can be a real nightmare for heartburn sufferers. Approximately one in four Americans has heartburn attacks at night. When you’re lying in bed, gravity works against you, keeping that corrosive acid stuck in your esophagus. You might have heard the advice to raise the head of your bed 6 to 9 inches, which can help. But Marrero says it’s not always practical if you share a bed. He says a better solution is to stop eating two to three hours before bedtime so that you go to sleep with an empty stomach.

Heartburn Treatments

If lifestyle changes don’t help and your heartburn doesn’t let up, your doctor might recommend an antacid to neutralize stomach acids or an acid-blocking drug, such as an H2 blocker. Then, Marrero says, "if someone is having really severe symptoms almost every day, we will go to a stronger, more potent medicine called a proton pump inhibitor, or PPI." Recently, the FDA warned consumers about the risk of hip, wrist, and spine fractures with PPIs. Marrero says these drugs are still safe, but he advises his patients to bone up on extra calcium and vitamin D while taking them.

You also can try other less traditional methods for heartburn relief, like chewing a stick of sugar-free gum. Chewing stimulates the production of saliva, a natural acid buffer. Plus, when you chew gum, you swallow more, which pushes acid back down your throat.

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Some nondrug treatments have been used for heartburn with some success. Chamomile has anti-inflammatory properties, and there is some evidence that licorice can form a protective barrier against stomach acids, but scientific research supporting their use is preliminary at this point. Before using any herbal remedy, check with your doctor to make sure it doesn’t have side effects and won't interact with other medications you’re taking.

Sometimes, those with heartburn just need a little relaxation. "Stress doesn’t necessarily cause acid reflux, but it always makes things worse," Marrero says. Acupuncture, meditation, and other stress-busting therapies have helped some of his patients.

When to Go to the Doctor for Your Heartburn

Most of the time, heartburn is more of an annoyance than a major medical issue. Frequent heartburn is a symptom of gastroesophageal reflux disease (GERD), otherwise known as acid reflux. In rare cases, acid reflux can turn into something more serious.

When is it time to get help for heartburn? People who have heartburn more than twice a week should talk to their doctor, says Marrero. He says to be on the watch for these symptoms: unexplained weight loss, anemia, or food getting stuck in the throat when swallowing. The constant flow of stomach acids can scar the esophagus, narrowing it so much that you have trouble swallowing. In some people, the cells of the esophagus can actually begin to change and turn cancerous. An early checkup is the best thing you can do to ensure your health and prevent any possible, though rare, complications.

Perlman-Smith’s heartburn eventually got so serious that she turned to her doctor for help. Medication relieved her symptoms, and she learned to use a little caution -- especially when it comes to spicy foods and alcohol. "Today, I try to stay away from things that would make my heartburn flare up," she says.

WebMD Magazine - Feature Reviewed by Michael W. Smith, MD on July 08, 2010

Sources

SOURCES:

Sara Perlman-Smith.

Frank Marrero, MD, Cleveland Clinic Swallowing Center.

National Digestive Diseases Information Clearinghouse: "Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)."

Fass, R. Chest, 2005; vol 127: pp 1658-1666.

Mayo Clinic: "Heartburn."

Moazzez, R. Journal of Dental Research, 2005; vol 84: pp 1062-1065.

Rakel, D. Integrative Medicine, 2nd ed. Saunders Elsevier, 2007.

FDA: "FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors."

Hawkey, C. Alimentary Pharmacology and Therapeutics, 2007; vol 25: pp 813-821.

Kligler, B. American Family Physician, 2007; vol 75: pp 1027-1030.

Nilsson, M. Gut, 2004; vol 53: pp 1730-1735.

National Digestive Diseases Information Clearinghouse: "Smoking and Your Digestive System."

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