Heartburn is a burning pain in the chest, just behind the breastbone. The pain is often worse when lying down or bending over.
Occasional heartburn is not unusual, and is not cause for alarm. Many people can manage the discomfort of heartburn on their own with simple lifestyle changes and over-the-counter medications. Your family physician has probably been able to help manage your condition effectively for a while.
When heartburn is more frequent or interferes with your daily routine, it may be a symptom of a more serious condition. You may require specialized medical care, more than an increased dose of medication, because sometimes medications just aren’t enough.
What causes heartburn?
Heartburn occurs when stomach acid backs up into the esophagus (the tube that carries food from your mouth to your stomach).
Normally, when you swallow, a valve around the bottom of your esophagus relaxes to allow food and liquid to flow down into your stomach, then the muscle tightens again.
If the valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus (acid reflux) and cause heartburn. The acid backup may be worse when you're bent over or lying down.
Sometimes, acid can flow into your esophagus without any pain at all. This "silent heartburn," if left untreated, can lead to complications such as esophagitis (irritation of the esophagus lining), narrowing of the esophagus, difficulties swallowing, worsening of asthma or chronic cough and Barrett's Esophagus (which can be a precursor to esophageal cancer).
Symptoms of heartburn
- A burning pain in the chest that usually occurs after eating and may occur at night
- Pain that worsens when lying down or bending over
- Trouble sleeping
- Gas, bloating
- Intolerance of certain foods
- Trouble swallowing
- Respiratory problems
How is it diagnosed?
Several procedures can help determine the extent of the heartburn:
EGD: EGD is the examination of the upper digestive tract, including the esophagus and stomach using a flexing endoscope.
Bravo: A tiny, gel cap-sized capsule is attached to the wall of the esopagus just above the opening to the stomach. It transmits the pH level in your esophagus to a small device worn on your pants or belt for 48-96 hours.
Manometry: Esophageal testing, or manometry, measures the muscle pressures and the pattern of contractions in the esophagus and helps diagnose conditions that cause heartburn. It can also help diagnose hiatal hernias, which often make heartburn worse.
How is it treated
- Lifestyle changes like food choice, meal times and healthy weight
- Medications to prevent acid production
- TIF (Transoral Incisionless Fundoplication) is a 45-minute long, non-invasive, incisionless procedure performed in the OR. The procedure is completed through the mouth and reconstructs the valve that will prevent stomach acid from irritating the esophagus.
- Stretta is a minimally invasive procedure that significantly reduces heartburn symptoms. Taking about 60 minutes, the procedure uses radiofrequency energy to regenerate the muscle tissue at the valve where the esophagus meets the stomach. The thicker muscle prevents acid from flowing up into the esophagus.
- Surgical correction of hiatal hernia
When to go to the ER:
Seek immediate help if you experience severe chest pain or pressure, especially when combined with other signs and symptoms, such as pain in the arm or jaw or difficulty breathing. Sometimes it can be difficult to tell the difference between severe heartburn and more serious cardiac problems.
When to see a specialist:
- Heartburn occurs more than twice a week
- Symptoms persist despite the use of over-the-counter or prescribed medications
- You have difficulty swallowing
- You have persistent nausea or vomiting
- You have weight loss because of poor appetite or difficulty eating
- You are tired of avoiding certain foods and relying on medications
- You are concerned about the side effects from certain medications