Heartburn Worry: Serious or Not?

What you need to know about heartburn -- when to worry, when not, what to do.

From the WebMD Archives

Heartburn is that awful burning sensation in your chest or throat, usually when acid rises up from your stomach. Heartburn is always an annoyance. But if you’re like many people with heartburn, you also probably find yourself worrying from time to time. Could it be something more serious? Is there something wrong with your digestive system? Or maybe you think it’s your heart.

Even when you’re pretty sure it’s heartburn, it can be hard to know what to do. Should you take an antacid, schedule an appointment to see your doctor, or call 911?

Here’s information you can use to know what to do the next time heartburn gives you that burning feeling.

What Is Heartburn?

Heartburn, also called acid indigestion, is a symptom of gastroesophageal reflux (GERD). It can occur when acid or other contents from your stomach "back up" into the esophagus. That’s the tube food passes through going from your mouth to your stomach.

The problem stems from a muscle that may be weak or may relax at inappropriate times. It’s called the lower esophageal sphincter or LES, and it’s located between your stomach and your esophagus. If it doesn't close quickly enough, it can’t prevent the acid backwash. That results in heartburn.

When acid reflux is frequent, you may have a condition called GERD, or gastroesophageal reflux disease.

How Do You Know If It’s Heartburn or Your Heart?

If you're trying to figure out if it's just heartburn from GERD -- which by itself is rarely life-threatening -- pay attention to any other symptoms. That’s the advice of Peter Galier, MD, an internal medicine specialist at Santa Monica UCLA Medical Center and Orthopaedic Hospital in Santa Monica, Calif. He is also an assistant professor of medicine at the University of California Los Angeles.

Galier typically asks patients who complain of heartburn these three questions:

  • Are you sweaty?
  • Do you have palpitations?
  • Are you short of breath?

If any of those symptoms occur with the heartburn, Galier says, you should see a physician and make sure it is not heart-related.

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Note the Time Your Heartburn Symptoms Occur

Think, too, about when the heartburn occurs. Galier says if it happens after a big meal, and it's just the burning in the chest, with no other symptoms, it’s more than likely heartburn or indigestion. But if you have any doubt, it's wise to ask your doctor for an evaluation.

"If you have chest pain after a meal, it's more likely to be reflux," agrees Glenn Eisen, MD, MPH, professor of medicine and director of endoscopy at the Oregon Health & Science University in Portland. But that's not a perfect test, he says. "It could be cardiac."

Phil Katz, MD, says that knowing what "classic" heartburn is like may help. Katz is president-elect of the American College of Gastroenterology and clinical professor of medicine at Jefferson Medical College in Philadelphia.

“The classic heartburn symptom,” he tells WebMD, “is burning that starts at the upper stomach or lower breastbone and progresses upward and occurs after a meal or when bending over." He adds, "It's rapidly relieved by an antacid within a few minutes.”

Is There Anything Besides Eating That Leads to Heartburn?

Besides eating a heavy meal, heavy lifting can cause heartburn, says Galier. So can exercise. And lying flat, especially after eating a big meal, can lead to heartburn, too.

People who are overweight or obese are more likely to suffer, Eisen says, noting that some people think only obesity raises heartburn risk. He also points out that pregnant women can suffer heartburn. He says that’s probably because elevated levels of the hormone progesterone cause a temporary weakness in the LES.

What's "Normal" With Heartburn?

"Heartburn should never be considered normal," says Galier. Food is often the culprit. People with heartburn typically may be sensitive to foods such as chocolate, carbonated beverages, peppermint, coffee, citrus foods, fried and fatty foods, and spicy foods.

Having heartburn more than occasionally can reduce your quality of life. It can affect not just what you eat, but how you sleep and what activities you do.

And if heartburn from acid reflux persists and you don't get treatment, complications can occur. They include damaging inflammation of the esophagus that affects the lining and causes bleeding. Another potential complication is Barrett's esophagus. With Barrett's esophagus the cells that line the esophagus become abnormal. That, in turn, boosts the risk of esophageal cancer.

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When Should Someone See a Doctor About Heartburn?

Galier says if you are reaching for antacids more days than not, you should see your doctor.

Eisen considers heartburn "occasional" if it occurs once a week or less. He says it’s time to seek medical help if you have had heartburn more than once a week for six months or longer more and are not getting better.

How Does the Doctor Evaluate Heartburn?

Your doctor may order several different tests and take the following steps to evaluate persistent heartburn that hasn't gone away even after you modify factors such as your diet:

  • Your doctor may ask for an EKG to help rule out heart-related problems.
  • Your doctor will perform an examination to see if you have any abdominal mass or a hiatal hernia. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm.
  • Your doctor will check your blood pressure.
  • Your doctor will take a careful medical history to see if medications are causing the problem.
  • Your doctor may ask for a gastric emptying study to see how fast food goes out of your stomach or a test to show how well the esophagus and the LES work.
  • Your doctor may refer you for an upper endoscopy. In this test, a flexible tube with a tiny camera helps the doctor assess the esophagus and look for damage or abnormalities.

How Is Heartburn Treated?

If you have uncomplicated heartburn from acid reflux, your doctor may prescribe over-the-counter or prescription medicines. These include common antacids such as Maalox, Mylanta, Rolaids, or Tums. Your doctor may also prescribe more powerful medications called proton pump inhibitors, such as Aciphex, Nexium, Prilosec, and Protonix. These medicines are considered very effective and help heal the esophageal lining. Other drugs like Tagamet and Pepcid reduce acid production, while still others like Reglan help empty the stomach.

Lifestyle modification, such as cutting down on foods that trigger your heartburn, can help. So can avoiding heavy meals, not eating a big meal within two hours of bedtime, and not lying down soon after a meal. Stress reduction may help reduce heartburn incidents. If you smoke, you should quit, as it can be a heartburn trigger.

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If you get exercise-induced heartburn, "try to exercise on a relatively empty stomach," Katz says. Take medication for heartburn before your workout.

If none of those steps help enough, surgery can help. Surgery can be done to strengthen the LES muscle or to repair the hiatal hernia.

WebMD Feature Reviewed by Brunilda Nazario, MD on January 23, 2009

Sources

SOURCES:

Phil Katz, MD, president-elect of the American College of Gastroenterology, clinical professor of medicine, Jefferson Medical College, and chair of gastroenterology at Albert Einstein Medical Center, Philadelphia.

Glenn Eisen, MD, MPH, professor of medicine and director of endoscopy, Oregon Health and Science University, Portland.

Peter Galier, MD, internal medicine specialist, Santa Monica UCLA Medical Center and Orthopaedic Hospital, Santa Monica, Calif.

American Gastroenterological Association: "Heartburn."

National Institutes of Health: "Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)."

© 2009 WebMD, LLC. All rights reserved.

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