Your Heart's Not Really Burning

Heartburn is a common but potentially serious digestive problem

/ Author:  / Reviewed by: Joseph V. Madia, MD

"I got heartburn during my second pregnancy," Marcy tells "It felt like fire in my throat. My doctor told me that the baby was pushing up on my stomach."

Some years later, Marcy said it returned. "I quit smoking in 2006 and gained a lot of weight, and it kicked in for real - like every night or when I lay down - here it came. In the middle of the night, this vile bitter vomit would come up, wake me up and go into my nose. It was awful."

What she's talking about is a serious form of heartburn.

What is heartburn?

Heartburn results from digestive problems. Here's a quick look at how your digestive system works.

When you eat, food travels from the throat into the stomach through the esophagus, also called the food pipe or swallowing tube. Once in the stomach, ringed muscle fibers called the lower esophageal sphincter (LES) act like a gate to keep the food from moving back up into the esophagus.

When the LES doesn't close all the way or there are other digestive problems, then food and liquid and stomach acid can move backwards. This backward action is called reflux - thus the name acid reflux.

So you will experience acid indigestion when there are excessive amounts of acid reflux in the esophagus.

Other names for heartburn are:

  • Acid indigestion
  • Acid reflux
  • GERD (gastroesophageal reflux disease)

How does heartburn feel?

Like its name, heartburn causes a burning sensation usually around the middle of the chest behind the breast bone and in the throat. Common symptoms include:

  • Discomfort that lasts a few minutes or a few hours and is usually worse at night
  • Chest pain, especially noticeable when bending over, lying down or eating
  • A burning in the throat
  • An acidic, hot, sour or salty fluid in the throat, mouth or nose
  • Nausea after eating

Less common and often more serious symptoms of heartburn are:

  • Coughing and wheezing
  • Trouble swallowing
  • Hiccups
  • Change in voice or hoarseness
  • Vomiting
  • Feeling that food is stuck in the middle of your chest or throat
  • Sore throat

What causes heartburn?

The exact cause of heartburn isn't fully understood. Research shows that several physical problems can be the culprit:

  • Some people experience it when the LES relaxes and the rest of the esophagus is working
  • A hiatal hernia can also contribute to the symptoms. A hiatal hernia results from an anatomical abnormality that interferes with digestion

Certain common medications may also cause acid reflux, including:

  • Medicines for seasickness, anticholinergics
  • Beta-blockers and calcium channel blockers for high blood pressure and heart disease
  • Bronchodilators for asthma
  • Parkinson's disease dopamine-active drugs
  • Sedatives for anxiety and insomnia
  • Tricyclic antidepressants
  • Progestin for birth control or abnormal periods

Risks of heartburn increase with the following:

  • Pregnancy
  • Obesity
  • Smoking

In addition, certain foods can trigger acid indigestion. Common foods that worsen symptoms include:

  • Drinks with caffeine or alcohol
  • Citrus fruits and juices
  • Chocolate
  • Carbonated beverages
  • Fatty or fried foods
  • Full- fat dairy products
  • Garlic and onions
  • Mint flavorings
  • Spicy foods
  • Tomato-based foods, like spaghetti sauce, salsa, chili, and pizza

Marcy knows and avoids foods that cause her symptoms. "All kinds of breads (sandwiches) with meat -- particularly dry white chicken -- do stick in my throat and burn. It is agony until it passes whatever juncture that is. And red wine for dinner was a promise for an episode of pain later," the 59-year-old woman said.

"Even my morning coffee began to come back up -- in the afternoon. Just way bizarre. I thank the family of Ann Richards [who died of esophogeal cancer] for revealing the potential gravity of this. It sure got my butt in to see a doctor," Marcy said.

How common is GERD?

According to the College of Gastroenterology:

  • 60 million Americans have acid indigestion at least once a month
  • An estimated 15 million Americans experience heartburn every day
  • Acid reflux is more common among the elderly and women during pregnancy

What can you do about heartburn?

To avoid the misery of GERD, Marcy doesn't eat the foods she knows cause heartburn and never eats after 5 p.m.

Here are lifestyle changes that may help you:

  • If you know certain foods or beverages cause acid indigestion, avoid them
  • Avoid exercising or bending over after eating
  • Avoid wearing tight garments and belts
  • Don't eat within 2-3 hours of bedtime and don't lie down with a full stomach
  • Eat smaller meals
  • Reduce stress
  • Lose weight if necessary
  • Raise the head of your bed by 6-10 inches with blocks or books, or place a wedge under the mattress (Extra pillows don't work for the purpose.)

For occasional heartburn, take an over-the-counter antacid such as Alkak-Seltzer, Maalox, Mylanta, Rolaids or Tums.

Is heartburn serious?

It can be. Left untreated, GERD can damage the esophagus and cause a number of complications, some of which can be life-threatening.

Without proper treatment, GERD can lead to a narrowing of the esophagus or bleeding, and a condition known as Barrett's esophagus which increases the risk of a rare but deadly form of cancer of the esophagus.

Here are serious symptoms that should not be ignored:

  • Feeling that food is trapped in the breastbone or throat
  • Vomiting blood or having black, tarry bowel movements
  • Choking sensation of acid in the windpipe that causes shortness of breath, coughing or hoarseness

When should you see a doctor about heartburn?

You should see a doctor about your acid indigestion when:

  • Lifestyle changes and antacids don't relieve your heartburn 
  • You have any of the serious symptoms listed
  • You have heartburn more than twice a week

You may be advised to see a specialist in digestive diseases, a gastroenterologist.

What types of tests evaluate GERD?

Tests may be ordered to evaluate what's causing or complicating your digestive problems. You may undergo one or a combination of the following:

  • Barium Esophagram or Upper GI X-ray: looks at the anatomy of the digestive tract
  • Endoscopy: looks for problems in the esophagus and stomach
  • Esophageal Manmetry or Esophageal pH: examines how the esophagus functions and examine the degree of acid refluxed

Marcy had an endoscopy and learned that the heartburn she is currently experiencing is caused by a hiatal hernia.

Medications for GERD

A number of medications are available to treat GERD, as well as heal complications to the esophagus it may have caused. Here are common heartburn medications, some of which are available in both over-the-counter and prescriptions strength:

  • Axid AR
  • Zantac 75
  • Prilosec
  • Zegerid
  • Prevacid
  • Protonix
  • Aciphex
  • Nexium
  • Urecholine

You may also need to take a combination of medications.

Is surgery ever needed?

Yes. Surgery is an option when lifestyle changes and medications don't help. Several procedures are available to repair, strengthen or rebuild areas and organs of the digestive system.

Get the help you need

While heartburn is extremely common, affecting most Americans at some point in their lives, if it's an ongoing problem for you, please visit with your doctor. Untreated heartburn and GERD can lead to serious health consequences.

Review Date: 
April 21, 2011