Heartburn is the most common symptom of a condition
called gastroesophageal reflux
or acid reflux.
A muscle (lower esophageal sphincter) located between the esophagus
(swallowing tube) and stomach normally opens after swallowing.
This allows food to pass into the stomach. The lower esophageal
sphincter muscle then closes quickly to prevent the return (reflux)
of food and stomach juices back into the esophagus.
When the lower esophageal sphincter muscle either relaxes inappropriately
or is very weak, the acidic contents of the stomach can back up,
or reflux, into the esophagus. This is called gastroesophageal
reflux. In addition to heartburn, symptoms may include persistent
sore throat, hoarseness, chronic cough, asthma, heart-like chest
pain, and a feeling of a lump in the throat. When the acid contents
from the stomach regularly back up into the esophagus, a chronic
condition called gastroesophageal reflux disease or GERD occurs.
There are several factors that influence the occurrence and
severity of gastroesophageal reflux and heartburn:
- The ability of the lower gastroesophageal sphincter muscle
to open and close properly
- The type and amount of stomach juices that are backed up
into the esophagus
- The clearing action of the esophagus
- The neutralizing effect of saliva and other factors
People experience gastroesophageal reflux and heartburn in a
variety of ways. Heartburn usually begins as a burning pain that
starts behind the breastbone and radiates upward to the neck.
Often there is a sensation of food coming back into the mouth,
accompanied by an acid or bitter taste. Heartburn is sometimes
called acid indigestion and usually occurs after meals.
What are the Symptoms of Heartburn?
Burning pain behind the breastbone area
Burning pain or regurgitation that is worse when lying down or
What if Symptoms Persist?
People with severe esophageal reflux or with heartburn symptoms
unresponsive to the measures described above may need more complete
diagnostic evaluation. A variety of tests and procedures are currently
used to further evaluate the patient with heartburn:
- Endoscopy - a procedure where a
flexible tube is placed into the esophagus whereby your physician
will see the tissue lining of the esophagus.
- Biopsy - the removal of a small
sample of tissue of the lining of the esophagus to better determine
the causes of underlying disease.
- Esophageal manometric studies -
pressure measurements of the esophagus, which identify critically
low pressure in the lower esophageal sphincter muscle and determine
other disorders of the esophageal muscle function.
- Twenty-four hour pH monitoring -
done for those patients for whom the diagnosis is difficult
to make. Many physicians find it helpful to measure the acid
levels inside the esophagus. This is done by placing a thin
tube in the esophagus.
How Common is Heartburn?
Although heartburn is common in our society, it is rarely life-threatening.
However, heartburn can severely limit daily activities and productivity.
With proper understanding of the causes of heartburn and a consistent
approach to a treatment program, most people will find relief.Is
Heartburn Caused by Hiatal
Heartburn is not caused by hiatal hernia, which is the pushing
up of the stomach into the chest cavity through a hole in the
However, hiatal hernias do predispose individuals to heartburn.
The majority of people over 60 years of age have hiatal hernias
and most do not have any symptoms related to the condition.
Can Heartburn Require Surgery?
A small number of people with heartburn may need surgery because
of severe reflux disease and poor response to medical treatment
Fundoplication is a surgical procedure that reduces reflux.
Patients not wanting to take medication to control their symptoms
are also candidates for surgery.
What are the Complications of Long-Term Reflux
The reflux that causes heartburn can result in serious complications.
Esophagitis, an irritation of inflammation of the esophagus, can
occur as a result of the constant presence of stomach acid in
the esophagus. Esophagitis may result in esophageal bleeding or
ulcers. In addition, a narrowing or closure (stricture) of the
esophagus may occur.
Some people develop a condition known as Barrett’s esophagus,
a change in the cells lining the esophagus that predisposes the
esophagus to the development of cancer. Individuals with Barrett’s
esophagus should be monitored with periodic surveillance endoscopies
Tips to Control Heartburn
Avoid food, beverages, and medicines that affect the lower esophageal
sphincter muscle action or irritate the lining of the esophagus
such as: Fried or fatty foods
- Carbonated beverages
- Citrus fruits or juices
- Tomato Sauce
- Ketchup and mustard
- Aspirin and other pain medicine other than acetaminophen
- Decrease the size of portions at mealtimes.
- Meals should be eaten two to three hours before lying down
to lessen the chance of reflux.
- Elevate the head of the bed four to six inches.
- Lose weight, if overweight.
- Take over-the-counter medicines as directed for relief of
heartburn. Ask your pharmacist for a recommendation.
- Stop or decrease smoking, as cigarettes decrease the ability
of the lower esophageal sphincter muscle to work properly.
Any chest pain requires prompt medical evaluation.
Other causes, such as heart disease, must be considered.
For occasional heartburn, over-the-counter medicines
taken as directed can be helpful in reducing symptoms. If prolonged
or frequent use of nonprescription medicines (more than directed
on the product) becomes necessary, or if they do not completely
control symptoms, a physician should be consulted.