Make an Appointment
Talk to DoctorOverview
Heartburn is a painful and burning sensation experienced in the central part of the chest. It results from the reflux of stomach acid into the esophagus, a tube that passes through the chest in close proximity to the heart. The discomfort often gets worse in the evening, after eating, or when bending over or lying down.
Occasional heartburn is a common occurrence. It can persist for a duration ranging from a few minutes to a few hours. However, when heartburn becomes persistent, it signifies a symptom of chronic acid reflux, often diagnosed as gastroesophageal reflux disease or GERD.
With lifestyle modifications and over-the-counter drugs, the majority of people can self-treat their heartburn discomfort. While frequent heartburn that disrupts one’s everyday activities could be symptoms of a more serious health condtiton that requires treatment.
Symptoms
Distinguishing between heartburn and other chest pains can be challenging. When heartburn is caused by acid reflux, one might experience symptoms such as:
- A burning pain in the chest that sometimes happens at night and generally happens after eating
- Pain that gets worse when one bends over or lies down
- Acidic or bitter aftertaste
- Feeling nauseous
- Regurgitation of food
- Burping
If any of the signs and symptoms persist, consult a healthcare provider for proper diagnosis and treatment. Especially in cases where:
- Heartburn happens on a weekly basis
- Nonprescription drug use does not alleviate symptoms
- There is a tightness or squeezing in the chest area, similar to angina
- Gets persistent nausea or vomiting
- Has trouble swallowing
- Losing weight due to eating difficulties, poor appetite, or not getting enough calories
- Over the age of 60
If one experience significant chest pain or pressure, get medical attention immediately especially if it is accompanied by jaw or arm pain or trouble breathing, as these can be symptoms of heart attack.
Causes
With GERD, heartburn arises when stomach fluids, comprising acids and enzymes, flow backward into the esophagus. While the stomach is shielded by a thick mucus lining to withstand these substances, the esophagus lacks such protection.
The lower esophageal sphincter, a valve located at the base of the esophagus, is responsible for preventing the regurgitation of stomach contents. However, it may be weakened or fail to fully close, leading to the occurrence of heartburn. If one is lying down or hunched over, the acid backup can be worse.
Several factors can contribute to the weakening or excessive relaxation of the lower esophageal sphincter, leading to acid reflux and heartburn. These include inhaling smoke, increased abdominal pressure from factors like body weight, tight clothing, or pregnancy, lying down too soon after eating, and the intake of certain foods and medications, among others.
Risk factors
Heartburn is an occasional occurrence for many individuals. This is often triggered by several factors, such as:
- Food, such as spicy meals, fatty, oily, or fried foods, onions, citrus and tomato products, peppermint, and chocolate
- Carbonated drinks, coffee, or other caffeinated drinks and alcohol
- Being overweight
- Being pregnant
- Smoking and exposure to second-hand smoke
Diagnosis
Healthcare providers typically identify heartburn based on its description, and for occasional or mild cases, further investigation may not be necessary. However, if there is a suspicion of a chronic condition, examination of the esophagus for potential signs of damage may be necessary.
Tests that may be ordered include:
- Upper endoscopy: Also known as an EGD procedure, this procedure examines the upper gastrointestinal (GI) tract, spanning from the esophagus through the stomach and reaching the upper section of the small intestine. Administered with medication for comfort, the endoscope is guided down the throat to inspect for indications of esophagitis, hernia, or Barrett’s esophagus.
Endoscopy examinations provide an internal view of the organs by inserting an endoscope, a slender tube equipped with a small, illuminated camera, into the body. It is possible to take a biopsy sample of tissue for analysis. - X-ray: This diagnostic imaging technique is used to visualize the structure and condition of the esophagus and stomach.
- Ambulatory acid probe tests: A tiny computer that is worn around the waist or on a strap over the shoulder is connected to an acid monitor. This is inserted into the esophagus to determine the duration and timing of stomach acid reflux into the esophagus.
- Esophageal motility testing: Esophageal pressure and movement is assessed by this test.
Treatment
Occasional heartburn can be managed at home using over the counter (OTC) medications and lifestyle changes. However, frequent heartburn may necessitate prescription medications for effective treatment.
Heartburn medications include:
- Antacids: Although they are not capable of healing an esophagus that has been damaged by stomach acid, they can provide rapid relief from heartburn by neutralizing stomach acid. These medications often contain ingredients that treat various symptoms. For instance, simethicone helps with gas, and magnesium helps relieve mild constipation.
- H2 blockers: Such as cimetidine and famotidine, work to decrease stomach acid levels. Although not as fast-acting as antacids, H2 blockers may offer longer-lasting relief.
- Proton pump inhibitors: This include esomeprazole, lansoprazole, and omeprazole. These are potent acid-blocking medications that also facilitate the healing of tissues. These may be prescribed as the initial treatment if the heartburn is notably severe or if there are indications of tissue damage in the esophagus.
Other treatments for heartburn include antibiotics or antivirals for infections, topical steroids or dupilumab to address inflammation, and low-dose neuromodulators along with complementary therapies for functional heartburn.
In cases where GERD does not respond to medication or as an alternative to long-term medication, procedures such as Nissen fundoplication, transoral incisionless fundoplication, or LINX device may be suggested.
