Heartburn & GERD

Heartburn, GERD, and other causes of upper abdominal pain are diagnosed and treated by the GI Department of Premier Medical Group. Heartburn is defined as a painful burning sensation in your chest, and is usually worsened when you lie down or bend over. Heartburn isn’t a disease; it’s a symptom, identified by the physicians in the GI Department of Premier Medical Group. Infrequent heartburn is common and no cause for alarm. Almost everyone has occasional heartburn. It happens when acid backs up into your esophagus. Generally people can manage the symptoms of heartburn with over-the-counter medications and diet changes. Repeated episodes of heartburn and sour-tasting fluid in your throat can be a sign of something more serious, GERD, or gastroesophageal reflux disease. This is also referred to as reflux disease. If you have other symptoms such as crushing chest pain, it could be a heart attack. Get help immediately.

What is heartburn and GERD?

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Heartburn is defined as a painful burning sensation in your chest, especially after eating and/or when lying down at night. Heartburn isn’t a disease; it’s a symptom. Infrequent heartburn is common and no cause for alarm. Almost everyone has occasional heartburn and chest pain after eating. It happens when acid backs up into your esophagus. Generally, people can manage the symptoms of heartburn with diet changes and over-the-counter medications.

GERD, or gastroesophageal reflux disease, is characterized by repeated episodes of heartburn and sour-tasting fluid in your throat, which can be a sign of something more serious. This is also referred to as acid-reflux disease. If you have other symptoms such as crushing chest pain, it could be a heart attack. If you have any doubt about the difference between heartburn and a heart attack, get help immediately.

What causes heartburn?

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The most common causes for heartburn are over-eating, eating late at night, pregnancy, certain foods, alcohol, and some medications. It’s important to treat heartburn because over time reflux can damage the esophagus. Heartburn ensues when stomach acid backs up into your esophagus. When you swallow your food, the lower esophageal sphincter—a circular band of muscle around the bottom part of your esophagus—relaxes to allow food and liquid to flow down into your stomach and then closes. When the lower esophageal sphincter does not relax in its normal function, the stomach acid can flow back up into your esophagus. This acid backup can be worse when you bend down or lie down. Chest pain after eating is very common.

Causes for heartburn and GERD include:

  • Overeating:Almost everyone gets heartburn after a hearty meal. Eating a heavy meal and then bending over or lying down is especially problematic. It’s also common to have chest or stomach pain when lying down at night. Stomach pain when lying down at night may also be a sign of peptic ulcers.
  • Pregnancy:This happens due to the increased levels of hormones and pressure from the developing fetus. It’s usually worse in the third trimester.
  • Stomach abnormalities:hiatal hernia can cause heartburn, and it can happen at any age.
  • Smoking:Smoking can damage the mucus membranes, impair muscle reflexes in the throat, increase acid secretion, and reduce salivation which neutralizes the effect of acid. Smoking can also increase the risk for cancer of the esophagus.
  • Obesity: This may also be a contributing factor, possibly due to increased pressure on the stomach and esophagus.
  • Aspirin and ibuprofen,some muscle relaxers or blood pressure medications.
  • Certain foods: Eating large meals or lying down right after a meal. The most common foods which may trigger symptoms include:
    • Chocolate
    • Carbonated beverages
    • Citrus fruit
    • Coffee and tea
    • Fatty and fried foods
    • Garlic and onions
    • Pizza
    • Mint
    • Spicy foods (chili, curry)
    • Tomato based foods such as spaghetti sauce, salsa

What are the symptoms of heartburn?

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Typically, heartburn occurs right after you have eaten a big meal. You feel a burning sensation in your chest. Most people assume it’s just heartburn, and more than likely it is just that. There is also the chance the chest pain is a warning sign of a heart attack, so it is very important to learn the difference between heartburn and something more serious.

The most common characteristics of heartburn:

  • Heartburn usually occurs after eating or while lying down or bending.
  • Heartburn can be short-lived or continue for a few hours.
  • Heartburn causes acid to move up into the esophagus that could leave a sour taste in your mouth.
  • Heartburn causes a burning sensation in your chest that may start in your upper abdomen and radiate all the way to your neck.

You should see a doctor if your symptoms include any of the following:

  • Severe chest pain
  • Difficulty breathing
  • Arm or jaw pain
  • Sweating or feeling weak

Most often, it’s relatively easy for people to tell the difference heartburn and a heart attack. However, a person with little to no history of heartburn or heart disease may still experience a sudden and somewhat severe onset of chest pain and mild heart palpitations. There is no shame if you can’t tell the difference between heartburn and a heart attack. If you have any doubt whatsoever, don’t wait to get help. We discuss this in further detail in our Frequently Asked Questions.

You should also see a doctor if your heartburn occurs more than twice a week, you have difficulty swallowing or the symptoms last despite using over-the-counter medications. Keep in mind, too, that stomach pain when lying down at night can be a symptom of heartburn, pancreatitis, or ulcers.

How is heartburn diagnosed?

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Heartburn is most often diagnosed by the symptoms you describe to your doctor. If he or she feels it is necessary to rule out something more serious, additional testing may be recommended. Your esophagus can be viewed through an endoscope, which is a long, thin, flexible tube inserted through the mouth, or by X-ray. Another test used to diagnose GERD is a twenty-four-hour esophageal pH probe study. A long, narrow, flexible tube is inserted through the nose down into the esophagus and a probe is left there for twenty-four hours. This will detect your acid levels to decide if there is a correlation with your symptoms. Another technique is called a Bravo, which measures twenty-four-hour acid. To rule out any heart issue, your doctor may also want to take an electrocardiogram (ECG), a recording of the heart’s electrical activity.

How is heatburn treated?

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More than likely the over-the-counter medicines will help your occasional heartburn, however if it continues, you may need prescription medicines or surgery. If you have been using these over-the-counter medications for more than two weeks, it’s time to see the doctor, preferably a gastroenterologist. After the doctor completes a medical history and gets the results of any tests you may have had, he can better recommend a treatment plan. Your treatment would depend on the severity of your GERD. The following are some of the most suggested treatments for GERD.

Lifestyle Changes

  • Wear loose fitting clothes
  • Lose weight
  • Eat smaller, more frequent meals
  • Stop smoking
  • Do not lie down until three hours after your meal
  • Avoid fatty, greasy, spicy foods
  • Avoid tomato based foods
  • Sleep with head elevated
  • Avoid caffeine and carbonated beverages

Medications

  • Over the counter antacids, such as Maalox, Mylanta, Rolaids, Alka-Seltzer ,Tums and Titralac
  • Foaming agents such as Gavison cover your esophageal lining with foam to prevent reflux
  • H2 Blockers such as Pepcid AC and Zantac 75, are available with without a prescription and provide short term relief by decreasing the acid production in your stomach
  • Proton pump inhibitors, such as Prilosec, Nexium and Prevacid also decrease the production of acid in your stomach, but are known to be more effective in relieving symptoms and healing the esophageal lining
  • Prokinetics are in a category of medications that help to make stomach empty faster

If your symptoms do not improve with lifestyle changes or medications, you may need additional tests.

  • Upper endoscopy
  • Barium swallow radiograph
  • Biopsy (a tiny piece of tissue is removed from the esophagus and it is sent to lab for analysis)
  • pH monitoring (a very small tube is inserted into esophagus or a tiny device is clipped to the esophagus which measures when and how much acid comes up into your esophagus as you go about your daily activities)
  • Surgery (an option when medicine and lifestyle changes do not help to manage GERD)

Frequently Asked Questions

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Are there other digestive symptoms which cause chest pain?

Yes:muscle spasms and gallbladder attacks.

Are there long-term complications of GERD?

Yes. Left untreated, GERD can cause inflammation of the esophagus and scars from tissue damage can lead to strictures which narrow the esophagus. Some people develop Barrett’s esophagus. These abnormal cells may lead to cancer of the esophagus.

How can I tell the difference between heartburn and a heart attack?

The symptoms can be very similar which is why many people do not want to believe they are having a heart attack. Warning signs of a heart attack include sudden pressure and a tightening, crushing pain that lasts more than a few minutes. Most heart attacks start slowly with mild chest of upper body discomfort. You may feel pain in your back, jaw, stomach, shoulders, or arms, especially the left arm. Other symptoms can include shortness of breath, sweating, lightheadedness, and nausea. When in doubt, seek help.

When should you get medical help?

Seek medical attention when the over-the-counter medications are not working and you are experiencing worse heartburn than usual. Also if you have had heart problems before, or you have heart disease, diabetes, smoke or are overweight.