Heartburn is a common stomach discomfort that affects approximately 60 million Americans annually and about 25 million adults daily. Heartburn gets its name from the chest pains that regularly accompany it—pains that can be so severe you may think you're having a heart attack.
In fact, the pains have nothing to do with your heart. Rather, they are caused by stomach acid that washes up into the esophagus and produces a burning sensation and discomfort. The symptoms are most often caused by a condition known as gastroesophageal reflux disease, or GERD.
Symptoms of Heartburn
Most symptoms of heartburn occur after you eat or when you are lying down.
- Painful burning sensation in the upper abdomen that moves up into the chest, often making its way to the neck and back of the throat
- Fluid at the back of the throat
- Difficulty in swallowing foods
- Slight rashes on the body, such as on the face or abdomen
- Dental erosions
- Sore throat
- Belching and regurgitation of bitter gastric juices
- Discomfort that worsens when you lie down (unlike chest pain due to heart attack, which is often associated with physical activity)
- In some cases, nausea
Heartburn or Heart Attack?
Heartburn and heart attack do have overlapping symptoms. But there are major differences. The following symptoms are more likely signaling a heart attack:
- pain that radiates up to the jaw or out to the arm
- pain accompanied by sweating, nausea, dizziness, or shortness of breath
- pain on physical exertion
If these symptoms are present, call 911, or have someone take you to a hospital emergency room immediately.
What Causes Heartburn?
The principal cause of this stomach distress and of GERD, is the malfunctioning of your lower esophageal sphincter (LES). This muscle temporarily relaxes to let food pass into your stomach and then closes to keep stomach acids from splashing, or refluxing, into your esophagus—the food tube that runs from the throat to the stomach.
When the LES doesn't close properly, stomach acids back up and irritate the lining of the esophagus, causing an uncomfortable burning sensation. This typically occurs after meals, when the stomach is secreting gastric juices and when pressure in the stomach is more likely to push stomach contents up through the LES.
Other factors include eating right before bed, being overweight, drinking or smoking excessively, exercising immediately after eating, wearing tight clothing and using certain medications.
If you are pregnant, overweight, or over the age of 40, the LES begins to weaken, increasing your risk of heartburn. (At least one-quarter of all pregnant women experience heartburn every day.)
What If You Do Nothing?
Mild occasional heartburn will usually resolve itself in a matter of hours and is no cause for concern. But if you have heartburn frequently, you should see your doctor, since persistent acid reflux can lead to inflammation and scarring of the esophagus, making it difficult to swallow. Chronic GERD can also lead to a precancerous condition called Barrett's esophagus. You will probably need to adopt some lifestyle and dietary changes in combination with medications to reduce or eliminate the problem.
Home Remedies for Heartburn
There are many over-the-counter preparations aimed at alleviating heartburn. None is recommended for long-term use. Be sure to read warning labels carefully. Pregnant women, children and people with ulcers or kidney problems should consult a doctor before using any type of heartburn medication.
- Take an antacid. If you have heartburn symptoms, don’t try to “tough it out.” The discomfort of occasional heartburn (once or twice a month) can be relieved by taking an over-the-counter antacid. These medications come in tablet, liquid, or foam and in regular and extra-strength formulations.Be aware that magnesium-containing antacids may cause diarrhea, while those containing calcium most often cause constipation.Antacids should remedy the situation almost immediately. A recommended dose taken one to three hours after eating should provide varying degrees of relief. If a single dose fails to bring relief, the problem could be more severe and you should contact your physician.Don’t use antacids frequently or regularly. Not only may side effects worsen, but antacid use may mask symptoms that require medical attention. Antacids can also interfere with the absorption of other medications.
- Consider an H2-blocker. These over-the-counter drugs—which contain 50 percent of the minimum dosages in the prescription forms—are meant to be taken before heartburn strikes in order to prevent excess acid from being secreted. If you already have heartburn, you will get faster relief from a conventional antacid. If you think you are going to get heartburn, H2-blockers may be worth a try.
- Don’t drink milk as a remedy. Contrary to popular myth, milk is not a recommended antidote to heartburn. A glass of milk does provide immediate relief as it goes down, but milk lacks a buffering action and will eventually stimulate even more acid production in the stomach. In less than 30 minutes you may develop heartburn that’s more severe than the case you’re treating.
- Don’t overeat; instead, eat more frequent, smaller meals. When you overeat, the excess food squeezes your stomach and forces digestive juices upward. Instead of eating a large lunch and large dinner, which cause the stomach to produce a lot of acid, eat four to six smaller meals and space them throughout the day.
- Avoid fatty or acidic foods. Certain foods regularly bring on discomfort or exacerbate symptoms in many heartburn sufferers. Included on the list are oranges and grapefruit, Bloody Mary mix, yellow onions, tomatoes and tomato-based sauces and high-fat foods, especially greasy or fried meat. (Fat slows gastric emptying.) Red wine, after-dinner liqueurs, chocolates and peppermints are also prime causes of heartburn.
- Try to avoid becoming constipated. Straining during bowel movements can increase abdominal pressure and encourage heartburn. Increasing your intake of dietary fiber and fluids is the safest, most effective way to promote more efficient elimination.
- If you smoke, quit. Smoking affects the lower esophageal sphincter and allows stomach acids to enter the esophagus.
- Avoid caffeine. The caffeine in soda, coffee, tea and chocolate can increase the production of stomach acid secretions and lead to heartburn.
- Limit your alcohol intake. Many beverages containing alcohol relax the LES and may cause heartburn.
- Loosen your belt. If you eat more than usual, loosen your belt after a big meal to keep it from squeezing your stomach and forcing acids upward.
- Watch those midnight snacks. Don’t eat just before retiring and don’t eat a large meal less than four hours before bedtime. The combination of a large meal and the horizontal resting position will tilt digestive juices toward your esophagus. It’s better to stay upright for at least several hours after eating.
- Sleep on your left side. If you often have heartburn at night, this position will keep the acidic contents of your stomach below the juncture with the lower esophagus, thus reducing acid backup into the esophagus.
- Raise your bed. Keeping your body at a slight upward-tilting angle will also help prevent stomach acids from moving into your esophagus at night. Put six-inch blocks of wood under the bed frame at the head of the bed, or buy a wedge that fits under your mattress.
- Reduce daily stress. If stress causes heartburn, find ways to reduce it through professional counseling, relaxation techniques, or regular exercise.
- Check medication side effects. Certain medications such as antihistamines, birth control pills, antihypertensives, sedatives, some heart drugs and asthma medications may aggravate heartburn because they decrease the strength of the LES. If you are taking any drug regularly, ask your physician if it may be the cause of your heartburn.
- If you’re overweight, lose weight. Extra pounds stress the LES and contribute to its weakening.
Beyond Home Remedies: When To Call Your Doctor
Contact your physician if you have persistent heartburn and experience little or no improvement after two weeks of self-care measures, or if symptoms include wheezing, difficulty swallowing, vomiting blood that looks like coffee grounds, or passing black stools. Your symptoms may be caused by a problem other than gastroesophageal reflux, such as an ulcer, gallbladder disease, or other gastrointestinal problems.
What Your Doctor Will Do
A good medical history will help your physician make a diagnosis of heartburn. The doctor will first seek to rule out angina and heart attack, since the chest pain of these serious ailments is often indistinguishable from heartburn. If heartburn is then suspected, your diet will be reviewed to identify offending foods. Your doctor may also prescribe an endoscopy, in which an endoscope is inserted into your esophagus and stomach (gastroscopy) to determine your condition and, if necessary, obtain a tissue sample for biopsy.
For chronic reflux and heartburn, your doctor may prescribe medications that reduce acid in the stomach. These drugs include H2-blockers (such as Tagamet and Pepcid AC) and proton pump inhibitors (such as Prilosec, Prevacid, or Acip-Hex). There are also medications that reduce heartburn by speeding up the emptying of stomach contents.
In rare cases, severe reflux may require surgical treatment. But never opt for surgery until all other measures have been exhausted.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media