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You enjoyed the meal, but now you’re paying for it, big time. You’ve got heartburn — an uncomfortable burning sensation radiating up the middle of your chest. Heartburn, the most common gastrointestinal malady, can hit after you eat spicy foods, when you lie down to take a nap, or perhaps at bedtime. Many women experience this sensation during pregnancy.
About one-third of Americans have heartburn at least once a month, with 10% experiencing it nearly every day. One survey revealed that 65% of people with heartburn may have symptoms both during the day and at night, with 75% of the nighttime heartburn patients saying that the problem keeps them from sleeping, and 40% reporting that nighttime heartburn affects their job performance the following day. This epidemic leads people to spend nearly $2 billion a year on over-the-counter antacids alone. Clearly, it’s a major problem.
Heartburn is an expression of a condition known as gastroesophageal reflux disease (GERD), often called “reflux,” in which acid and pepsin rise from the stomach into the esophagus, much like water bubbling into a sink from a plugged drain.
While GERD — and its symptom, heartburn — can be difficult to cope with, many people manage them quite well. However, other people spend countless hours and untold sums of money looking for a way to spell relief.
This report explains the causes of GERD, and what you can do to prevent and treat it.
Prepared by the editors of Harvard Health Publications in consultation with Lawrence S. Friedman, M.D., Professor of Medicine at Harvard Medical School, Chair of the Department of Medicine at Newton-Wellesley Hospital, and the Assistant Chief of Medicine at Massachusetts General Hospital. 24 pages. (2008)
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Many people can manage heartburn without seeking medical care, through dietary changes, over-the-counter medications, and relaxation therapy. A doctor may be helpful if your symptoms don’t respond to self-help techniques and if they interfere with sleep or daily life.
If you do seek your physician’s advice, he or she will review your medical history and ask detailed questions about the nature of the pain and its pattern of onset. For example, your doctor may ask whether symptoms are worse after you eat a heavy meal or known dietary troublemakers such as high-fat foods or dairy products. Your doctor will want to know if bending over to tie your shoelaces or lying down aggravates the symptoms and whether the pain seems linked to anxiety or stress.
For typical reflux symptoms, doctors usually forgo diagnostic tests and proceed straight to treatment, starting with a proton pump inhibitor (PPI) such as omeprazole or lansoprazole. If this provides relief, the odds are that the diagnosis of GERD was correct. Once the symptoms are under control, the patient may either continue with the PPI or switch to a less powerful medication. That might be an H2-receptor antagonist (H2 blocker) such as cimetidine (Tagamet), ranitidine (Zantac), or famotidine (Pepcid), or an antacid like Tums.
Your doctor will be alert for other symptoms, such as frequent nonburning chest pain, bleeding into the GI tract, dysphagia (difficulty in swallowing), hoarseness, or constant coughing and wheezing. Such symptoms may be associated with GERD, but could have other causes and might warrant tests to gain more information.
For example, GERD is sometimes accompanied by respiratory problems such as asthmatic wheezing, coughing, or hoarseness. When asthma strikes adult nonsmokers with no history of lung disease or allergies, pH-monitoring studies sometimes suggest that GERD is the culprit. As many as 70% of patients with asthma experience reflux.
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