Why do you experience heartburn all day. What are the signs that your heartburn may be more than just occasional discomfort. How can you distinguish between mild reflux and a more serious condition. When should you seek medical evaluation for persistent heartburn symptoms.

Understanding GERD: More Than Just Occasional Heartburn

Gastroesophageal reflux disease (GERD) is a chronic condition that goes beyond occasional bouts of heartburn. While many people experience mild reflux from time to time, persistent symptoms occurring more than twice a week may indicate GERD. This condition involves stomach acid frequently flowing back into the esophagus, potentially causing damage over time.

Dr. John Dowd, a gastroenterologist at Concord Gastroenterology Associates, explains: “Everybody has reflux. What defines whether it is a disease or not is how long the acid is in contact with the esophagus. When we see very high quantities, for very long periods of time, that’s pathologic. That designates a disease state.”

Key Symptoms of GERD

• Frequent heartburn (more than twice a week)
• Regurgitation of food or sour liquid
• Difficulty swallowing
• Chest pain
• Chronic cough
• Hoarseness or sore throat

The Spectrum of GERD: From Mild to Severe

GERD can range from mild to severe, with symptoms varying in frequency and intensity. Understanding where you fall on this spectrum is crucial for appropriate treatment and management.

Mild GERD

Mild GERD is characterized by symptoms occurring no more than twice a week. These cases can often be managed with lifestyle changes and over-the-counter medications.

Moderate to Severe GERD

When symptoms occur more frequently or are accompanied by additional concerns, it may indicate moderate to severe GERD. Dr. Dowd advises seeking medical evaluation if you experience any of the following:

• Difficulty or pain when swallowing
• Signs of gastrointestinal bleeding
• Unexplained weight loss
• Nighttime coughing
• Persistent symptoms despite over-the-counter treatments

Diagnostic Approaches for GERD

Proper diagnosis is essential for effective GERD management. Gastroenterologists use various tools and tests to assess the severity of reflux and its impact on the esophagus.

Endoscopy

An endoscopy is a common procedure used to evaluate the extent of esophageal damage caused by GERD. Dr. Dowd notes that only about a third of patients with reflux symptoms show evidence of damage during an endoscopy. However, this rate increases significantly in patients with more severe or longstanding symptoms.

Specialized Testing

In addition to endoscopy, gastroenterologists may use other specialized tests to assess the duration and frequency of acid exposure in the esophagus. These tests help determine if the reflux is pathological and requires more intensive treatment.

Treatment Options for GERD

GERD treatment typically follows a step-up approach, starting with lifestyle modifications and progressing to medication or surgical interventions if needed.

Lifestyle Changes

• Avoiding trigger foods
• Eating smaller meals
• Not lying down shortly after eating
• Elevating the head of the bed
• Quitting smoking
• Maintaining a healthy weight

Medications

For mild cases, over-the-counter antacids or H-2 blockers (e.g., Tagamet, Axid) may provide relief. More severe cases may require proton pump inhibitors (PPIs), which reduce stomach acid production. However, Dr. Dowd cautions against long-term use of PPIs without medical supervision.

Surgical Interventions

In cases where medications and lifestyle changes are ineffective, surgical options like fundoplication may be considered. This procedure strengthens the lower esophageal sphincter to prevent acid reflux.

Beyond Heartburn: When GERD Mimics Other Conditions

GERD symptoms can sometimes mimic other serious conditions, making accurate diagnosis crucial. Dr. Dowd emphasizes the importance of proper evaluation, especially when symptoms are atypical or severe.

GERD and Heart Attack Symptoms

Chest pain from GERD can sometimes be mistaken for a heart attack. Conversely, what seems like heartburn could actually be a cardiac issue. Dr. Dowd recounts cases where patients referred for GERD evaluation were ultimately sent to cardiologists due to concerning symptoms.

Respiratory Symptoms

GERD can also cause or exacerbate respiratory symptoms like chronic cough, asthma, or recurrent pneumonia. These atypical presentations may require collaboration between gastroenterologists and pulmonologists for proper diagnosis and treatment.

Long-Term Risks of Untreated GERD

Chronic, untreated GERD can lead to several serious complications, underscoring the importance of proper management and regular medical follow-up.

Esophageal Complications

• Esophagitis: Inflammation of the esophagus
• Strictures: Narrowing of the esophagus due to scar tissue
• Barrett’s esophagus: Precancerous changes in the esophageal lining
• Esophageal cancer: While rare, chronic GERD is a risk factor for this type of cancer

Extra-esophageal Complications

• Dental erosion
• Chronic laryngitis
• Worsening of asthma symptoms
• Increased risk of pneumonia

When to Seek Medical Evaluation for GERD

While occasional heartburn is common, certain symptoms warrant prompt medical attention. Dr. Dowd advises seeking evaluation from a gastroenterologist if you experience:

• Persistent heartburn occurring more than twice a week
• Difficulty or pain when swallowing
• Unexplained weight loss
• Signs of gastrointestinal bleeding (e.g., dark stools, vomiting blood)
• Nighttime coughing or choking
• Symptoms that persist despite over-the-counter treatments

Early evaluation and intervention can prevent the progression of GERD and reduce the risk of complications. Don’t hesitate to consult a healthcare professional if you’re concerned about your symptoms.

Living with GERD: Management Strategies for Long-Term Health

While GERD is a chronic condition, many people can effectively manage their symptoms and maintain a good quality of life with proper care and lifestyle adjustments.

Dietary Modifications

Identifying and avoiding trigger foods is crucial for GERD management. Common triggers include:

• Spicy foods
• Fatty or fried foods
• Citrus fruits and juices
• Tomato-based products
• Chocolate
• Caffeine
• Alcoholic beverages

Keeping a food diary can help you identify your personal triggers and make informed dietary choices.

Meal Timing and Portion Control

How and when you eat can significantly impact GERD symptoms. Consider these strategies:

• Eat smaller, more frequent meals throughout the day
• Avoid eating within 3 hours of bedtime
• Chew food thoroughly and eat slowly

Lifestyle Adjustments

In addition to dietary changes, several lifestyle modifications can help manage GERD:

• Maintain a healthy weight
• Quit smoking
• Avoid tight-fitting clothing around the abdomen
• Elevate the head of your bed by 6-8 inches
• Practice stress-reduction techniques like meditation or yoga

Medication Management

If prescribed medication for GERD, it’s important to take it as directed and communicate with your healthcare provider about any side effects or concerns. Regular follow-ups can help ensure your treatment plan remains effective and appropriate for your needs.

Alternative Therapies

Some people find relief from GERD symptoms through complementary approaches, such as:

• Acupuncture
• Herbal remedies (e.g., licorice root, chamomile)
• Relaxation techniques

Always consult with your healthcare provider before starting any alternative treatments to ensure they’re safe and won’t interact with your current medications.

By implementing a comprehensive management strategy and working closely with your healthcare team, you can effectively control GERD symptoms and minimize the risk of complications. Remember, everyone’s experience with GERD is unique, so it may take some time to find the right combination of treatments and lifestyle changes that work best for you.

Is It “Just” Heartburn or Something More Serious?

By John Dowd, DO, Concord Gastroenterology Associates

10/28/2021

When is the occasional bout of heartburn not “just heartburn”? If you are experiencing heartburn on a daily basis, it is likely time to be evaluated for gastroesophageal reflux disease (GERD). Persistent, untreated GERD may lead to more serious conditions. Sometimes, it can be a precursor to other diseases, including cancer.

John Dowd, DO, a gastroenterologist with Concord Gastroenterology Associates, provides insight into what GERD is, what it is not, and how you can address symptoms in a safe, healthy way.

Reflux Signs & Symptoms

The stomach makes a very powerful acid. This acid works to sterilize the food you eat. When acid enters the esophagus, the defense mechanisms other parts of the digestive tract possess are lacking — which causes a burning sensation.

Beyond burning, reflux can cause damage to the esophagus in the form of ulcerations or erosions, especially if it occurs on a chronic basis. “Heartburn is really a symptom of acid reflux,” states Dr. Dowd. Other symptoms that can occur as a result of reflux include cough, hoarseness, throat pain, throat clearing, chest pain, nausea, and even vomiting.

And it can be very painful — even mistaken for a heart attack. It is not infrequent that Dr. Dowd’s colleagues in the emergency department see patients for GERD-related heart attack symptoms. The first step in these cases is to assess the patient for a cardiac issue and then treat them accordingly.

In some cases, the opposite occurs. Dr. Dowd recounts situations where patients came to him for a GERD evaluation and he ultimately sent them to a cardiologist. “One patient said, ‘Every time I am going up this hill, walking my dog, I get this bad pain in my chest. And my doctor sent me here for an evaluation of reflux.’ I picked up the phone and got him an appointment with a cardiologist.”

Mild, Moderate, or Severe?

Per Dr. Dowd, “Everybody has reflux. What defines whether it is a disease or not is how long the acid is in contact with the esophagus. We do specialized testing to evaluate reflux. When we see very high quantities, for very long periods of time, that’s pathologic. That designates a disease state. When it is minimal and is cleared rapidly, people usually do not have a problem.”

Reflux is considered mild if it occurs no more than twice a week. Take this GERD risk quiz to learn more about your GERD symptoms and risks.

When Is Reflux Severe?

When individuals report suffering with symptoms more than twice a week, or if any of the below symptoms are associated with reflux, the condition requires further evaluation by a gastroenterologist.

• Difficulty swallowing
• Painful swallowing
• Evidence of gastrointestinal bleeding
• Unexplained weight loss
• Coughing at night

Typically, patients will undergo an endoscopy to determine if there is damage to the esophagus — and to what extent. According to Dr. Dowd, only about a third of patients who experience reflux have evidence of damage.

“When we identify patients who have more severe symptoms or longstanding duration of symptoms, that rate of damage goes up significantly. The rate of abnormalities seen in endoscopy is much higher. So, those patients are the ones who really need a gastroenterologist.”

Treatment Options

Patients with mild GERD symptoms are often advised to try over-the-counter antacids called H-2 blockers (e.g. Tagamet, Axid). Patients who require the next level up in therapy are given a class of drug called proton pump inhibitors (PPIs). However, these medications should not be used for long periods of time.

Ultimately, Dr. Dowd urges individuals who are suffering with symptoms to get checked out — especially those with significant indications. “Anyone who has difficulty swallowing, painful swallowing, weight loss, loss of appetite, or signs or symptoms of gastrointestinal bleeding should be evaluated by a gastroenterologist.”

Listen to the Podcast

Dr. John Dowd discusses heartburn and when you should seek help from a doctor.

Visit our podcast page to find the latest episode or subscribe to the Health Works Here Podcast on Apple Podcasts, Spotify, Google Podcasts, and wherever podcasts can be heard.

Request an Appointment

Dr. John Dowd is a board-certified gastroenterologist. For more information, or to make an appointment, fill out the form on this page or call (978) 287-3835.

Related Content

• Take this GERD risk quiz to learn more about your GERD symptoms and risks
• Learn About Concord Gastroenterology Associates
• When to See a Doctor About Common Digestive Disorders

Other Causes of Heartburn and GERD

Written by WebMD Editorial Contributors

• Besides foods, what are other causes of heartburn?
• Can exercise be a cause of heartburn?
• What should I do if I’ve changed my diet and still have heartburn?

Heartburn is that burning sensation in your chest or throat that’s caused by acid rising up from your stomach. It’s a common symptom of the condition called gastroesophageal reflux disease or GERD, which is also called acid reflux.

When you talk to your doctor about heartburn, the doctor will first ask you about your diet. That’s because eating certain foods is one of the main causes of heartburn. Coffee (including decaf), soda, tomatoes, alcohol, and chocolate are often heartburn triggers.

But eliminating foods that cause heartburn problems may not be enough. Many other factors can also play a role in triggering heartburn and causing GERD.

Other heartburn triggers include:

• Overeating. Overeating can trigger heartburn. That’s because the stomach remains distended when there are large quantities of food in it. There is a muscle located between your esophagus and your stomach. Your esophagus is a tube that lets food pass from your mouth to your stomach, and the muscle between it and your stomach is called the lower esophageal sphincter or LES. The more your stomach stays distended, the more likely the LES won’t close properly. When it doesn’t close, it can’t prevent food and stomach juices from rising back up into the esophagus.
• Eating habits. Eating too rapidly can be a heartburn trigger. So can eating while lying down or eating too close to bedtime. It helps not to eat during the two or three hours before you go to bed.
• Smoking.Smoking cigarettes is another potential cause of heartburn and GERD.
• Hiatal hernia. Your diaphragm is a muscular wall that separates your stomach from your chest. It helps the LES keep stomach acid where it belongs. When the LES and the upper part of the stomach move above the diaphragm you develop a hiatal hernia. The hernia makes acid reflux, which causes heartburn, more likely. You may not even know you have a hiatal hernia. Often, heartburn is the only symptom.
• Obesity or being overweight. Research suggests that being obese or overweight can be a trigger for heartburn and reflux disease. In one study comparing people with and people without GERD, those who had heartburn problems typically were more overweight than those without GERD.
• Medication. Common medications taken for other problems, including over-the-counter and prescription drugs, can increase the likelihood of heartburn. That includes medicines used to treat asthma, high blood pressure, heart problems, arthritis or other inflammation, osteoporosis (low bone density), anxiety, insomnia, depression, pain, Parkinson’s disease, muscle spasm, or cancer. Also, drugs used for hormone therapy can be a heartburn trigger.

Exercise can trigger heartburn. Sometimes that’s due to increased pressure on the abdomen, which can increase the risk of acid reflux. In one study looking at different types of exercise, weightlifters had the most heartburn and acid reflux. Runners had milder symptoms and less reflux than weightlifters. Cyclists had the least reflux.

If you have ruled out food as a culprit for your heartburn and suspect one of these other factors, talk with your doctor about your options for treating and preventing heartburn.

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Heartburn

Heartburn is a feeling of discomfort and burning in the upper abdomen (pit of the stomach) and in the chest (more precisely behind the sternum – along the esophagus). Heartburn is caused by acidic stomach contents entering the esophagus. For the stomach, an acidic environment is normal, it is a necessary component of the digestive process. But the esophagus is intended only for transporting food, and the ingress of acid from the stomach into it causes irritation of the mucous membrane.

Heartburn symptoms

Heartburn is often accompanied by belching and bloating (flatulence). There may be a feeling of nausea.
Heartburn appears, as a rule, after eating and can last for a considerable time – up to 2 hours or longer. Lying down and bending over can trigger or exacerbate heartburn.
In some cases, patients complain that heartburn makes swallowing difficult and interferes with sleep. In an asthmatic, heartburn can cause wheezing, coughing, and difficulty breathing.
Sometimes heartburn can be mistaken for a burning sensation in the chest caused by problems of the cardiovascular system (this is how angina pectoris can manifest itself). However, a burning sensation in the chest with angina pectoris usually occurs after exercise or stress and is not associated with food intake. In the case of angina pectoris, the burning sensation will pass if you take nitroglycerin, but nitroglycerin does not work on heartburn. If you managed to defeat heartburn with nitroglycerin, contact a cardiologist – you need to do an ECG and check the condition of the heart.

Causes of heartburn

Heartburn can occur even in a healthy person. As a direct cause of heartburn may be:

• overeating. With an excessive amount of food eaten, the stomach stretches, and the air that was in the lumen of the stomach enters the esophagus. Together with air, drops of gastric contents can also enter the esophagus;
• too many citrus fruits eaten. Citrus juice further increases the acidity in the stomach, which leads to irritation of the mucous membrane;
• spices and spices. The gastric mucosa is adapted to dishes of a certain spiciness. Eating unexpectedly spicy foods (something exotic) is very likely to give you heartburn;
• coffee if you drink too much or make it too strong;
• carbonated drinks or foods that cause gas. The gases accumulated in the stomach will exit through the esophagus (belching), and at the same time drops of the contents of the stomach will cause irritation of the mucous membrane;
• Aerophagy, i.e. swallowed air. You can swallow air, for example, if you talk while eating;
• certain drugs;
• stress;
• lifting weights and bending over immediately after eating, increasing intra-abdominal pressure.

Causes of heartburn

A number of factors favor the occurrence of heartburn . This:

• smoking. Tobacco smoke provokes the release of excess gastric juice, irritating the gastric mucosa;
• overweight (obesity). Obesity increases intra-abdominal pressure;
• pregnancy. In this case, intra-abdominal pressure rises due to the enlarged uterus;
• Too tight clothing, squeezing the abdominal cavity.

Recurrent heartburn is a symptom of many diseases of the gastrointestinal tract such as:

• reflux gastroesophageal disease;
• hiatal hernia;
• chronic gastritis with increased secretion;
• peptic ulcer of the stomach and duodenum;
• chronic pancreatitis;
• chronic cholecystitis;
• biliary dyskinesia;
• esophageal sphincter insufficiency;
• cancer of the stomach or pancreas.

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Heartburn: what to do?

With an attack of heartburn, doctors prescribe adsorbents, enveloping agents, drugs that reduce acidity. Baking soda is often used as a home remedy, but it is undesirable to use it as a regular remedy. Baking soda, although it neutralizes the acid, causes an increase in carbon dioxide when it enters the stomach, which creates increased pressure inside the stomach and can cause a second bout of heartburn.

If heartburn occurs from time to time, the presence of some chronic disease should be assumed. In this case, it is necessary to consult a gastroenterologist and undergo an examination.

Heartburn prevention

Whatever the cause of heartburn, there are measures that will definitely benefit you:

• eat right. Minimize fatty, spicy and salty foods. Try to eat less chocolate, coffee, alcohol, carbonated drinks. Avoid large meals. Food should be chewed thoroughly;
• do not go to bed immediately after eating, do not lift heavy objects or bend over;
• wear clothing that does not compress the abdominal cavity;
• watch your weight;
• quit smoking.

Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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More than half of the adult population of our planet is familiar with heartburn. A fire inside can ignite after eating, during a sports workout, or when you lie down on the couch. Few people take heartburn seriously – more often it is treated as a problem that just needs to be endured.

Sometimes heartburn is a relatively harmless consequence of eating unsuitable foods, but it is often a symptom of a serious illness that requires immediate treatment. How to recognize how big the danger is? Answers to important questions about heartburn will be given by an endoscopist of the highest category at the Medexpert LDC, Engels, President of the Association of Endoscopists of the Saratov Region Vasily Vladimirovich Gladkov.

How can I tell if I have heartburn? What sensations does a person experience with this disease?

Gladkov V.V. : Heartburn occurs when aggressive gastric juice containing hydrochloric acid enters the lower esophagus and irritates its mucous membrane. Normally, this does not happen: the esophagus is separated from the stomach by a special valve – the sphincter, which allows food to pass into the stomach, but does not allow it to get back. However, under certain conditions, the valve stops working correctly – then hydrochloric acid is thrown into the esophagus. This causes a real burn, which is felt as a burning sensation. But it is not at all necessary that patients experience a burning sensation, it can be a feeling of fullness, pressure or heat. Heartburn is most likely with increased acidity, but it can also occur with low and normal acidity of gastric juice. According to statistics, from 40 to 60% of the population of developed countries periodically feel heartburn, while 10-20% experience this condition more than once a week. Most often, heartburn occurs about 15-30 minutes after eating.

What are the main causes of heartburn?

Gladkov V.V. : There are several main causes of burning sensation: these are diseases of the gastrointestinal tract. As a rule, heartburn is one of the most common symptoms indicating problems in the digestive system, such as chronic diseases of the gastrointestinal tract (gastric ulcer, chronic gastritis with increased gastric secretion, gastroesophageal reflux). Also, a common cause of heartburn is an unbalanced diet, in particular a passion for sweets and flour products. Especially if sugar-containing foods are combined with protein: the duet causes fermentation. A rare meal, dry food can also stimulate the release of acid. And, of course, overeating. If the holidays follow one after another, or if you eat more than once every three or four hours in small portions, but chew constantly and in large quantities, then the food simply ceases to fit in the stomach and is thrown back because of this.

The cause of persistent heartburn is most likely a serious medical condition. Therefore, the often occurring burning sensation behind the sternum requires urgent intervention: delay in medical care can cost a person health, and sometimes life. In this context, modern and high-quality diagnostics is of great importance. It is important! In some cases, burning behind the sternum is a medical emergency. By the “mask” of heartburn, an attack of angina pectoris and myocardial infarction can be hidden. With timely access to a gastroenterologist and further examination, this terrible disease can be avoided, stopped at any stage.

What are the methods of diagnosing and treating heartburn?

Gladkov V.V. : The diagnosis of heartburn is complex. A thorough examination of the organs of the gastrointestinal tract, namely gastroscopy, can help establish the correct diagnosis. The endoscopic equipment used in the MedExpert LDC is represented by modern video endoscopes operating in the magnification and narrow band imaging (NBI) mode. These modes allow you to detect not only early forms of cancer, but also to see suspicious areas of the mucous membrane (precancerous changes).

Heartburn is not as harmless as many who experience it are used to thinking. If the attacks are repeated systematically, this is a reason to suspect the disease. In such cases, you can not hesitate, because the consequences can be very serious. With frequent or severe heartburn, you should consult a gastroenterologist for a diagnosis and the appointment of suitable drugs.