Heartburn

Heartburn is an uncomfortable feeling of burning or warmth in the chest. While the pain of heartburn is felt in the chest, heartburn has nothing to do with your heart. Heartburn is caused by stomach acid.

Continual bouts of heartburn can be a symptom of a more serious condition called gastroesophageal reflux disease. Frequent or severe heartburn may limit daily activities and lead to further complications such as ulcers in the esophagus. With proper understanding of heartburn and treatment, relief can be obtained from this condition.

About 30% of adults experience occasional heartburn, while 10% experience heartburn every day.


Heartburn Causes
Food that is swallowed travels from the mouth to the stomach through a hollow tube called the esophagus. Before entering the stomach, food must pass through a tight muscle at the lower part of the esophagus called the lower esophageal sphincter. The lower esophageal sphincter prevents food from traveling backward into the esophagus.

Once in the stomach, stomach acid digests the food. This acid is very strong and can damage most parts of the body. Fortunately, the stomach is protected from its own acid by a special mucous layer. The esophagus, however, does not have any such special protection. If the lower esophageal sphincter does not close completely, the lower part of the esophagus can be damaged by stomach acid. When this happens, heartburn may be experienced.

The lower esophageal sphincter may not close completely thus allowing stomach acid into the esophagus for these reasons:
- Certain foods and drinks are known to loosen the lower esophageal sphincter (chocolate, peppermint, caffeine-containing beverages, fatty foods, and alcohol).
- Heartburn often depends on the body's position. It is easier for stomach acid to flow back into the esophagus if you are lying down or bending over.
-Anything that increases the pressure on the stomach and forces stomach acid backward into the esophagus can also cause heartburn. This is why lifting, straining, coughing, tight clothing, obesity, and pregnancy can worsen heartburn.
- People who suffer from certain medical conditions may have an increased chance of heartburn. These conditions include hiatal hernia, diabetes, and many autoimmune diseases.
- Many prescription medications can loosen the lower esophageal sphincter, including certain blood pressure and heart medications, and the asthma drug theophylline.
- Many substances directly irritate the lining of the esophagus and can contribute to heartburn (spicy foods, citrus fruits and juices, tomatoes and tomato sauces, cigarette smoke, aspirin, ibuprofen, and medicines for osteoporosis).

Heartburn Symptoms
The pain of heartburn is described as a burning feeling in the chest. Often, the sensation may spread up into the throat, jaw, arms, or back. That's why heartburn is often mistaken for chest pain due to a heart attack. However, do not second guess yourself. If you are having chest pain for any reason, seek medical attention immediately, if only to rule out a heart attack.

Heartburn (often called acid indigestion) typically occurs 30-60 minutes after meals. The pain is worse when lying down, bending forward, and straining to pass stools. The pain is relieved by standing upright, swallowing saliva or water, or by taking antacids.

If small amounts of stomach acid or food travel beyond the esophagus and up into the mouth, you may experience bitter or sour taste. This is known as regurgitation. It is common after meals, especially if you are lying down, bending over, or straining. Stomach acid can also affect the respiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth). You may feel as if you have a lump in your throat.

If the acid exposure continues for long periods of time, the esophagus becomes damaged. You may then have difficulty swallowing. In more serious cases, you may lose weight and become dehydrated. Very rarely, the esophagus may bleed or tear completely because it is so damaged. In severe cases, you may vomit blood or have small amounts of blood in your bowel movements. However, all these are uncommon.

When to Seek Medical Care
Call your health care provider if your heartburn continues to bother you despite lifestyle modifications and use of antacids or low doses of acid blockers. Call if you have heartburn more than 3 times a week for over 2 weeks. Chronic heartburn can sometimes lead to serious complications that require immediate medical attention. Go to a hospital's emergency department if you have any of the following symptoms:
- Throwing up blood or passing blood in your stools
- Severe pain, dizziness, or lightheadedness
- Difficulty swallowing
- Dehydration
- Unintentional weight loss

NOTE: The pain of heartburn can often be confused with pain that is actually due to more serious heart problems, such as a heart attack. If you or a family member has a history of heart disease, you need to be particularly aware of this possibility. If your pain is accompanied by sweating, nausea, vomiting, difficulty breathing, or is worse with activity, you may need to have your heart evaluated immediately.

Heartburn Treatment
- Antacids
- Acid blockers
- Possible surgery

Tips to Prevent Heartburn
- Raise the head of your bed by placing 4 to 6-inch blocks under the legs at the head of the bed.
- Try to eat two to three hours before lying down.
- If you take naps, try sleeping in a chair.
- Lose weight if you're overweight.
- Don't overeat.
- Eat high-protein, low-fat meals.
- Avoid tight clothes, such as girdles and tight belts.
- Certain foods bother certain people.
- Avoid foods and other things that give you heartburn.
- Avoid tension and stress.