Heartburn

 

What is heartburn?

Heartburn is an irritation of the esophagus that causes burning discomfort in the chest just behind the breastbone. Heartburn can occur in association with eating certain food or taking certain drugs, including chemotherapy drugs.

What causes heartburn?

Heartburn is caused when harsh stomach juices come in contact with and irritate the delicate lining of the esophagus, which is the tube that connects the mouth to the stomach. Stomach juices help break down food in the stomach and contain a strong acid, called hydrochloric acid. Although the stomach is naturally protected from the harmful qualities of acid, the esophagus is not.

Stomach juices come into contact with the esophagus when the muscle that separates the stomach from the esophagus, called the lower esophageal sphincter, does not work properly. When working normally, this muscle works like a natural valve, letting food into the stomach but keeping stomach juices out of the esophagus. When not functioning properly, this muscle relaxes and allows stomach juices to flow upward into the esophagus. Your doctor may call this backward movement of stomach juices gastroesophageal reflux. The hydrochloric acid damages the lining of the esophagus causing heartburn and its associated symptoms.

Heartburn can also be caused by either a gastric (stomach) or duodenal (first portion of the small intestine) ulcer.

What are the symptoms of heartburn?

Heartburn may feel like:

  • A burning chest pain that begins at the breastbone that moves up toward the throat
  • Food or liquid is coming back into the mouth or throat
  • An acid or bitter taste at the back of the throat
  • A worsening pain/burning behind the breastbone when lying down or bending over

It is important to distinguish the causes of heartburn because both the treatment and follow-up may differ depending on the cause. Therefore, these symptoms should be reported to your doctor.

How can heartburn be prevented?

In general, there are a number of lifestyle changes that you can make to prevent or lower your risk of experiencing heartburn. These may include:

  • Stop smoking
  • Limit or eliminate alcohol
  • Limit your caffeine intake (coffee, soda, tea)
  • Lose some weight if you are overweight
  • Avoid fatty food (deep fried food)
  • Do not eat 2 to 3 hours before going to bed
  • Avoid food that causes you to have heartburn, especially spicy food

How is heartburn treated?

Frequently sleeping in a more upright position (by using pillows) or putting blocks under the bottom of the upper part of your bed, will keep the acid from coming into your esophagus at night, thereby relieving heartburn while lying down. Avoiding things that cause heartburn can help, but if lifestyle changes are not enough to prevent heartburn, your doctor may prescribe medication. Effective over-the-counter and prescription medications are available.

Over-the-counter antacids - Antacids work by neutralizing the acid in your stomach. They may contain the following compounds alone or in combination: calcium carbonate, aluminum hydroxide, magnesium hydroxide, and magaldrate. Examples are Maalox, Mylanta, Rolaids, or Tums.

H2 blockers - These medications decrease stomach acid by blocking histamine from binding to the H2 receptors on cells in the stomach lining. Histamine, a natural substance produced by the body, stimulates cells in the stomach lining to release acid into the stomach. H2 blockers decrease gastric acid secretions. A few examples of these drugs that may be prescribed include Tagamet® (cimetidine), Pepcid, Axid® (nizatidine), or Zantac. Pepcid and Zantac are now available over-the-counter.

Proton-pump inhibitor - These medications inhibit the final step in the production of gastric acid. Examples include Prilosec® (omeprazole), Prevacid® (lansoprazole), Nexium® (esomeprazole), Protonix® (pantoprazole), or Aciphex® (rabeprazole). If it is determined that an ulcer is the underlying cause of your heartburn, these medications may be prescribed for short-term treatment of the ulcer. However, an ulcer is caused by the H. pylori bacteria and must be treated with a combination of medication and antibiotics for long-term results.

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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