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Heartburn -- Overview

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by Wood D

(Gastroesophageal Reflux Disease; Gastro-oesophageal Reflux Disease [GORD]; GERD; Reflux, Heartburn)

 

Risk Factors

Factors that increase your chance of heartburn include:
Foods and beverages associated with heartburn include:
  • Alcohol use, especially in excess
  • Caffeine drinks such as coffee or carbonated soft drinks
  • Citrus fruits
  • Chocolate
  • Fried foods
  • Spicy foods
  • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
Medications and supplements associated wtih heartburn include:
  • Anticholinergics
  • Calcium channel blockers
  • Theophylline, bronchial inhalers, and other asthma medications
  • Nitrates
  • Sildenafil
  • Bisphosphonates
 

Symptoms

Heartburn symptoms usually occur after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.
Common heartburn symptoms may include:
  • Burning feeling that starts in the lower chest and moves up the throat
  • Feeling that food is coming back up
  • Sour or bitter taste in the throat
Other symptoms and complications of reflux include:
  • Sore throat
  • Hoarseness
  • Chronic cough
  • Feeling of a lump in the throat
  • Asthma
  • Waking up with a sensation of choking
  • Difficulty swallowing
If reflux persists, the acid can damage the esophagus. Symptoms of esophageal damage include:
  • Bleeding and ulcers in the esophagus
  • Vomiting blood
  • Black or tarry stools
  • Inflammation and scarring of the esophagus
  • Barrett's esophagus — precancerous condition that can lead to esophageal cancer
  • Dental problems, which may occur because of the effect of stomach acid on tooth enamel

When Should I Call My Doctor?

It is common to experience heartburn occasionally. If you have heartburn at least two times a week, make an appointment to see your doctor. Call your doctor if you have any symptoms of heartburn complications.

When Should I Call for Medical Help Immediately?

Heartburn and chest pain due to a heart attack can feel similar. Get medical help right away if you have:
  • Squeezing or chest pressure
  • Pain in the left shoulder, left arm, or jaw
  • Trouble breathing
  • Sweating, clammy skin
  • Nausea
  • Weakness
  • Lightheadedness
  • Pain that starts during activity or stress
If you are not sure of the cause of any pain in your chest, call for emergency help right away.
 

Diagnosis

Other tests may include:
  • 24-hour pH (acid) monitoring
  • Manometry to test muscle strength in the lower esophagus
 

Treatment

Talk to your doctor about the best treatment plan for you. Treatment will depend on what is causing your heartburn. Treatment may focus on preventing heartburn from occuring or repairing damage causing the heartburn.

Medication

Medication may help relieve symptoms and repair any damage to the esophagus. Many prescription heartburn medications are available over-the-counter. Your doctor may recommend the following.
  • Proton-pump inhibitors block acid production in the stomach
  • H-2 blockers decrease the amount of acid secreted by the stomach
  • Antacids neutralize stomach acid

Procedures

If symptoms are severe and you cannot tolerate medication, surgery may be an option.
The most common surgery for heartburn is fundoplication . The doctor wraps the stomach around the esophagus. This creates pressure on the muscle at the opening to the stomach.
Endoscopic Procedures
An advantage of endoscopic techniques is that they do not involve incisions in the skin. Instead, the doctor inserts a lighted device called an endoscope through the mouth and down the esophagus. The doctor can perform one of a variety of procedures with this scope to decreases the backward flow of stomach acid into the esophagus.
If surgery or endoscopy is successful, you may no longer need heartburn medication.
 

RESOURCES

American Gastroenterological Association
http://www.gastro.org

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

 

CANADIAN RESOURCES

Canadian Institute for Health Information
http://www.cihi.ca

Health Canada
http://www.hc-sc.gc.ca

 

References


Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 25, 2013. Accessed April 26, 2013.


Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/ . Updated April 30, 2012. Accessed April 26, 2013.


Heartburn. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/heartburn.html . Updated July 2010. Accessed April 26, 2013.


Understanding Heartburn and Reflux Disease. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/heartburn-gerd . Updated April 25, 2010. Accessed April 26, 2013.


Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack%5FUCM%5F002039%5FArticle.jsp . Updated March 22, 2013. Accessed April 26. 2013.


9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med . 2008;168:1798-1804.


3/1/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Maalox Total Relief and Maalox liquid products: medication use errors. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm200672.htm . Published February 17, 2010. Accessed April 26, 2013.

 

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