Why do some people experience heartburn all day long. What are the common causes of persistent heartburn. How can you differentiate between occasional heartburn and GERD. When should you seek medical attention for chronic heartburn symptoms.

Understanding the Difference Between Heartburn and GERD

Heartburn is a common digestive issue that affects millions of people worldwide. While occasional heartburn is normal, persistent symptoms may indicate a more serious condition known as gastroesophageal reflux disease (GERD). Understanding the difference between these two conditions is crucial for proper diagnosis and treatment.

Heartburn occurs when stomach acid flows back into the esophagus, causing a burning sensation in the chest or throat. GERD, on the other hand, is a chronic condition characterized by frequent acid reflux that can lead to more severe complications if left untreated.

Key Differences Between Heartburn and GERD:

• Frequency: Heartburn occurs occasionally, while GERD symptoms persist more than twice a week
• Duration: Heartburn is usually short-lived, whereas GERD symptoms can last for extended periods
• Severity: GERD symptoms are often more intense and may include additional complications
• Impact on daily life: GERD can significantly affect quality of life and require long-term management

Common Causes of Persistent Heartburn

While occasional heartburn can be triggered by various factors, persistent symptoms may have underlying causes that require medical attention. Understanding these causes can help in managing and preventing chronic heartburn.

Dietary Factors:

• Consuming large meals or eating close to bedtime
• High-fat or spicy foods
• Citrus fruits and tomato-based products
• Chocolate, mint, and carbonated beverages
• Alcohol and caffeine

Lifestyle Factors:

• Obesity or being overweight
• Smoking
• Lack of physical activity
• Stress and anxiety
• Wearing tight-fitting clothing

Medical Conditions:

• Hiatal hernia
• Pregnancy
• Certain medications (e.g., aspirin, ibuprofen, some blood pressure medications)
• Scleroderma or other connective tissue disorders

Recognizing the Symptoms of GERD

Identifying the symptoms of GERD is crucial for early diagnosis and treatment. While heartburn is the most common symptom, GERD can manifest in various ways, some of which may not be immediately associated with digestive issues.

Common GERD Symptoms:

• Persistent heartburn (burning sensation in the chest)
• Regurgitation of food or sour liquid
• Difficulty swallowing (dysphagia)
• Chest pain
• Chronic cough
• Hoarseness or sore throat
• Sensation of a lump in the throat
• Disrupted sleep due to heartburn or coughing

Are you experiencing any of these symptoms regularly? If so, it’s essential to consult a healthcare professional for proper evaluation and treatment.

Potential Complications of Untreated GERD

When left untreated, GERD can lead to various complications that may significantly impact your health and quality of life. Understanding these potential risks emphasizes the importance of seeking timely medical attention.

Possible Complications:

1. Esophagitis: Inflammation and irritation of the esophageal lining
2. Esophageal stricture: Narrowing of the esophagus due to scar tissue formation
3. Barrett’s esophagus: Changes in the esophageal lining that increase the risk of esophageal cancer
4. Esophageal cancer: A rare but serious complication of long-term, untreated GERD
5. Respiratory problems: Chronic cough, asthma, or pneumonia due to aspiration of stomach contents
6. Dental erosion: Damage to tooth enamel from frequent exposure to stomach acid

Have you been experiencing persistent heartburn or other GERD symptoms for an extended period? If so, it’s crucial to consult a gastroenterologist to assess your risk for these complications and develop an appropriate treatment plan.

Diagnostic Procedures for GERD

Accurate diagnosis of GERD is essential for effective treatment. Gastroenterologists employ various diagnostic procedures to evaluate the severity of the condition and rule out other potential causes of symptoms.

Common Diagnostic Tests:

• Upper endoscopy: A procedure that allows visualization of the esophagus, stomach, and upper small intestine
• Ambulatory acid (pH) probe test: Measures the amount of acid in the esophagus over a 24-hour period
• Esophageal manometry: Evaluates the strength and coordination of esophageal muscles
• Barium swallow radiograph: An X-ray examination that helps identify structural abnormalities
• Impedance monitoring: Detects the movement of both acidic and non-acidic fluids in the esophagus

Are you concerned about persistent heartburn or other GERD symptoms? Discussing these diagnostic options with your healthcare provider can help determine the most appropriate approach for your situation.

Treatment Options for GERD

Managing GERD often involves a combination of lifestyle changes, medications, and, in some cases, surgical interventions. The choice of treatment depends on the severity of symptoms and individual patient factors.

Lifestyle Modifications:

• Maintaining a healthy weight
• Avoiding trigger foods and large meals
• Eating slowly and not lying down immediately after meals
• Elevating the head of the bed
• Quitting smoking
• Reducing alcohol and caffeine intake

Medications:

• Antacids: Provide quick relief for occasional heartburn
• H2 blockers: Reduce stomach acid production
• Proton pump inhibitors (PPIs): Decrease acid production and allow the esophagus to heal
• Prokinetics: Strengthen the lower esophageal sphincter and help empty the stomach faster

Surgical Options:

• Fundoplication: A procedure that reinforces the lower esophageal sphincter
• LINX device: A ring of magnetic beads placed around the junction of the stomach and esophagus
• Transoral incisionless fundoplication (TIF): A less invasive endoscopic procedure

Have you tried lifestyle changes or over-the-counter medications without success? Consulting a gastroenterologist can help determine if prescription medications or surgical interventions may be appropriate for your situation.

When to Seek Medical Attention for Heartburn

While occasional heartburn is common and can often be managed with lifestyle changes and over-the-counter medications, certain symptoms warrant immediate medical attention. Recognizing these warning signs can help prevent serious complications and ensure timely treatment.

Seek Medical Care If You Experience:

• Heartburn symptoms more than twice a week
• Persistent heartburn that doesn’t respond to over-the-counter medications
• Difficulty swallowing or painful swallowing
• Unexplained weight loss or loss of appetite
• Chest pain, especially if accompanied by shortness of breath or jaw or arm pain
• Vomiting blood or passing black, tarry stools
• Chronic hoarseness or wheezing
• Nighttime reflux that interferes with sleep

Are you experiencing any of these symptoms? Don’t hesitate to consult a healthcare professional for proper evaluation and guidance.

Lifestyle Changes to Manage and Prevent GERD

Making certain lifestyle modifications can significantly reduce the frequency and severity of GERD symptoms. These changes, when implemented consistently, can improve quality of life and potentially reduce the need for medications.

Effective Lifestyle Strategies:

1. Maintain a healthy weight: Excess weight puts pressure on the abdomen, increasing the risk of acid reflux
2. Eat smaller, more frequent meals: Large meals can increase stomach pressure and exacerbate symptoms
3. Avoid trigger foods: Common triggers include spicy, fatty, or acidic foods, as well as chocolate and caffeine
4. Don’t lie down after eating: Wait at least three hours after meals before reclining
5. Elevate the head of your bed: Raising the head of your bed by 6-8 inches can help prevent nighttime reflux
6. Quit smoking: Smoking weakens the lower esophageal sphincter, increasing the risk of acid reflux
7. Manage stress: Stress can exacerbate GERD symptoms, so finding effective stress-management techniques is crucial
8. Wear loose-fitting clothes: Tight clothing can put pressure on your abdomen and lower esophageal sphincter
9. Stay upright after meals: Avoid bending over or exercising immediately after eating
10. Chew gum: Chewing sugar-free gum after meals can increase saliva production, which helps neutralize stomach acid

Have you tried implementing these lifestyle changes to manage your GERD symptoms? If you’re still experiencing persistent heartburn despite these modifications, it may be time to consult a gastroenterologist for further evaluation and treatment options.

Remember, while lifestyle changes can be effective in managing GERD symptoms, they should be used in conjunction with medical advice and treatment when necessary. Always consult your healthcare provider before making significant changes to your diet or lifestyle, especially if you have other medical conditions or are taking medications.

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.