What is heartburn?
Heartburn is a symptom of acid reflux that occurs when the acidic contents of the stomach flow back up into the esophagus, the tube connecting your mouth to your stomach. As the name implies, the common presentation of heartburn is a burning or hot sensation in the middle of the chest that works its way up into the throat.
Usually, heartburn pain is worse after eating, at night, and while laying down. Heartburn can also cause the sensation of bloating or a lump in the throat. Additionally, acid may come up into the mouth, leading to a sour or bitter taste.
Most heartburn is temporary and only occurs once in a while. Most people suffer from heartburn occasionally, but in some people, acid reflux becomes chronic and can cause gastroesophageal reflux disease (GERD).
GERD is a more serious version of acid reflux and can lead to additional medical problems. Serious medical issues related to long-term GERD are irritation of the esophagus (esophagitis), narrowing of the esophagus (strictures), changes in the esophageal cells (Barrett’s esophagus), and esophageal cancer.
What causes heartburn?
The most common cause of heartburn is a diet full of foods that can trigger heartburn. Acidic foods can increase the acidity of the stomach and contribute to heartburn. Some acidic foods often associated with heartburn are tomatoes, citrus fruits, and alcohol. Other foods that can contribute to heartburn are caffeine, chocolate, peppermint, greasy/fatty foods, and spicy foods.
Some foods can actually help alleviate and prevent heartburn. Changing your diet to include more high-fiber foods like oatmeal, brown rice, green vegetables, and root vegetables can help with heartburn. Foods that are basic — the opposite of acidic — such as cauliflower, fennel, and bananas can also help treat heartburn. Watery foods like cucumber, lettuce, and watermelon are also good for preventing heartburn. Other foods that may help with heartburn are ginger, low-fat milk, and lemon water with honey.
Eating too much too quickly can also cause pressure in the stomach, leading to stomach contents backing up into the esophagus. If you suffer from heartburn, try to eat slowly and eat smaller meals spread throughout the day.
In addition to diet, physical changes can also lead to heartburn. Normally, to prevent the stomach contents from moving back into the esophagus, a tight band of muscle at the base of the esophagus called the lower esophageal sphincter contracts after food passes through. If the lower esophageal sphincter stops functioning normally, stomach contents can be allowed to enter the esophagus — leading to heartburn.
Any physical change that increases pressure in the abdomen, such as pregnancy or weight gain, can also promote the backflow of stomach contents and lead to heartburn. Losing weight is a very effective method of preventing heartburn.
A condition called a hiatal hernia can also lead to heartburn. A hiatal hernia consists of part of the stomach bulging through the diaphragm, the wall of muscle that divides your chest and abdomen.
Other factors that can contribute to heartburn are medications, smoking, and high stress levels. Discussing medication changes with your doctor, quitting smoking, and minimizing stress can all help heartburn symptoms.
The impacts of heartburn on lifestyle
While mild heartburn may just be uncomfortable for most, chronic heartburn or GERD can significantly decrease quality of life for others. Heartburn can be exacerbated by lying down, so many people experience impaired sleep with heartburn. In addition to sleep deprivation, heartburn can also interfere with work, lead to issues with eating and drinking, and an overall decrease in well-being.
One study found that the impact of GERD on lifestyle was comparable to that of other chronic diseases like congestive heart failure and diabetes. The impacts of chronic heartburn can be quite severe. However, there are treatments available that can help alleviate symptoms and improve quality of life.
Medical treatments for heartburn
If lifestyle changes do not help ease heartburn symptoms, there are many medications available. Over-the-counter (OTC) medications can be categorized into three main categories: antacids and supplements, H2-blockers, and proton pump inhibitors.
Antacids decrease heartburn discomfort by neutralizing stomach acid and are best used for occasional heartburn. Antacids are fast-acting, so they can relieve symptoms quickly, but their effects do not last as long as other medications. Moreover, antacids do not heal any damage to the esophagus caused by acid reflux.
Common OTC antacids include Tums, Mylanta, and Gaviscon. Some liquid antacids like Gaviscon can also coat the esophagus with a protective layer, which can increase the relief experienced when using the medication.
Natural supplements which manage heartburn symptoms are also an increasingly popular option. The most common active ingredient is D-limonene which a naturally occurring terpene made from citrus peels. It is thought to both neutralize stomach acid and support normal peristalsis.
Histamine-2 receptor antagonists (H2-blockers) are OTC treatments for heartburn that work by decreasing acid production in the stomach. H2-blockers do not work as quickly as antacids but their effects last longer and they can help heal damage in the esophagus caused by acid reflux. Pepcid AC (famotidine) and Tagament HB (cimetidine) are common OTC H2-blockers.
Proton pump inhibitors (PPIs) take the longest to work, but they are meant to treat more frequent heartburn. PPIs work by blocking the major mechanisms of acid production in the stomach, and they are more effective at blocking acid production than H2-blockers. Additionally, PPIs are the most effective at healing damage to the esophagus caused by acid reflux.
Omeprazole (Nexium 24hr and Prilosec OTC) and lansoprazole (Prevacid 24hr) are all widely available OTC PPIs. PPIs can interact with other medications so be sure to speak with your medical provider before starting a PPI.
If OTC medications do not sufficiently treat your heartburn, there are several prescription PPIs available that may offer relief.
Rabeprazole (Aciphex) is a prescription PPI that is available as a pill and as a delayed-release capsule, meaning the medication slowly gets released from the pill in your stomach throughout the day. In addition to treating heartburn, rabeprazole is also used to treat gastrointestinal ulcers.
Dexlansoprazole (Dexilant) is another prescription PPI used to treat heartburn and GERD. Like rabeprazole, dexlansoprazole is available as a delayed-release tablet. Pantoprazole is another PPI available by prescription. Pantoprazole (Protonix) is available as a packet, a pill, and a delayed-release tablet.
All prescription PPIs can have side effects. There is an association between PPI treatment and an increased risk of bone fractures — hip fractures in particular. It is thought that this occurs because lowering stomach acid levels long-term can lead to decreased calcium absorption.
Moreover, people who take PPIs may be at an increased risk of developing pneumonia. Taking PPIs can also increase the risk of infection with the bacteria Clostridium difficile, which can cause life-threatening diarrhea. PPI use has also been associated with iron and vitamin B-12 deficiency.
Additionally, all prescription PPIs have known drug interactions with many other medications. Given the side effects and the drug interactions of PPIs, it is important to not take PPIs unless they are needed.
Overall, there are many options available for treating heartburn, ranging from diet changes to prescription medication. Heartburn is very common, but with all of the available treatments, there is no reason to suffer. Discuss your heartburn with your medical provider to find the treatment that is right for you.
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