Heartburn -- Overview

Heartburn is a burning sensation in the lower chest. Heartburn can be caused by different conditions, but most often it is related to gastroesophageal reflux disease (GERD). Treatment may depend on the cause of your heartburn. In most cases, heartburn can be treated with medications, lifestyle changes, or surgery.

  • Causes

    Heartburn is caused by stomach acid that moves up into the esophagus. A muscle at the top of the stomach allows food to enter the stomach. This muscle also closes to prevent food and acid from moving back up into the esophagus. Certain conditions can keep this muscle from closing completely, which allows acid to flow out. This causes heartburn.

  • Definition

    Heartburn is a burning sensation in the lower chest. Heartburn can be caused by different conditions, but most often it is related to gastroesophageal reflux disease (GERD).

    Treatment may depend on the cause of your heartburn. In most cases, heartburn can be treated with medications, lifestyle changes, or surgery.

    Heartburn
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  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may be able to make a diagnosis based on your symptoms. Your doctor may also take images of your esophagus or stomach with an upper GI series. A sample of your esophagus may be taken and sent for examination. This is often done during an endoscopy.

    Other tests may include:

    • 24-hour pH (acid) monitoring
    • Manometry to test muscle strength in the lower esophagus

  • Prevention

    There are no current guidelines to prevent heartburn.

  • Risk Factors

    Factors that increase your chance of heartburn include:

    • Obesity
    • Smoking
    • Exercising or strenuous activity immediately after eating
    • Lying down, bending over, or straining after eating
    • Pregancy
    • Prior surgery for heartburn such as vagotomy
    • Diabetes
    • Scleroderma
    • Certain nervous system disorders
    • In-dwelling nasogastric tube

    Foods and beverages associated with heartburn include:

    • Alcohol use, especially in excess
    • Caffeinated products
    • Citrus fruits
    • Chocolate
    • Fried foods
    • Spicy foods
    • Foods made with tomatoes, such as pizza, chili, or spaghetti sauce

    Medications and supplements associated wtih heartburn include:

    • Anticholinergics
    • Calcium channel blockers
    • Theophylline, bronchial inhalers, and other asthma medications
    • Nitrates
    • Sildenafil
    • Bisphosphonates

  • Symptoms

    Heartburn symptoms usually occur after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

    Common heartburn symptoms may include:

    • Burning feeling that starts in the lower chest and moves up the throat
    • Feeling that food is coming back up
    • Sour or bitter taste in the throat

    Other symptoms and complications of reflux include:

    • Sore throat
    • Hoarseness
    • Chronic cough
    • Feeling of a lump in the throat
    • Asthma
    • Waking up with a sensation of choking
    • Difficulty swallowing

    If reflux persists, the acid can damage the esophagus. Symptoms of esophageal damage include:

    • Bleeding and ulcers in the esophagus
    • Vomiting blood
    • Black or tarry stools
    • Inflammation and scarring of the esophagus
    • Barrett's esophagus— precancerous condition that can lead to esophageal cancer
    • Dental problems, which may occur because of the effect of stomach acid on tooth enamel

  • Treatment

    Talk to your doctor about the best treatment plan for you. Treatment will depend on what is causing your heartburn. Treatment may focus on preventing heartburn from occuring or repairing damage causing the heartburn.