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HEARTBURN

WHAT IS HEARTBURN?

Heartburn is a way we describe the pain that occurs when acid, bile, and digestive enzymes travel into the esophagus and cause injury. Pain fibers in the esophageal lining travel to the brain and may interpret this injury as burning, fullness, or discomfort in the chest or abdomen. Normally, digestive enzymes, acid, and bile reside in the stomach where digestion begins. When an excessive amount of these digestive juices are entering or refluxing into the esophagus, damage occurs. Over time this injury to the esophagus can lead to scar tissue, narrowing, pre-cancers (Barrett’s esophagus), and cancer of the esophagus. The causes of acid reflux, also known as GERD (Gastroesophageal Reflux Disease), are many and require an evaluation by your gastroenterologist. Typical causes of heartburn are related to:
  • Obesity
  • Poor diet
  • Smoking
  • Medications
  • Hiatal Hernia
  • Acid overproduction in the stomach

WHAT ARE THE SYMPTOMS OF HEARTBURN?

The typical symptoms of Heartburn include:

  • Nausea
  • A sensation of burning in your chest, most commonly after meals, which may worsen in the evening or while lying down
  • Pain in the upper abdomen and/or chest
  • Regurgitating food followed by a sour taste
  • Difficulty swallowing

HOW IS HEARTBURN DIAGNOSED?

Our evaluation begins with a detailed history of symptoms, when did they start, how often do they occur, and what makes symptoms better or worse. We review medications that could be causing GERD.

Family history can be important for identifying underlying traits for increased acid production and injury. Diet, lifestyle, and fitness are also highly associated with heartburn.

Finally, we look for any red flags that may indicate more serious underlying conditions are present. Red flags or warning signs in heartburn include: difficulty swallowing, pain with swallowing, weight loss, blood in stool, or vomiting blood.

Testing

When it comes to diagnosing Heartburn and its related conditions, there are 5 tests that we rely on.

HOW IS HEARTBURN TREATED?

In most cases heartburn can be greatly improved or even resolved through better diet, losing weight if overweight, and avoidance of trigger foods.

When diet and lifestyle are not effective, most patients are placed on an H2 blocker – Famotidine also known as Pepcid. These medications are very effective in improving symptoms rather quickly and their effects last several hours.

When H2 blockers are not effective, your physician may recommend a more powerful acid inhibitor known as PPIs (Proton Pump Inhibitors). These medications have a much longer effect and are superior to H2 blockers in controlling symptoms.

Any patient with severe heartburn, trouble swallowing, having pain, losing weight, or with symptoms over 5 years should be evaluated by their gastroenterologist.

Diet and Lifestyle

The association of poor diet, obesity, and sedentary lifestyle is well known as a cause of chronic heartburn. Many individuals have found that when they lose weight, change diet, and start exercising regularly, the heartburn goes away. Studies have also shown the risk of future cancers is also decreased when patients improve their lifestyle. There are also many foods known to cause increased acid reflux.

A detailed review of current diet and habits can really help get heartburn under control. Nutrient deficiencies have also been associated with increased esophageal cancer rates. Nutrient analysis can help identify these deficiencies and are part of our nutrition testing program.

Please visit our weight management/nutrition program if you need help getting back on track.

Identifying Medications That Cause Adverse Reactions

Many common medications have been associated with increased heartburn symptoms. The list of these medications is long, but can be divided into three main categories:

  • Direct Irritants – Cause inflammation and injury due to direct contact.
  • Reduce Protective Mucus Barrier – Lowers mucus production, making it easier for acid to harm the lining of the esophagus.
  • Lower Esophageal Sphincter Pressures – Enable more stomach acid to enter the esophagus.

Please refer to our Resource room to review many of the medications associated with worsening heartburn.

FAQs

Heartburn can cause a wide variety of symptoms including chest pain, fullness in the chest, nausea, and more. When someone feels what we call “classic symptoms” they will often report chest burning, a feeling of stomach contents coming up into the chest and mouth, and a sour taste that follows.

There are also “atypical symptoms” where an individual may not feel chest burning and regurgitation, but they may feel a sore throat, ear pain, a cough, and even sinus problems. These can all be caused by acid reflux.

Absolutely. When acid and bile travel from your stomach and into your esophagus and mouth, there can be irritation and soreness in the throat. If the acid and bile are also leaking into the airway, a chronic cough may occur. Interestingly, many patients are not even aware that acid is causing their cough. When stomach contents are dripping into the airways, we call this “aspiration.” When a reflux is severe, patients can even develop pneumonia and chronic lung injury due to the harmful effects of acid and bile in the lungs.

Heartburn can certainly cause esophageal cancer. Any patient with a history of more than 5 years of reflux, is over 50 years old, male, and Caucasian, is at much higher risk of esophageal cancer than the average population.

Symptoms that cause us to worry about cancer include weight loss, difficulty swallowing, blood in stool, or sudden increase in pain with swallowing. These can all be signs that heartburn has led to an esophageal cancer.

Back pain is a little bit unusual as a symptom of heartburn.

Most patients with heartburn experience chest tightness, burning, and pain in the throat and sinuses.

Vomiting can occur when acid and bile are burning and irritating the stomach lining.

When the stomach is unhappy due to acid irritation, nausea often follows.

If acid and bile are refluxing into your lungs, you may feel shortness of breath, wheezing, and coughing.

Acid and bile are very irritating to the lungs.

Heartburn is now considered a serious medical condition. There is a strong correlation with chronic heartburn and esophageal cancer.

Any individual with over a 5 year history of heartburn or severe symptoms should have an evaluation to be sure early cancer and pre-cancers have not developed within the esophagus.

When acid levels in the stomach are high, some individuals will feel bloated and full.

Stomach bloating just by itself is not the most common symptom of heartburn.

The symptom of jaw pain is not typical for heartburn.

Heartburn is a very common symptom. Perhaps 20-40% of the US population experience some heartburn.

About 20% of all heartburn patients develop a condition known as Barrett’s esophagus. Barrett’s is a precancerous change in the esophageal lining. About 20% of Barrett’s patients may develop an esophageal cancer.

So yes, heartburn can kill you if it leads to Barrett’s esophagus and progresses to esophageal cancer. Cancer of the esophagus has a very poor survival rate.

Yes.

  • One of the fastest growing cancers in the US is esophageal cancer caused by heartburn.
  • Any patient with a history of heartburn and acid reflux for more than 5 years should be evaluated by a gastroenterologist.
  • Any patient with heartburn noticing pain with swallowing, weight loss, or decreased appetite should also be evaluated.

Yes.

  • When acid and bile travel from the stomach to the esophagus, inflammation and injury may occur.
  • The esophagus is very sensitive to acid and bile and was not built to handle low pH caustic juices from the stomach.
  • Pain fibers in the chest may be activated and lead to a sense of chest discomfort, burning, fullness, or chest wall tenderness.

Heartburn can feel like a fluttering in the chest but it is not causing heart palpitations or irregular heart beats. When acid and bile travel up into the esophagus, there can be spasm of the esophageal wall, even fluttering that may mimic a heart palpitation.

Having said that, any individual who has unusual chest or palpitation symptoms should be evaluated by their doctor. You should never assume that chest complaints are being caused by heartburn until a complete medical evaluation has been performed.

Heartburn is not a typical cause of diarrhea. However, the antacids that are used to treat heartburn can cause diarrhea.

Patients having chronic diarrhea usually require a different evaluation focusing on the lower intestinal tract.

In some cases, high stress conditions can trigger excessive stomach acid production and more reflux. Also, individuals under stress may be drinking more coffee or alcohol and are less active and over eating – all factors that may cause more reflux.

So it’s hard to say what caused the symptoms, if it was the body’s reaction, or if it was the behaviors that are associated with stress that caused the increase in heartburn.

Heartburn is often associated with pregnancy and is well documented as a common occurrence. Heartburn often begins later in pregnancy and would be unusual as a first sign of being pregnant. However, morning sickness and nausea are often reported early in pregnancy.

Heartburn caused by pregnancy will usually resolve over time. During the pregnancy antacid medications may be required to control acid reflux.

In most cases, these medications can be discontinued when the mother returns to normal health after the pregnancy.