What to Do When Heartburn Keeps Coming Back
SIOUX FALLS (July 1, 2008) - Heartburn. Really having nothing to do with your heart, that burning sensation in your chest and throat is thanks to stomach acid that's in the wrong place at the wrong time.
An occasional episode is incredibly common, says Dr. Cristina Hill Jensen, gastroenterologist with Avera Gastroenterology Clinic of Sioux Falls. "Probably everyone has had an episode of heartburn at least once in their lives."
A smaller percentage of the population suffers more often. Some 20 percent have an episode of heartburn about once a week, and 7 percent struggle with symptoms daily. Those who do experience heartburn this often may be sufferers of acid reflux disease.
Acid reflux can occur in infancy, all the way through adulthood in males and females alike. Symptoms may include heartburn, but also chest pain, abdominal discomfort, nausea or even a chronic cough or constant throat-clearing, Dr. Hill Jensen said.
"We all have stomach acid," Dr. Hill Jensen said. Heartburn happens when that acid comes up out of the stomach and bathes the esophagus with acid. Acid reflux is due to a lazy lower esophagus sphincter which normally closes off the stomach contents. "Some individuals have more episodes of relaxation."
The cause of heartburn may be as basic as eating patterns and habits. Eating a heavy meal, and then lying down on the couch to watch TV might bring on an attack. Pregnant women are especially prone to heartburn in their third trimester, as the growing baby puts pressure on the stomach. Being overweight can contribute to heartburn and acid reflux.
Eating too much at one sitting, spicy foods, red sauces, caffeine and alcohol can also either cause heartburn, or worsen acid reflux symptoms.
Acid reflux and frequent heartburn can usually be diagnosed based on symptoms, without any invasive test. It's treated with medications with lifestyle changes, such as smaller meals, not eating before bedtime, avoiding caffeine and other triggers, and not lying down immediately after eating.
Today's medications work very well to combat acid reflux and frequent heartburn symptoms, Dr. Hill Jensen said.
Antacids, such as Mylanta, Tums or Rolaids are primarily used for mild symptoms, and occasional heartburn. They work by neutralizing the acid in the stomach. "If you just have heartburn once in a while, these medications will work effectively and quickly," Dr. Hill Jensen said.
H2 blockers are the next step, and a good place to start for symptoms of acid reflux, Dr. Hill Jensen said. They block part of the pathways that leads to acid formation, specifically histamine, a chemical that encourages acid secretion. These drugs, available over the counter, include Pepcid AC, Tagamet, and Zantac.
A stronger class is proton-pump inhibitors, which block the proton pump - the final step in acid production. Examples are Prilosec, Nexium and Prevacid.
Labels on over-the-counter H2 blockers and proton-pump inhibitors warn patients against taking these medications for longer than two weeks without consulting a doctor. Surgery is an option for those who have chronic acid reflux that does not respond well to medications. "For some, the condition will get better after taking medication for a few months. Others need to be on medication chronically and a few need to have surgery," Dr. Hill Jensen said.
Acid reflux should be treated, because it can lead to more serious conditions, such as esophagitis, which is irritation of the lower esophagus; narrowing of the esophagus caused by scarring; or Barrett's esophagus, which involves precancerous changes to the esophagus. Warning signs that require a doctor's attention include weight loss, symptoms which are not responsive to medications, vomiting, severe chest pain, or a sensation of food getting stuck in the chest region.
"The majority of people get better on these medications, and side-effects are very minimal," Dr. Hill Jensen said.
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