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Heartburn (Acid Reflux)

Alternative names: Acid Reflux, Acid Indigestion, Gastroesophageal Reflux Disease, GERD, Peptic Esophagitis, Reflux Esophagitis

What is heartburn?
What are the signs of heartburn?
What causes heartburn?
How does my doctor tell if I have heartburn?
How is heartburn treated?

What is heartburn?

Heartburn is a burning feeling in your chest and neck. It is often caused by acid reflux, where food or liquid rises from the stomach back into the esophagus, the tube that connects your mouth to your stomach. Acids from your stomach can irritate the esophagus, and cause the burning sensation.

Almost everyone suffers from heartburn at one time or another, but frequent, chronic heartburn can be a sign of gastroesophageal reflux disease (GERD).

What are the signs of heartburn?

  • A burning under the breastbone of the chest, sometimes rising up into the neck
  • A bitter or acid taste in your mouth
  • Feeling like food is rising into your mouth or throat, especially when you lie down or bend over
  • Belching
  • A hoarse or sore throat
  • Difficulty swallowing

Heartburn is often worse after eating rich meals, eating citrus fruit, drinking hot beverages, or drinking alcohol.

Serious signs of gastroesophageal reflux disease (GERD) include:

  • Feeling like food is trapped behind your chest
  • Vomiting blood
  • Having black, tarry bowel movements
  • Feeling like you are choking

What causes heartburn?

At the bottom of your esophagus is a band of muscles that shuts off the swallowing tube from the stomach. If this muscle, or sphincter, grows weak or doesn't close the right way, food and liquid can move back up into the esophagus.

Other things that can cause heartburn:

  • A hiatal hernia, where the top of the stomach pushes up into the chest cavity
  • Pregnancy
  • Scleroderma, a disease that affects the tissue of the skin and internal organs
  • Certain medications for high blood pressure, birth control, asthma, Parkinson's disease, and other conditions

How does my doctor tell if I have heartburn?

Your doctor may suspect acid reflux as a cause for your heartburn just by hearing about your symptoms. He or she also may recommend any of these tests:

  • In an upper gastrointestinal endoscopy, the doctor uses an endoscope - a tiny video camera mounted on a thin, flexible tube with a light at the end - to look inside your esophagus and stomach. The doctor inserts the endoscope through your mouth. You will be given medication to make you relaxed and drowsy during the procedure, which only takes 15-20 minutes.
  • An upper gastrointestinal X-ray (upper GI series) shows the condition of your esophagus and stomach. Before the test, you will drink a chalky material that helps the esophagus and stomach show up on the X-ray.
  • An esophageal manometry motility study tests the muscles of the esophagus as well as the band of muscles at its bottom . The doctor inserts a thin, flexible tube that has pressure sensors on its sides into one nostril of your nose, and eases it down into your esophagus. You will be asked to swallow several times while the doctor takes readings of the muscle contractions. The test takes 20 to 30 minutes.
  • An esophageal 24-hour pH study uses a thin, flexible tube inserted in your nose, and a portable recorder, to learn what happens in your lower esophagus when you feel the symptoms of heartburn. The small recording device makes a 24-hour record of the pH, or acid level, in your esophagus. When you feel the symptoms of heartburn, or acid reflux, you push a button on the recorder. Your doctor can then study these results.

How is heartburn treated?

Occasional heartburn that is not a symptom of gastroesophageal reflux disease (GERD) often can be treated by making changes to your diet and habits.

Non-Surgical

Lifestyle:

  • Don't overeat, especially late at night
  • Avoid foods and drinks that can cause acid indigestion, such as coffee, peppermint, chocolate, greasy or spicy foods, tomato products, and alcoholic beverages
  • Stop smoking, as tobacco relaxes the muscle between the esophagus and the stomach and also helps create stomach acid
  • Keep from lying down after meals, as this often makes heartburn worse
  • Raise the head of your bed before sleeping

Medications:

  • Over-the-counter antacids
  • H2 (histamine) blockers and proton pump inhibitors (PPI) reduce the amount of acid the stomach makes. Some are available over-the-counter; stronger ones need a prescription.
  • Promotility agents tighten the muscles at the bottom of the esophagus

Non-Surgical Procedures:

  • In endoscopic treatment for GERD, doctors use one of several techniques to alter the function of the band of muscles at the base of the esophagus, and allow for normal swallowing and digestion.

Surgical

  • A doctor may recommend anti-reflux surgery (fundoplication) for a patient who has gastroesophageal reflux disease that is not helped by medication. The surgery tightens the sphincter muscle between the esophagus and the stomach.
  • The Endoscopy Center at Dartmouth-Hitchcock Medical Center is developing endoscopic procedures to perform anti-reflux surgery
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