We all know that the burning sensation in the chest is not really ‘heart’-burn, but it doesn’t make it any more pleasant, does it? Heartburn is the backup of acid from the stomach into the esophagus. Most of us have had it at least once, especially after eating too much — think about that over the coming holiday season.
Let’s look first at how heartburn happens. At the bottom of the esophagus where it meets the stomach is a circular sphincter muscle. If it weakens or faces pressure, it can allow the escape of acidic digestive juices from the stomach into the lower esophagus. Pressure on the stomach such as when it’s too full, or when lying down can pressure the sphincter and cause the leakage. That is heartburn.
Mere heartburn is pretty simple and goes away, often on its own. But if it is not going away or occurs too often, it could be more serious. Heartburn may be a symptom of GERD (gastroesophageal reflux disease) and if you have at least two incidents of heartburn a week, it may be time to seek medical advice. Heartburn is unpleasant, but GERD is more serious. Among its effects are interrupted sleep and subsequent tiredness, hoarseness, laryngitis, chronic cough, painful swallowing and more. And it may damage the esophagus. You could have GERD without the acid reflux. This is called non-erosive reflux disease (yes, NERD).
What can you do? If it is simple, occasional heartburn, try an antacid such as calcium carbonate or one of the other treatments like aluminum or magnesium compounds. Sodium bicarbonate is the active ingredient in the fizzy antacids but these are not recommended because they contain too much sodium; they may also contain aspirin, itself a contributor to heartburn.
The first step is usually an antacid, but if they don’t do the job, you can turn to H-2 blockers. These reduce the production of stomach acid by blocking histamines (which stimulate stomach acid). The next step could be PPIs, or proton pump inhibitors. These actually turn off almost all production of stomach acid. In either case, do not take the medication for more than 14 days. If the problem persists, it is definitely time to see your doctor.
Looking more broadly at the problem, there are steps to take that can reduce the occurrence of heartburn. Quitting smoking should help and losing weight if you are overweight can, too. A large study of female nurses in 2006 found that for women in the ‘normal’ weight range, an increase of just 10 pounds in weight led to an increased risk for GERD of 40 percent; when the women lost weight, the symptoms decreased.
It’s a good idea to avoid eating two to three hours before bed, as would eating smaller meals to reduce the pressure in your stomach. Stay away from foods and drinks that you think cause symptoms. These may include spicy, fatty or fried foods, alcohol, milk, peppermint, chocolate, coffee and tea. At night, elevate the head of your bed and let gravity reduce the pressure on the esophageal sphincter muscle. You might also chew sugarless gum after meals to stimulate the production of saliva which then helps neutralize stomach acid.
The best advice we can give is to suggest paying special attention if you have persistent heartburn or unexplained symptoms such as poor sleep, difficulty swallowing, chronic cough or hoarseness. If you do, seek medical advice as you well may have GERD, or NERD.
Written by Dr. Paul Martiquet, Medical Health Officer for the Sunshine Coast and Powell River.