Treating Severe, Chronic Heartburn

Written by Amanda Gardner

Medically Reviewed by Jennifer Robinson, MD on April 16, 2022

• Watch What You Eat, Drink, and Do
• Treatments
• Surgery
• Endoscopic Treatment

If you feel uncomfortable in the middle of your chest every time you finish a meal, you may have chronic heartburn. This is when the acid from your stomach leaks up into the tender tissue of your esophagus (food pipe), causing pain and burning. You need treatment. If you don’t control your heartburn, it could damage your esophagus and even lead to cancer. There are some simple ways to make sure this doesn’t happen to you.

Making some changes to your lifestyle can go a long way toward easing the pain of heartburn.

Say goodbye to cigarettes. Smoking causes your body to make less saliva, a liquid that helps stamp out stomach acid. That can lead to burning in your esophagus. Tobacco may also cause your stomach to make more acid and relax the muscles at the lower end of your esophagus that can shut down the opening between the stomach and the esophagus. Chewing gum and sucking on lozenges can help you make more saliva.

Avoid trigger foods. For many people, these are spicy and high-fat foods, chocolate, peppermint and other mints, coffee, citrus fruits or juices, tomato products, carbonated drinks, and onions.

Don’t lie down after you eat. If you need an afternoon siesta, snooze upright (or almost upright) in a chair. Eat dinner at least 2-3 hours before you go to bed, and don’t make the last meal of the day your biggest one.

Raise the head of your bed. If the top of your bed is higher than the bottom, it’s harder for the acid to travel up. You can do this with a block of wood under the bed or a foam wedge under the mattress.

Be careful what medications you use. Aspirin, ibuprofen, and other medications, such as some sedatives and blood pressure drugs, can trigger heartburn. Ask your doctor if any of your medications might be causing your symptoms. There may be something else you can take.

Eat several small meals during the day. Your stomach produces acid based on how much food you eat. Less food means less acid. Don’t overload your stomach.

Limit alcohol. Alcohol can relax the muscles around the lower end of your esophagus, making it easier for acid to bubble up.

Stay slim. One study found that overweight people who lost weight were more likely to have their heartburn go away. Another reason to lose weight: You’ll respond better to heartburn medications.

Wear loose clothing. Tight clothing, including belts, can cause stomach contents to push upward.

Relax. Stress causes stomach acid to bubble up.

If you have chronic severe heartburn, you may need medications. Both over-the-counter and prescription drugs are available.

Antacids are usually the first type of drugs doctors recommend for chronic heartburn. You can get them over the counter. They work by stamping out the acid in your stomach. Antacids work right away, but they don’t last long. They also don’t help a damaged esophagus heal. Look for products that have both magnesium and aluminum salts. They’re less likely to cause diarrhea and constipation.

h3 blockers are available over the counter and by prescription. Although they don’t kick in as quickly as antacids, they last longer. They work by slowing down how much acid your stomach makes. They include cimetidine (Tagamet) and famotidine (Pepcid, Zantac 360). Ranitidine was removed from the market in 2020 after it was found to contain a cancer causing agent.

Proton pump inhibitors (PPIs) also block acid production. You can get them over the counter or with a prescription.

You may need more than one type of medication. Talk to your doctor about the best treatment plan for you. Make sure you’re aware of the side effects of all the medication you take.

The most common surgery for extreme heartburn is fundoplication. The surgeon wraps the top of your stomach around the bottom of your esophagus to strengthen it and help keep the acid where it belongs. This often can be done laparoscopically — it involves only a small cut and typically lets you go home in 3 days or less.

The goal of this treatment is the same as surgery. But instead, your doctor puts a thin tube called an endoscope down your throat and into your esophagus. They then use stitches or heat to create scar tissue to tighten the sphincter and stop stomach acid from leaking.

Newer treatments involve using implants (such as the LINX system, which involves titanium beads linked together to form a retaining wall) to keep acid from seeping out of the stomach.

Transoral Incisionless Fundoplication (TIF) is the newest therapy performed with an endoscope, which seems to have good short-term results.  

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Is sudden heartburn a cause for concern? Causes and treatment

People without a history of heartburn can suddenly develop heartburn as a result of eating certain foods, some eating patterns, drinking, and smoking. Stress, anxiety, certain medications, and some medical conditions can also cause it.

Heartburn is a common condition that causes a burning sensation in the chest and throat. A person may also experience:

• a burning sensation in the middle of the chest
• pain that feels like burning indigestion
• a foul, acidic taste in the mouth
• difficulty swallowing
• coughing or hoarseness
• pain that worsens when bending over or lying down

This article will discuss why a person may suddenly develop heartburn despite not experiencing it before.

The United Kingdom’s National Health Service notes that many people develop heartburn from time to time, and the cause is not always obvious.

Experiencing heartburn for the first time is usually not a cause for concern.

However, if someone without a history of heartburn starts to experience it frequently or severely, they should speak with a doctor to rule out any underlying medical conditions and to determine the appropriate treatment.

People should contact a doctor if they experience severe and persistent symptoms that cannot be relieved by using over-the-counter (OTC) medications.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that some foods and drinks can bring on symptoms of heartburn.

Examples of foods that may cause heartburn include:

• tomatoes
• chili peppers
• caffeine
• citrus fruits
• fried and fatty foods
• alcohol
• peppermint
• onions
• chocolate

These types of foods can irritate the lining of the esophagus, which can lead to heartburn.

Learn more about foods that cause heartburn.

Heartburn can develop as a result of:

• eating a large meal
• eating a meal late at night
• eating a meal that is calorie dense
• lying down too soon after eating
• eating too quickly

According to research from 2019, eating large or calorie dense meals can cause gastric distention, or the enlargement of the stomach.

It can also cause the lower esophageal sphincter (LES) to relax. This can cause stomach acid to travel up to the esophagus, leading to heartburn. The LES is the muscle that separates the esophagus from the stomach.

Eating a meal late at night can increase the production of stomach acid.

Lying down within 3 hours of eating can also cause stomach acid to travel up the esophagus.

When a person eats quickly, they tend to swallow air, which can contribute to the development of gas and bloating. Additionally, eating too fast can cause a person to overeat, leading to increased pressure on the LES, resulting in acid reflux.

The American Psychological Association notes that stress can lead to heartburn. This is because stress may cause a person to eat more or less than usual, or increase their use of tobacco or alcohol.

It can also make it more challenging to swallow foods or cause a person to swallow more air than usual. This causes bloating, gas, and burping.

Additionally, people may turn to comfort foods high in fat, sugar, or salt when stressed, which can also bring on heartburn.

The authors of a 2018 cross-sectional study suggest that anxiety can cause heartburn due to the following reasons:

• Anxiety can reduce the pressure on the LES.
• Anxiety can cause muscle tension, increasing pressure around the stomach, and pushing the acid upward.
• Anxiety can increase the production of stomach acid.

Learn more about the relationship between acid reflux and anxiety.

The NIDDK notes that the following medications can result in heartburn:

• benzodiazepines
• some asthma medications
• tricyclic antidepressants
• calcium channel blockers
• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen

Certain medical conditions can cause heartburn. These include:

• hiatal hernia
• gastroesophageal reflux disease (GERD)
• peptic ulcer disease

If someone develops one of these conditions, they may experience heartburn for the first time.

Heartburn is common during pregnancy, with an incidence of 17–45% in pregnant women.

During pregnancy, the pregnancy hormone called progesterone relaxes the LES. This allows food and acid to travel up to the esophagus.

As the pregnancy progresses, a person may begin to experience heartburn more often. The uterus begins to push against the stomach, also pushing the contents of the stomach upward.

Learn more about heartburn during pregnancy.

A person can treat mild, occasional heartburn with lifestyle modifications and OTC medications, while more severe or frequent symptoms may require prescription medications or surgery.

Some treatments for heartburn include:

• Lifestyle modifications: People should aim to:
  • avoid dietary triggers
  • eat smaller, more frequent meals
  • avoid lying down immediately after a meal
  • elevate the head of the bed can help reduce the frequency and severity of heartburn
  • stop smoking, if they smoke
  • achieve and maintain a moderate body mass index
• OTC medications: People can take antacids to neutralize stomach acid to provide immediate relief. h3 receptor blockers and proton pump inhibitors (PPIs) can reduce stomach acid production and provide longer-lasting relief.
• Prescription medications: For more severe or frequent heartburn, a doctor may prescribe stronger medications, such as higher dose PPIs.
• Surgery: Surgery may be an option for people who do not respond to medications.

A person may mistake heartburn for the following conditions:

• angina, which is chest pain that results from reduced blood flow to the heart
• gallstones, which can cause pain in the upper abdomen or back
• pancreatitis, which refers to the inflammation of the pancreas, causing pain and discomfort in the upper abdomen
• peptic ulcer, which are open sores in the lining of the stomach, causing a burning pain in the upper abdomen
• hiatal hernia, which is when part of the stomach protrudes into the chest cavity through the diaphragm, which can cause heartburn-like symptoms
• anxiety and stress, which can cause physical symptoms including chest pain and tightness in the chest

People should contact a doctor if they experience any of the following:

• severe or persistent chest pain or discomfort
• shortness of breath or difficulty breathing
• pain that radiates to your arm, neck, or jaw
• sweating or nausea accompanying chest pain
• vomiting blood or passing black, tarry stools
• difficulty swallowing or pain when swallowing
• unintentional weight loss
• symptoms that do not improve with OTC medications
• recurrent heartburn or acid reflux

These symptoms may be signs of a more serious condition, such as a heart attack, esophageal injury, or stomach ulcer.

It is essential to seek prompt medical attention if someone experiences any of these symptoms to receive appropriate diagnosis and treatment.

While occasional and mild heartburn is usually not a cause for concern, severe chest pain or pressure, shortness of breath, or pain that radiates to the arm or jaw may indicate a heart attack, requiring immediate medical attention.

A person without a history of heartburn may start experiencing it due to changes in diet or lifestyle, certain medications, medical conditions, or stress and anxiety.

If the symptoms are frequent or severe, people should contact a doctor to rule out any underlying medical conditions and determine the appropriate treatment.

Causes and symptoms of heartburn, ways to eliminate it

Publication date: 12/22/2020

HeartburnHeartburn in pregnant womenPainkillersCholecystitisUlcer and gastritisUlcers

Contents of the article

• What is heartburn and why does it appear?
• Symptoms of heartburn
• Heartburn after eating: causes and treatment
• How to get rid of heartburn during pregnancy
• What to do if you suffer from heartburn every day
• What helps with heartburn?
• Ask an expert about article

What is heartburn and why does it occur?

Heartburn is one of the most common complaints faced by pharmaceutical workers and physicians. Heartburn is a burning sensation in the upper abdomen and along the esophagus. Heartburn appears due to the fact that the contents of the stomach enter the esophagus, as the work of the sphincter is disrupted – a special muscle that regulates the diameter of the hole during the transition from the esophagus to the stomach. The acidic contents of the stomach irritate the receptors of the mucous membrane of the esophagus, and there is a burning sensation.

Symptoms of heartburn

Burning behind the sternum. It occurs after eating and lasts from several minutes to several hours.

• Burning in esophagus and throat
• Pain and discomfort in the upper abdomen
• Nausea, flatulence, eructation after eating
• Bitter or sour taste in mouth and throat
• Difficulty swallowing
• Cough
• Chest pain, especially after eating, if you lie down or bend over

Heartburn after eating: Causes and treatment

Typically, heartburn after eating appears as a symptom of gastrointestinal (GI) problems or as a reaction to “bad” food. When this occurs, the reflux of gastric contents into the esophagus.

We list the possible causes of heartburn:

• gastrointestinal diseases: reflux disease, gastric and duodenal ulcers, gastritis, cholecystitis
• cancer of the cardia of the stomach
• diaphragmatic hernia
• increased stomach acidity
• fatty, spicy, salty foods
• overweight
• stress
• junk food
• overeating
• smoking
• medication (aspirin, diclofenac, ibuprofen)

Treatment can only be prescribed by a doctor after a comprehensive examination.

To eliminate unpleasant symptoms, a diet and drugs are prescribed:

• Almagel, Gastal, Gaviscon, Rennie, Maalox – neutralize hydrochloric acid in the stomach
• Omez, Gastrozol, Losek, Rabeprazole, Pariet, Nexium, Emanera – reduce the production of hydrochloric acid

How to get rid of heartburn during pregnancy

Pregnant women in the second trimester experience heartburn more often than other people. According to some authors, 50-80% of pregnant women suffer from heartburn. Women who eat meat experience heartburn more often than vegetarians. The cause of heartburn in pregnant women is the compression of the digestive organs by an overgrown uterus, as well as hormonal changes that are inevitable during this period.

What to do if you suffer from heartburn every day

Heartburn can occur in a healthy person as a result of malnutrition and bad habits. In this case, it is worth taking preventive measures if the symptoms recur periodically:

• exclude fried, dairy, spicy foods, spices, sausages, fast food, coffee, chocolate, alcohol, carbonated drinks, pastries and sweets from the diet
• limit citrus fruits, cabbage, apples, sour berries, tomatoes
• switch to smaller meals: reduce portions and eat 5-6 times a day
• eat warm food (not hot or cold)
• give preference to baked and steamed dishes
• chew food thoroughly
• do not lie down, do not bend over, do not lift heavy things after eating
• have dinner 3 hours before bedtime
• stop smoking
• reduce excess weight
• avoid stress

If necessary, you can take drugs that reduce the acidity of the stomach. Sold without prescription:

• Almagel
• Gastal
• Gaviscon
• Maalox
• Omez
• Rabeprazole
• Rabiet
• Rennie
• Phosphalugel

If these measures do not help, and heartburn bothers you often, you should consult a gastroenterologist. Most likely, it’s not about nutrition and lifestyle, but about the disease of the gastrointestinal tract. The doctor will identify the cause of heartburn, prescribe examinations, tests, make a diagnosis and write out a treatment regimen.

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What helps with heartburn?

Heartburn remedies used by pregnant women are alginate-based preparations. Alginates are salts of alginic acid isolated from kelp raw materials. They have an enveloping effect and prevent the reflux of acidic stomach contents into the esophagus. The same action has an infusion of flax seeds. Other drugs can be used only in consultation with the doctor.

For other patient groups, antacids are recommended for short-term use. Before use, read the instructions.

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What to do to prevent heartburn from leading to esophageal cancer0008

You can treat a cough for a long time, take an X-ray of the lungs and not guess that it’s not about the respiratory system at all. Often, reflux disease becomes its cause, and then you need to go to a gastroenterologist for treatment.

August 23, 202115

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Symptoms of the disease with the harsh name of GERD are familiar to almost every second person. The most common is heartburn. Someone manages to get rid of it quickly, while others suffer from it all their lives and can even lead to cancer of the esophagus. How to live with a diagnosis of gastroesophageal reflux disease, said gastroenterologist Victoria Kovalevich.

When the cause of a “cold” is in the gastrointestinal tract

– Victoria Vladislavovna, what symptoms do patients with GERD most often complain about?

– The main one is heartburn. Other complaints: belching, difficulty or pain in swallowing, a feeling of bitterness or a sour taste in the mouth.

– Atypical ones?

– Some of the symptoms of GERD do not appear to be related to gastroenterological problems. Rather, they can be confused with ENT diseases, diseases of the respiratory system or heart. These are pain behind the sternum, dry cough, sore throat and sore throat, hoarseness of voice. There may even be damage to the tooth enamel and violations of the mucous membrane in the oral cavity.

– That is, you can drink expectorants for a long time, gargle and wonder why nothing helps.

– Yes, that’s why the doctor needs to take anamnesis very carefully in order to accurately understand the origin of the complaints. We often see patients who first unsuccessfully treat chronic laryngitis with ENT doctors, chronic bronchitis with a pulmonologist, and only lastly go to gastroenterologists. And the cause of the symptoms in the end is the so-called high reflux. When thrown into the esophagus, the contents of the stomach reach the oral cavity, irritating, among other things, the mucous membrane of the nearest ENT organs.

But the opposite happens. Appearing complaints are immediately attributed to reflux, and the reason is actually something else. For example, pain behind the sternum (in the esophagus) can be associated with cardiac problems and even become a harbinger of a heart attack.

– How to understand what is what? When can I wait for a planned visit to a gastroenterologist, and when should I urgently call “03”?

– Even a doctor does not always immediately determine the exact cause of the ailment. Take the same pain behind the sternum, which can be a symptom of both GERD and angina on the background of myocardial ischemia. If chest pains are prolonged, not associated with eating, appear or worsen with physical exertion, radiate to the area of ​​​​the shoulder blades, neck or left shoulder, this is most likely a reason to contact a cardiologist as soon as possible. And in case of a sharp deterioration in well-being and jumps in blood pressure, call an ambulance.

Reflux flare-ups are most often caused by dietary disturbances. For example, overeating acidic or “gas-forming” foods. Or the wrong daily routine. For example, a person likes to lie down after eating, which is absolutely impossible to do with such a disease.

Read also

It is impossible to cure completely

– Why does the disease appear?

– The main reason for the development of GERD is the frequent reflux of stomach contents into the esophagus due to the fact that the sphincter that separates these two organs (cardia) weakens and ceases to close completely. There is no specific reason why it stops closing at some point, as such. A lot of them.

The disease is associated with lifestyle, nutrition, anatomical features of the structure and functional characteristics of the gastrointestinal tract. The tone of the sphincter decreases with an increase in intra-abdominal pressure, for example, during pregnancy. Among our patients are more common obese, smokers. Reduce the tone of the cardia and the intake of certain drugs from the group of nitrates (nitroglycerin), which are used in the treatment of angina pectoris. In general, it reduces the protective functions of the gastrointestinal mucosa and causes inflammation of the frequent use of painkillers – non-steroidal anti-inflammatory drugs (NSAIDs).

At the same time, simply throwing food from the stomach into the esophagus is not yet a disease. They happen to everyone from time to time, but not everyone gets sick. The question is the frequency and aggressiveness of the contents of the stomach. In violation of the motility of the stomach and esophagus, this occurs more often, with increased acidity of gastric juice – a more aggressive effect on the mucous membrane.

– Who, on the contrary, does not have low acidity?

– It happens, but less often. In this case, the symptoms can be caused not so much by the reflux of acidic gastric contents as by the ingress of bile into the refluxant, which also aggressively affects the mucous membrane. Due to impaired motility, bile from the duodenum enters the stomach, and then with gastric contents goes up into the esophagus.
That is, acidity itself is not a strict diagnostic criterion for establishing a diagnosis; a comprehensive assessment of the state of the mucosa in the esophagus and stomach is important, which is performed with fibroesophagogastroduodenoscopy. FGDS is the main method in the diagnosis of GERD.

– Are there situations when a patient suffers from heartburn, but there are no changes on FGDS?

– Gastroenterologists often see patients complaining of debilitating heartburn that persists for a long time, which prevents them from living, although neither erosion nor ulcers are detected in the esophagus during FEGDS. Such patients undergo another diagnostically valuable study – daily pH-metry of the esophagus and stomach. With the help of the thinnest probe and a special portable device, with which the patient walks all day and leads the usual daily routine, one can understand after what and how often castings occur, what character they have. Based on the results of such a study, the doctor understands how to help such patients – save them from excruciating heartburn, thanks to a correct understanding of the nature of reflux.

– Does the disease first appear in adults?

– Optional, it often occurs in children. There is no set date for the debut.

It is believed that almost every second person in Russia has some form of GERD.

– Is it forever?

– GERD is a chronic relapsing disease. If you adhere to the prescribed diet and lifestyle, then there are high chances that exacerbations will be very rare, and may never bother you at all after the treatment. But even in this case, it is usually impossible to say that the disease has completely disappeared. If you break the rules, you’ll get aggravated.

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Give up small meals and snacks

– What foods can provoke an exacerbation? What exactly should be given up?

– First of all, from spicy and sour foods. Secondly, from products that increase gas formation (vegetables and fruits with a high fiber content, legumes, carbonated drinks, including kvass, beloved by many). It is recommended to limit the diet of pastries, rye and just fresh bread with yeast, black coffee, chocolate, as well as alcohol, especially dry and sparkling wines, beer. Too hot and cold food also causes exacerbation.

– Doctors also always advise such patients to have fractional meals – eat often, but in small portions.

– Eating 5-6 meals a day has not been shown to be effective for GERD. It is now recommended to eat 3-4 regular meals a day and avoid snacking.

The fact is that food has a buffering function — mixing with acid in the stomach, it takes part of it onto itself and removes it further through the digestive system. Whatever we eat, be it a small nut, acid will still be produced in the stomach. But the nut will obviously not be able to “take it over” – he will leave, but the acid will remain. The same thing happens when we are hungry, think about food or look at something tasty. That is, we look forward to it. Through various channels of perception, the body receives a signal to prepare, stimulation of the production of acid and other digestive substances begins. Snacks every half an hour also “cheer up” the process. In order for food to fulfill its buffer functions, you need to eat normal portions, do not starve, but do not overeat.

– Are there foods that reduce acidity or can increase the tone of the cardia so that it closes better?

– Products do not increase the tone of the cardia and by and large do not reduce the acidity in the stomach. In principle, each person has his own rhythm of hydrochloric acid production in the stomach, if we do not reduce it with special medications. It’s just that some products act more aggressively on the mucous membrane or stimulate secretion more with the help of various mechanisms. Therefore, with GERD, it is advised to refuse, including spicy dishes, spices.

– What is better to eat?

– Very good for breakfast, for example, oatmeal with water, but you can also use milk if the patient can tolerate it. It gently “binds” the acid, envelops the mucous membrane, and does not allow it to irritate. Buckwheat porridge is also suitable. From vegetables, cauliflower, pumpkin, zucchini are recommended. From the “milk” without exacerbation – all in small quantities. Sweet fruits and berries are best eaten in the form of jelly, jam, compotes. Kissel is generally the “favorite” drink of gastroenterologists.

– Are there any special recommendations for sleeping too? Like sleeping on a high pillow?

– A high pillow will not help in any way, it will only cause inconvenience. The position of the upper body matters – the esophagus should be higher than the stomach. Some of our patients put additional bases under their mattresses to elevate the body. But this is a recommendation for especially severe cases of GERD.

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Soda “ricochet”

– What to do if an attack caught you by surprise, somewhere on a trip?

– If you have heartburn, you should definitely not drink soda, as is sometimes advised. After a short subsidence of heartburn due to the alkaline environment, the so-called rebound occurs – acid production increases and the person becomes even worse.

If we talk about how to help yourself here and now, then, first of all, you need to quickly remove dangerous foods from the menu. Don’t lie down after eating. Finally, take medication to relieve symptoms. Those who have reflux often keep drugs from the group of antacids or alginates in their medicine cabinet. These drugs can absorb part of the acid, relieve pain, create a barrier that prevents food from being thrown from the stomach into the esophagus. All of them help only to quickly alleviate the condition, they cannot be called the main means for treating the disease. This requires stronger drugs.

– Which ones?

– Primary treatment for GERD is proton pump inhibitors. They suppress acid production. In addition to the already mentioned alginates and antacids, which are used in complex therapy, prokinetics are also used. These drugs normalize the motor activity of the esophagus and other parts of the gastrointestinal tract, so that food enters the stomach from the esophagus, then goes into the duodenum and beyond.

There are also H2-histamine blockers – they are also used, but less frequently. As a rule, in patients with the so-called nocturnal acid breakthrough syndrome: in some, the physiology is arranged in such a way that acid is additionally produced at night. And proton pump inhibitors sometimes cannot cope with this problem.

7 rules against heartburn:

1. Eat 3-4 meals a day;

2. Do not starve or overeat;

3. Avoid snacking;

4. Do not eat too hot or cold food;

5. Do not lie down or bend over after eating for at least 30 minutes;

6. Eat dinner at least 3 hours before bedtime;

7. Do not wear tight belts.

– Can GERD lead to cancer of the esophagus?

– With a long course of the disease and inadequate therapy (or without it), such a precancerous condition as Barrett’s esophagus can develop ( a disease in which the squamous epithelium of the mucous membrane of the esophagus begins to be replaced by a cylindrical one, which should not be there – ed.