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Soothe Heartburn

  • Ease heartburn and GERD by paying attention to certain foods, meds and lifestyle habits.

  • Heartburn, also called acid reflux, isn’t about your heart at all; it’s about your digestive system. When stomach contents splash upward into the esophagus—the food tube that parallels your windpipe—you may feel a hot, burning sensation in your chest and throat. Nearly half of American adults occasionally experience heartburn after meals or when lying down.

    More than two or three heartburn episodes a week could indicate gastroesophageal reflux disease, or GERD. This isn’t life threatening, but you shouldn’t ignore it. “In some people, the acid can damage the esophagus lining, causing scars and an increased risk of esophageal cancer,” says gastroenterologist Neil Stollman, M.D., of Sutter Health Alta Bates Summit Medical Center in Oakland, California.

  • What are heartburn and GERD symptoms?

  • In addition to the burning sensation in your throat and chest, discomfort can spread to your neck, jaw or shoulder. (Note that a burning in your chest can also be a sign of a heart attack, so it’s important to know the difference. See a doctor if pain radiates to your arms or if you experience shortness of breath.)

    With heartburn, you might also experience a bitter or sour taste in your mouth; upper stomach pain; hoarseness, throat clearing or chronic cough; difficulty swallowing; frequent burping or hiccups; and dental or gum injury.

  • What causes heartburn and GERD?

  • Normally, the muscular valve at the bottom of the esophagus, called the lower esophageal sphincter, prevents stomach contents from flowing upward. However, certain foods, medications or other causes may displace or weaken the sphincter.

    Common food culprits include:

    • Citrus fruits
    • Onions and garlic
    • Spicy foods
    • Peppermint
    • Alcohol
    • Caffeine
    • Chocolate
    • Tomato-based foods, such as marinara sauce and pizza
    • Fatty foods, such as cheese, meats or avocados
    Medicines that may irritate the esophagus and trigger heartburn include antibiotics, aspirin, nonsteroidal anti-inflammatories, blood pressure medications, sedatives, antidepressants and more. If you think a medication may be causing or worsening your heartburn, see your doctor before making any changes.

    Another common heartburn contributor is a hiatal hernia, where the stomach pushes up through a gap (hiatus) in the diaphragm into the chest cavity. “This is common as we age and can be diagnosed on an X-ray or with a camera-assisted endoscopy test,” Dr. Stollman says.

    If you’re pregnant, you may notice heartburn symptoms because of increased abdominal pressure from the growing baby, as well as hormonal changes that relax the lower esophageal sphincter. Fortunately, most women’s heartburn disappears after the baby’s birth.

  • Medicines for heartburn

  • Many over-the-counter antacid medications, such as Tums, Rolaids, Mylanta or Maalox, provide fast relief by neutralizing stomach acid—but they don’t repair damage or prevent further heartburn episodes. Meds that reduce acid production (called H-2 blockers), such as Zantac, Pepcid and Tagamet, take about 15 to 30 minutes to work, but relief can last three to six hours. Combination over-the-counter meds, such as Pepsid Complete and Tums Dual Action, include both fast-acting antacids and longer-lasting H-2 blockers.

    For chronic heartburn, ask your doctor about proton pump inhibitors (PPIs). Typically taken once daily, these drugs effectively block stomach acid production, but research indicates possible long-term side effects. “The general rule is to treat with the lowest dose regimen that adequately controls your symptoms—enough but no more,” Dr. Stollman says.

  • Natural treatments for heartburn and GERD

  • If you experience heartburn infrequently and simple antacids relieve your symptoms, it’s OK to continue with that approach. You can also try these helpful lifestyle changes.

    • Don’t smoke. Smoking relaxes the sphincter muscle more than usual.
    • Achieve a healthy weight. Excess weight puts pressure on your stomach that can cause heartburn.
    • Eat slowly, and eat smaller meals.
    • Keep a food diary to help you to identify your heartburn triggers.
    • Wear loose clothing that doesn’t constrict your stomach.
    • Stay upright for two to three hours after eating.
    • Eat meals two to three hours before bedtime. In addition, use blocks or a foam wedge to raise the head of your bed about 4 to 6 inches.

  • When to see a doctor

  • If your GERD is chronic and troublesome, talk with your physician about an endoscopic exam.

    “You should consider an endoscopy if you have had heartburn for a long time—perhaps five years or more,” Dr. Stollman says. “You should also be seen if you have what we call ‘alarm symptoms’ of losing weight, difficulty in swallowing, vomiting or anemia.”

    An endoscope exam will help determine whether acid reflux has injured your esophagus. With chronic heartburn, your body creates new esophageal cells to replace damaged ones; however, the new cells carry a greater tendency to change and develop into cancer, a condition called Barrett’s Esophagus.

    “If the cells are normal, you won’t need further testing,” Dr. Stollman says. “However, if cellular changes are occurring, you may need regular surveillance endoscopy to monitor for the development of cancer.”

  • Surgery for GERD

  • If lifestyle changes and medications fail to help your GERD symptoms, if your body can’t tolerate the meds, or if you have a rather large hiatal hernia, surgery is an option. For GERD, doctors commonly use a laparoscopic technique, which requires only tiny incisions, to wrap the upper stomach around the lower end of the esophagus, strengthening the sphincter. Consult with an experienced GI surgeon to learn whether this procedure might be right for you.

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