What Your Heartburn Symptoms Are Really Telling You

Don’t automatically dismiss your heartburn as a minor inconvenience. It could signal that you have a serious underlying condition.

Is It Heartburn?

Heartburn typically feels like a burning sensation or discomfort in the chest, often starting behind the breastbone and rising toward the throat. It may be accompanied by a bitter or acidic taste in your mouth, or a sensation of food or liquid coming back up into your throat.

Occasional heartburn is common, but heartburn becomes concerning if it:

• Occurs more than twice a week
• Doesn’t improve with over-the-counter antacids or proton pump inhibitors.
• Interferes with daily activities or sleep
• Is accompanied by additional symptoms like chest pain, difficulty swallowing or unintentional weight loss

These can indicate gastroesophageal reflux disease (GERD) or other serious conditions requiring medical evaluation.

Conditions that Start with Heartburn

While GERD is the most common cause of persistent heartburn, several other conditions can also cause similar symptoms or contribute to reflux:

• Hiatal hernia. When part of the stomach pushes through the diaphragm into the chest, weakening the lower esophageal sphincter and allowing acid reflux.
• Esophagitis. Inflammation of the esophageal lining, often from chronic acid exposure, infections or certain medications.
• Barrett’s esophagus. A complication of chronic GERD in which the esophageal lining changes, increasing the risk of esophageal cancer.
• Functional heartburn. Reflux-like symptoms without measurable acid reflux or esophageal injury; thought to involve nerve hypersensitivity.
• Achalasia. A rare motility disorder causing impaired relaxation of the lower esophageal sphincter and difficulty swallowing. It can mimic reflux symptoms early on.
• Eosinophilic esophagitis (EoE). An allergic condition where white blood cells inflame the esophagus, leading to heartburn, chest pain, and food impaction.
• Gastroparesis. Delayed stomach emptying increases pressure and can worsen reflux
• Esophageal cancer. In advanced stages, it can cause heartburn-like symptoms, difficulty swallowing, unexplained weight loss or anemia from slow bleeding.

Symptoms To Watch

As these conditions progress, they may cause painful swallowing; food sticking in your throat; weight loss; anemia; dark, coffee-ground like stools; or unintentional weight loss.

Diagnosing Your Condition

Diagnosing GERD begins with a detailed history and physical examination. Typical symptoms, such as heartburn and acid regurgitation, are often enough to make a clinical diagnosis, especially if symptoms improve after using proton pump inhibitors for eight to 12 weeks.

However, further testing is needed when symptoms are persistent, and they don’t respond to medications.

Your doctor likely will perform an upper endoscopy to look directly at the esophagus and stomach lining. This test uses a thin, lighted tube called an endoscope that has a camera at one end. The tube is inserted through your mouth, usually while you are under sedation so you don’t feel anything. Your doctor can inspect these organs and take a small tissue sample (biopsy) if needed to confirm conditions like Barrett’s or cancer.

Another option is to measure your acid levels with pH monitoring while you go about your everyday activities. This can be accomplished in two ways:

• Wireless pH monitoring: your doctor inserts a thin tube while you are under sedation to clip a small Bravo capsule (about the size of a pencil eraser) to the lower part of your esophagus. The sensor in the capsule measures and records acid levels at that location over time, and the transmitter sends the information wirelessly to a recording receiver you wear on a belt. Typical it measures acid for 48-96 hours.
• Wired 24h pH impedance involves placing a narrow flexible tube through your nose into the distal esophagus. Before the test, your nose is numbed with a local anesthetic gel. The tube has a sensor that measures acid levels and the refluxes (which could be acid or non-acid) and sends the information to the attached recording receiver that you wear. Typically it measures acid for 24 hours.

For both tests, your doctor downloads this data and uses it to assess the severity of the reflux. You will need to keep a diary of any symptoms you experience and record the exact times for when you eat and when you are lying down. Also, you cannot take antiacid medicines, such as proton pump inhibitors (PPIs), for at least two weeks before the tests and during the tests.

Lifestyle Changes You Can Make

Lifestyle changes are a cornerstone of managing heartburn and related conditions. Elevating the head of your bed, sleeping on your left side, avoiding meals late at night, eating smaller meals and avoiding tight clothing all can help reduce reflux. Weight loss is particularly effective because excess abdominal fat increases pressure on the stomach and worsens reflux. Quitting smoking and limiting alcohol also are important.

Diet may play a role in heartburn symptoms. Spicy foods, chocolate, caffeine, fatty meals and acidic fruits can exacerbate GERD symptoms. To identify your individual food triggers, you will need to track your symptoms and what you eat and drink.

Regular, moderate exercise supports weight control and digestion, both of which reduce reflux. But avoid vigorous physical activity, especially soon after eating.

When Surgery Should Be Considered

Taking a proton pump inhibitor is typically the first step with issues related to GERD, and 90 percent of people suffering with GERD get relief with medical therapy. But you may be a candidate for surgery if you have medication-resistant GERD, large hiatal hernias or complications such as Barrett’s esophagus or recurrent aspiration. The most common surgical procedure is a laparoscopic Nissen fundoplication, in which the top of the stomach is wrapped around the lower esophagus to strengthen the LES and prevent reflux.

Newer options include the LINX magnetic ring device and endoscopic procedures like the Transoral Incisionless Fundoplication (TIF), which is a minimally invasive endoscopic procedure.  Another option could be Roux-en-Y gastric bypass surgery if you also qualify for weight-loss surgery.

This content is not AI generated.