How Do You Know If You Have Heartburn?

Heartburn is a burning pain in the chest usually caused by stomach acid reflux. This is the main symptom, but others include bitter taste or bloating.

Heartburn is a burning pain in the chest usually caused by acid reflux. Reflux occurs when the acid normally in the stomach backs up into the esophagus, the tube that carries food from the mouth to the stomach, resulting in irritation. 

When acid reflux occurs more than twice weekly, is long-lasting, or causes uncomfortable symptoms or damage, it is referred to as gastroesophageal reflux disease (GERD).

Despite the name, heartburn has nothing to do with the heart.

Heartburn feels like burning pain or discomfort in the chest, stomach, abdomen, or throat. 

Other symptoms that may accompany heartburn include: 

• Regurgitation of acid and undigested food back up into the throat or mouth 
• Acidic, bitter, or salty taste in the back of the throat
• Stomach pain
• Chest pain, especially when lying down or bending over
• Difficulty swallowing
• Feeling as if food is stuck in the throat
• Sore throat
• Hoarseness
• Unexplained dry cough
• Belching 
• Nausea 
• Vomiting (may be bloody)
• Bloating
• Bloody or black stools
• Unexplained weight loss
• Wheezing
• Hiccups
• Bad breath
• Respiratory problems
• Tooth erosion

Heartburn is usually caused by acid reflux and gastroesophageal reflux disease (GERD), which happen when the lower esophageal sphincter becomes weak or relaxes, causing stomach contents to back up into the esophagus. 

Causes of lower esophageal sphincter weakness or relaxation include:

• Overweight or obesity, which puts increased pressure on the abdomen 
• Pregnancy, which also puts increased pressure on the abdomen
• Hiatal hernia 
• Smoking or inhaling secondhand smoke
• Certain medicines
  • Antidepressants 
  • Antihistamines
  • Asthma medications 
  • Calcium channel blockers
  • Painkillers
  • Sedatives

The cause of heartburn is diagnosed with a history and physical exam.

Tests used to diagnose the cause of heartburn include: 

• Upper gastrointestinal (GI) endoscopy and biopsy
• Upper GI series
• Esophageal pH and impedance monitoring
• Esophageal manometry

In some cases, heartburn can be managed with lifestyle changes or with non-prescription medicines. 

Home remedies to relieve heartburn include:

• Lose weight if you are overweight or obese
• Raise the head of the bed 6 to 8 inches using blocks of wood or rubber under 2 legs of the bed or a foam wedge under the mattress
• Avoid foods that worsen heartburn symptoms 
  • Coffee
  • Chocolate
  • Alcohol
  • Peppermint
  • Fatty or greasy foods
  • Spicy foods
  • Tomatoes
  • Citrus fruits
  • Garlic and onions
• Don’t overeat
• Don’t eat 2 to 3 hours before bed
• Lying down with a full stomach can make heartburn worse
• Wear loose clothing around the stomach area
• Don’t smoke

If lifestyle changes do not relieve symptoms of heartburn, medications used to treat the condition include: 

• Antacids
  • Best for mild symptoms
  • Only work for a short time
  • Available without a prescription
  • Examples include aluminum hydroxide and magnesium hydroxide (Maalox), calcium carbonate and magnesium hydroxide (Rolaids), sucrose and calcium carbonate (Tums), and simethicone (Mylanta)
• Histamine blockers
  • Stronger and longer-lasting than antacids
  • Many available without a prescription
  • Examples include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR)
• Proton pump inhibitors (PPIs)
  • Used for frequent and more severe symptoms
  • Some are available over-the-counter (OTC) and some require a prescription
  • Examples include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), and rabeprazole (AcipHex) 
• Prokinetics
  • Used to help the stomach empty faster
  • Examples include bethanechol (Urecholine) and metoclopramide (Reglan) 
• Antibiotics
  • Can help the stomach empty faster
  • Erythromycin has fewer side effects than prokinetics.

In severe cases of heartburn caused by gastroesophageal reflux disease (GERD) when symptoms do not improve with lifestyle changes or medications, surgery may be recommended. Types of surgery to treat gastroesophageal reflux disease (GERD) include: 

• Fundoplication
  • A laparoscopic procedure in which a thin tube with a tiny video camera and the top part of the stomach is sewn around the esophagus to reduce reflux
• Endoscopic techniques
  • Endoscopic sewing uses small stitches to tighten the sphincter muscle
  • Radiofrequency creates heat lesions, or sores, to help tighten the sphincter muscle
  • Results for endoscopic techniques are not as good as those for fundoplication