What is your heartburn telling you?
“Heartburn is a very common condition that almost everyone experiences at one time or another in their lives. It could be telling you something as simple as the need to avoid spicy foods, or if it is reoccurring, then it could be a symptom of gastro-esophageal reflux disease, which is also referred to as GERD,” said Dr. John Wysocki, a gastroenterologist at Baystate Medical Center.
Not an illness, but rather a symptom, heartburn is a burning feeling in your chest just below or behind your breastbone. The pain often rises in your chest from your stomach and may even spread to your neck, jaw or throat.
After food passes through the esophagus into the stomach, a muscular valve called the lower esophageal sphincter (LES) closes, preventing the movement of food or acid upward. Gastroesophageal reflux, or heartburn, occurs when the LES relaxes too frequently, allowing acid from the stomach to flow backward into the esophagus. GERD symptoms may worsen with a hiatal hernia, when part of the stomach bulges through this opening into your chest.
Among those at risk for heartburn or reflux are those who:
• eat a very spicy or high fat diet (as well as other foods and beverages such as alcohol, carbonated or caffeinated drinks, citrus fruits and juices, peppermint and spearmint, tomatoes and tomato sauces)
• smoke cigarettes
• are overweight or obese
• are pregnant
• are taking pain relievers such as Ibuprofen or other medications to treat depression, sea sickness, insomnia, high blood pressure, heart disease, and more
• have a hiatal hernia, which occurs when the upper part of your stomach pushes up through your diaphragm and into your chest, making reflex of acid easier.
Most people with chronic heartburn can be successfully treated with a combined regimen of lifestyle modifications and medications, noted Dr. Wysocki.
Antacids such as Maalox, Mylanta or Tums help to neutralize stomach acid. H2 blockers, including Pepcid AC, Tagamet and Zantac, reduce stomach acid production. Also, proton pump inhibitors, such as Prilosec OTC and Nexium, are most effective at reducing stomach acid production.
Lifestyle modifications include eating smaller meals, losing weight if overweight, reducing stress, avoiding bending over or exercising immediately after eating, avoiding eating within 3 hours of bedtime, sleeping with your head elevated 6-8 inches off of the bed, and wearing looser clothes and belts that are not as snug around the waist.
If you have heartburn often, or it doesn’t go away after a few weeks of self-care, or if you have other symptoms such as difficulty swallowing or frequent nausea and vomiting, Dr. Wysocki said to consult your doctor.
“The concern is that if left unchecked by your physician, more severe and chronic cases of GERD can result in stomach acid injuring the inner lining of the esophagus, resulting in complications such as esophagitis and possibly esophageal cancer,” said Dr. Wysocki.
For those whose heartburn is uncontrollable or complications such as Barrett’s esophagus develop, surgery may be recommended. Medications do not cure the injury or the symptoms. And even when damage is not present, GERD patients may want an alternative to a lifetime of medication. Rather than treating the symptoms, surgery can correct the reflux itself. The procedure, call fundoplication, involves first repairing a hiatal hernia, if present, followed by wrapping the top part of the stomach around the end of the esophagus to reinforce the lower esophageal sphincter, thus creating a “one-way” valve inhibiting the upward flow of stomach acids.
Surgery is most often performed laparoscopically, where surgeons use several small incisions on the abdominal wall into which a tiny camera and thin operating instruments are inserted into the abdominal cavity. Advantages of minimally invasive surgery include less pain and a lower risk of infection, shorter hospital stay, and a quicker recovery.
Sometimes your “heartburn” is telling you something more serious that requires calling 9-1-1, noted Dr. Wysocki.
“Heartburn can be associated with having a heart attack, since the heart and esophagus are located close to one another in the chest. If a good burp relieves your symptoms and they don’t return, then it’s most likely a good case of heartburn. But, if you are having difficulty breathing, break out in a cold sweat, are nauseous or lightheaded, and have pain radiating to one or both arms, neck, jaw or back, it could mean you are having a heart attack, and you should seek immediate medical attention,” he said.
For more information on Baystate Medical Center, visit baystatehealth.org/bmc.