Q&A: What to Do About Heartburn

By Melissa Tennen

Heartburn is much more than an annoyance. It can wreck your quality of life. But you can get help. Learn what Gary W. Falk, M.D., associate professor of internal medicine at The Cleveland Clinic Foundation, says about the symptoms and signs and when to get help.

What is heartburn?

Gary W. Falk: Heartburn is the sensation of burning felt just below the breastbone and is related to the reflux, or regurgitation, of the contents of the stomach into the esophagus. Other than the burning feeling, other symptoms are difficulty breathing, coughing, chest pain and a sore throat. It can occur after meals, after certain foods or lying down after having a heavy meal. Sometimes, as with chronic heartburn, there isn’t a trigger.

What usually triggers it?

Falk: Fatty foods, alcohol, caffeine, large heavy meals can. In chronic cases, the reasons are not clear. Stress is not a factor.

Is there a connection with cancer?

Falk: With frequent heartburn, there is no question that it is a risk factor for esophageal cancer.

What is Barrett’s esophagus?

Falk: Barrett’s esophagus is a change in the lining of the esophagus whereby the normal cells lining the esophagus change because of irritation from stomach acid. The condition means an increased risk of cancer of the esophagus. Symptoms include heartburn, burning sensation and difficulty swallowing.

When should you see a doctor?

Falk: Once upon a time people would think it’s the norm to have heartburn and something that they would have to live with. If you have it on a regular basis and you have done things like cut back on foods or drinks like coffee and it hasn’t helped, you should see a doctor. You should also see a doctor when your “heartburn” might be a symptom of heart disease. Heart symptoms include pain that comes on with exertion or is associated with shortness of breath, sweating, nausea, irregular heartbeat, or pain that goes to your neck, back, shoulders, jaw or arms. People with high blood pressure, family history of heart disease, cigarette use, diabetes, and age over 40 are at higher risk for heart disease.

Are more people getting help?

Falk: We do know that more people have been made aware that they should see a doctor because of direct-to-consumer advertising from pharmaceutical companies as well as educational programs from professional societies.

Can you take care of chronic heartburn yourself?

Falk: Probably not. Once you weed out factors such as fatty, spicy or acidic foods, alcohol and caffeine and eating within three hours before bed and you still have it several times a week, you probably need help from a doctor to get relief. There is no evidence that lifestyle modifications work for chronic heartburn.

The advice we give, particularly if you have alarm signs such as difficulty swallowing and losing weight, is that you should not self medicate. If you are drinking 10 cups of coffee a day, that’s a lifestyle issue and you can probably reduce your heartburn by easing up on the coffee. If you have heartburn on a regular basis that is not related to lifestyle issues like coffee or late meals, you should see a doctor.

But for patients with regular heartburn or acid regurgitation, it is essential that you don’t eat three hours before bed, and that you avoid certain foods and eat fat in moderation. Fatty foods empty slower from the stomach. And don’t over-indulge in coffee and alcohol. If you are drinking lots of caffeine, it is best to cut down.

What kinds of medications are out there for heartburn?

Falk: Medications that alleviate symptoms include antacids after meals and at bedtime, histamine receptor blockers, promotility agents and proton pump inhibitors. The very important message is that help is available.

What if medications fail?

Falk: Anti-reflux operations may help some patients who don’t get relief from medications. But you must be very careful in choosing who does your procedure. Some doctors look at this as minor surgery, but it’s not. Consumers need to be extra cautious.

If not done correctly, you may have trouble swallowing, diarrhea and pain. This could all mean lots of medical visits. Surgery when done well will work. But you can’t give a lifetime guarantee. Patients need to know how many surgeries the doctor has done.

There are now a number of endoscopic approaches to reflux disease. While these procedures are FDA-approved, there is not enough long-term safety and efficacy data about these procedures.

Tips for preventing and coping

The Cleveland Clinic suggests some changes you can make in your diet and lifestyle.

  • Don’t go to bed with a full stomach. Eat meals at least two hours before lying down – the added time will give acid levels a chance to decrease before putting one’s body in a position where heartburn is more likely to occur.
  • Don’t overeat. Eat smaller portions at meal times, or try eating four or five small meals instead of three large ones.
  • Eat slowly. Take time to eat – don’t rush. Try putting your fork down between bites.
  • Wear looser- fitting clothes.
  • Avoid the trigger foods: onions, mints, chocolate, coffee or tea, carbonated beverages, alcohol, citrus fruits or juices, tomatoes, mustard, vinegar, and fried and high-fat foods.
  • Stop smoking. Nicotine can weaken the lower esophageal sphincter, the muscle that controls the opening between the esophagus and stomach, preventing the acid-containing contents of the stomach from entering the esophagus.

External Source

The Cleveland Clinic