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What is heartburn?

Heartburn is a burning pain or warmth usually felt in your chest, behind the breastbone, after eating. It happens when fluids in your stomach flow back into your esophagus. The esophagus is the tube that carries food from your throat to your stomach. The acid and bile from your stomach can burn and irritate your esophagus, throat, and vocal cords. The burning pain is called heartburn and the backward movement of stomach fluids is called reflux.

Everyone has heartburn once in a while. Most of the time it’s mild and lasts for a short time. If you have heartburn most days of the week, you may have a condition called gastroesophageal reflux disease (GERD). It is important to get treatment for GERD because without treatment, GERD can damage the lining of your esophagus.

What is the cause?

When you swallow food and liquids, they flow down the esophagus to the stomach. A ring of muscle around the lower end of this food pipe opens up and lets the food go into your stomach. Normally, the muscle then closes and keeps stomach contents from going back into your esophagus. If the ring of muscle is weak or too relaxed or has too much pressure working against it, it doesn’t stay closed and stomach acid and food can flow backwards into your esophagus. The acid can irritate the esophagus and cause pain.

The ring of muscle sometimes does not work properly if:

  • You are overweight.
  • You eat too much.
  • You lie down soon after eating.
  • You wear tight clothes that push on your stomach.
  • You smoke.
  • You have a hiatal hernia (part of your stomach pokes through your diaphragm, which is the muscle between your chest and belly that helps you breathe).

Foods that may make heartburn worse are:

  • Foods high in fat
  • Sugar
  • Chocolate
  • Peppermint and other mint flavorings
  • Onions and garlic
  • Acidic foods, like oranges or tomatoes
  • Spicy foods
  • Caffeine drinks, such as coffee and tea
  • Carbonated drinks, such as colas
  • Alcohol

Heartburn can also be made worse by:

  • Taking certain medicines, such as aspirin or ibuprofen
  • Smoking cigarettes

Heartburn is very common during the last few months of pregnancy. The weight of the baby pushes on the stomach and can cause the ring of muscle to let acid flow back into the esophagus.

What are the symptoms?

Symptoms may include:

  • Burning pain or warmth in your chest or throat, usually close to the bottom of your breastbone (the main symptom)
  • Bitter or sour taste in your mouth
  • Belching and a feeling of bloating or fullness in your stomach
  • Frequent unexplained dry cough

Heartburn usually happens 30 to 60 minutes after a large meal, especially if you bend down, lie down, or lift something after your meal. You may feel better when you sit up.

It may be hard to tell it from a heart attack. Get emergency care if your heartburn does not get better within 15 minutes after treatment or if you have chest discomfort (pressure, fullness, squeezing or pain) that keeps going away and coming back, especially if you have sweating, lightheadedness, or chest discomfort that goes to your arms, neck, jaw, or back. These symptoms may be signs of a heart attack.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

  • Endoscopy, which uses a slim, flexible, lighted tube passed through your mouth to look at your esophagus and stomach
  • Barium swallow, which is an X-ray taken of the upper part of your digestive tract after you swallow barium. Barium is a liquid that helps your esophagus and stomach show up well on the X-ray.

In some cases, depending on your medical history and your symptoms, you may need tests to make sure the pain is not caused by heart disease.

How is it treated?

The goal of treatment is to control reflux so that you have fewer symptoms and to prevent long term damage to your esophagus. Your healthcare provider may recommend or prescribe:

  • Lifestyle changes such as quitting smoking, changing your diet, or losing weight. If you drink alcohol, your provider may recommend drinking less or not drinking at all.
  • Medicine to lower the acid in your stomach

If you have a hiatal hernia, you may need surgery to repair the problem.

How can I take care of myself and help prevent heartburn?

To feel better and prevent problems:

  • Follow the full course of treatment prescribed by your healthcare provider.
  • Take nonprescription antacids after meals and at bedtime, according to your provider’s recommendation.
  • Take medicines with plenty of liquid. Swallowing medicine without enough liquid can irritate your esophagus.
  • Eat smaller, more frequent meals. Avoid overeating and late-evening snacks or meals.
  • If certain foods or drinks seem to cause your symptoms or make them worse, avoid those foods.
  • Try to keep a healthy weight. If you are overweight, lose weight. Extra weight puts pressure on your stomach. The pressure can cause stomach contents to push up into your esophagus.
  • If you smoke, try to quit. Smoking can increase stomach acid and cause stomach acid to flow backwards into your esophagus. Talk to your healthcare provider about ways to quit smoking.
  • Wear loose fitting clothes without belts.

It may also help if you:

  • Sit up during meals and don’t lie down for at least an hour after eating. It’s best to not eat for 2 to 3 hours before you go to bed.
  • Raise the head of your bed 6 to 8 inches by putting the frame on wood blocks. If you cannot raise the frame of the bed, try placing a foam wedge under the head of your mattress. Sleeping on your left side may also help. Just using extra pillows will not help.
  • Chew sugarless gum after meals. Some studies have shown that this decreases reflux.

Ask your healthcare provider:

  • How and when you will hear your test results
  • What activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth.
Last modified: 2014-12-05
Last reviewed: 2014-12-05
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

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