Heartburn

What Is Heartburn?

The basics

Heartburn is a term used to describe the pain of gastroesophageal reflux disease.  This condition affects mostly adults when the esophageal sphincter becomes lax, or there is too much pressure on the abdominal contents, which causes gastric contents to be pushed up into the esophagus, causing esophageal irritation and pain.

Know this

It is important to know that conditions other than gastric reflux can cause chest pain. Cardiac-related chest pain can mimic symptoms of heartburn. Costochondritis is a condition of inflammation of the cartilage of the sternum that can cause sharp central chest pain.  These, as well as many other conditions, can cause reflux-like heartburn symptoms.   Be sure to get a proper medical evaluation to have other causes of chest pain ruled out before treating yourself.  

Certain conditions like pregnancy and obesity can make heartburn worse.  For overweight individuals, losing weight can significantly improve your symptoms by reducing pressure on abdominal contents. Additionally, there is some evidence that avoiding certain foods and adding other foods to the diet can lessen heartburn symptoms.

To manage heartburn symptoms, try this:

• Eat smaller meals, which helps to reduce abdominal pressure and prevent reflux.
• Wait at least 3 hours before lying down after eating
• Raise the head of the bed 30 degrees at night while you sleep
• Wear loose-fitting clothing
• If you are overweight, work on losing weight

Foods that have been shown to contribute to reflux symptoms:.

•     Spicy foods
•     Beer
•     Wine
•     Chocolate
•     Coffee
•     Carbonated beverages
•     Fried foods
•     Acidic foods, like tomato sauce and juices
•     Citrus foods, including citrus juices

    

In addition to avoiding particular foods, certain diets also reduce symptoms of acid reflux.  These include the Mediterranean diet, a very low carb diet, and a high fiber diet. 

Get a prescription

There are over-the-counter medications to try.  These should be used on a short-term basis and according to package instructions.  If your symptoms last longer than two weeks, see your doctor for proper evaluation and treatment options.  

Two common classes of medications used to treat acid reflux are proton pump inhibitors like Prilosec and Prevacid, and histamine blockers (H-2 antagonists) like Pepcid and Tagamet.

Medications are thought to be safe for short-term use but become problematic when used longer.  Proton pump inhibitors can adversely affect kidney function, block absorption of certain vitamins and minerals, and may contribute to osteoporosis by reducing bone metabolism with long-term use.

It is important to discuss your specific medical situation with your health care provider, who can help make the best decision about treatment options.

Common concerns:

As mentioned above, one concern with acid reflux is to rule out other conditions and ensure a proper diagnosis is made.  Gastroesophageal reflux can lead to irritation to the lining of the esophagus and stomach and can cause erosive lesions, which can be cancerous. These more serious conditions can be treated with further testing and appropriate medical care.

References

Cesario S, Scida S, Miraglia C, Barchi A, Nouvenne A, Leandro G, Meschi T, De' Angelis GL, Di Mario F. Diagnosis of GERD in typical and atypical manifestations. Acta Biomed. 2018 Dec 17;89(8-S):33-39. doi: 10.23750/abm.v89i8-S.7963. PMID: 30561415; PMCID: PMC6502210.

Fossmark R, Martinsen TC, Waldum HL. Adverse Effects of Proton Pump Inhibitors-Evidence and Plausibility. Int J Mol Sci. 2019;20(20):5203. Published 2019 Oct 21. doi:10.3390/ijms20205203.

Heartburn. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/heartburn/symptoms-causes/syc-20373223 Updated April 17, 2020. Accessed July 29,2021.

Morozov S, Isakov V, Konovalova M. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol. 2018 Jun 7;24(21):2291-2299. doi: 10.3748/wjg.v24.i21.2291. PMID: 29881238; PMCID: PMC5989243.

Surdea-Blaga T, Negrutiu DE, Palage M, Dumitrascu DL. Food and Gastroesophageal Reflux Disease. Curr Med Chem. 2019;26(19):3497-3511. doi: 10.2174/0929867324666170515123807. PMID: 28521699.