Heartburn is usually experienced as a burning sensation or pain behind the breastbone or a back up of bitter acid into the mouth. Ten percent of Americans experience it daily and 25 percent of pregnant women have heartburn. This discomfort is caused when the lower esophageal sphincter (LES) does not close properly and the stomach contents leak back into the esophagus.
Most people experience heartburn after eating a large meal. Along with swallowed air, a large meal can increase pressure in the stomach, which overpowers the LES muscle. Other factors are:
- Nicotine (any tobacco products)
- Fried or fatty foods
- Caffeine (coffee, tea, colas, chocolate)
- Citrus fruits and juices
- Peppermint and spearmint
- Lying flat
- Hiatal hernia
- Certain prescription medicines
Beyond the basic symptoms, there are several tests used to diagnose reflux:
- Upper GI series: X-rays are taken after you drink barium to monitor the functioning of the esophagus and stomach.
- Upper GI Endoscopy: After taking a mild sedative, a thin, lighted, flexible tube, called an endoscope, is inserted into the esophagus to visually inspect it and the stomach.
- Esophageal Manometry: This is a test that measures the pressure within the esophagus, especially the LES pressure.
- pH Monitor: This is a test that measures how often stomach acid flows into the lower esophagus and the degree of acidity.
An antacid or milk temporarily relieves heartburn for most people. However, the following measures are recommended for recurring reflux:
- Antacids: These should be taken 30 to 60 minutes after eating and again at bedtime. Liquid antacids are preferred to tablets.
- Drugs: Your doctor can prescribe medicines that reduce and eliminate the secretion of stomach acid and increase the strength of the LES muscle. The most potent of these are called proton pump inhibitors.
- Surgery: Surgery is rarely required to treat reflux. However, when antacids and drugs are ineffective, surgery (which can be performed laparoscopically) to strengthen the LES muscle must be considered.
The following measures will help:
- Eat smaller, more frequent meals.
- Do not lie down immediately after eating, and avoid eating for several hours before going to bed.
- Avoid excessive bending, lifting, abdominal exercises, girdles, and tight belts.
- If you are overweight, lose weight.
- Stop using all tobacco products.
- Avoid fatty foods, alcohol, coffee, chocolate and peppermint.
- Elevate the head of your bed eight to ten inches so gravity can keep stomach juices out of your esophagus while you sleep. Extra pillows, by themselves, are usually sufficient.
- Review all medications you are taking with your physician since certain prescription or over-the-counter medications can weaken the LES and aggravate reflux.
In some people, acid in the lower esophagus can lead to tissue damage, resulting in:
- Chronic bleeding and anemia
- Scar formation and narrowing of the lower esophagus
- Barrett’s esophagus, which can occur when reflux irritates the lower esophagus over a long period of time and the lining of the stomach extends into the esophagus. This can be serious because it carries a slight risk of cancer developing.
- Lung problems, which can develop if reflux causes stomach fluid to enter the breathing tubes
Call your doctor if your heartburn is chronic and persistent, experiencing vomiting, difficulty swallowing, lack of appetite, or unexplained weight loss.