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.”

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

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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

How to Get Rid of Heartburn Fast

Heartburn can be an unpleasant and even painful symptom to experience. It is typically characterized by a burning sensation or discomfort in the chest, often behind the breastbone, which results from stomach acid flowing back into the esophagus. Fortunately, there are several simple methods for stopping heartburn in its tracks or reducing your chances of getting heartburn in the first place. Read on to learn how to get rid of heartburn fast. 

How To Stop Heartburn

The best way to beat heartburn is to lower your chances of experiencing it all together. By taking proactive steps to make lifestyle changes, you can avoid triggers that may exacerbate acid reflux, which may cause heartburn.

If you’re looking to decrease the frequency of heartburn and take control of your symptoms, there are a few helpful tips you can follow. These simple strategies can make a real difference in managing heartburn more effectively.

1. Maintain good eating habits

If you’re prone to experiencing heartburn, it’s wise to steer clear of trigger foods, especially those that have previously caused heartburn symptoms. Some examples of problematic foods include:

• Onions
• High-fat fried foods
• Citrus fruits like oranges
• Tomato-based products
• Alcoholic beverages

To lessen the likelihood of experiencing reflux or heartburn, it’s a good idea to avoid lying down immediately after eating. Wait two to three hours before lying down, and avoid heavy late-night meals. Opting for smaller, more frequent meals throughout the day decreases the chances of experiencing nighttime heartburn symptoms.

2. Consider weight loss

Losing weight can help lessen heartburn episodes. Studies have shown that being overweight increases abdominal pressure, which can cause stomach acid to reflux into the esophagus, causing the sensation of heartburn. Maintaining a healthy weight relieves extra pressure on the abdomen and helps prevent nagging heartburn symptoms.

3. Dress comfortably

Even your clothing choices can negatively affect your heartburn symptoms. It’s best to avoid tightfitting clothing as it adds pressure to the abdomen, increasing the risk of heartburn. Skipping tight belts and waistbands and opting for comfortable, loose clothing is a better choice.

4. Elevate the head of the bed

Elevating the head of your bed can help put an end to nighttime heartburn. The most effective approach is to place a wedge between your mattress and box spring or bed frame to achieve this. Relying on extra pillows is not recommended as they tend to shift around during the night and may not provide the necessary consistent head and upper body elevation.

When You Need Fast Relief

Over-the-counter and prescription medications can help relieve heartburn symptoms if you need immediate relief. These medications include antacids and acid blockers such as h3 blockers and proton pump inhibitors (PPI).

1. Antacids

Antacids like Pepto-Bismol and calcium carbonate neutralize stomach acid, promptly relieving heartburn symptoms. Antacids work right away, though they do not treat the underlying cause of heartburn.

2. h3 Blockers

h3 blockers such as cimetidine and famotidine reduce stomach acid production, delivering longer-lasting relief. They typically begin working within the hour and provide up to 12 hours of relief.

3. Proton pump inhibitors

PPIs like omeprazole and esomeprazole decrease stomach acid production and offer extended relief for heartburn. PPIs have a delayed onset of action and can take a few days to be effective, but they provide extended relief.

For severe cases of heartburn, a prescription may be required for more potent doses of antacid medications.

When To See a Doctor

You should see your doctor if you are experiencing persistent heartburn that doesn’t respond to lifestyle changes or medications or if you have any of the following symptoms:

• Difficulty swallowing
• Unintended weight loss
• Chest pain
• Worsening heartburn

Evaluating your symptoms to rule out more complicated conditions such as gastroesophageal reflux disorder (GERD) is essential.

If you are bothered by chronic heartburn symptoms, schedule an appointment today!

Request Appointment

Related:

• Everything you need to know about heartburn
• The Secret to Beating Heartburn Without MedicationThe Best Heartburn Tips You’ll Read Today
• Heartburn Medicine Options: What You Should Know

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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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Heartburn – causes, how to treat.

12/15/2020

A huge number of people suffer from heartburn. According to various sources, from 60 to 70% of the total population of Russia are faced with this disease. So what is heartburn. Heartburn occurs when the acid in the stomach backs up into the esophagus (reflux). Normally, this should not happen. Between the stomach and esophagus is a sphincter valve that must contract. If it does not completely block the passage, the contents of the stomach are partially thrown into the esophagus. The walls of the stomach are lined with an epithelium that tolerates an acidic environment (PH-3), while the walls of the esophagus have a different structure and therefore the acid that enters the walls of the esophagus harms it.

How does heartburn manifest itself?

Approximately 40% of people with heartburn experience a burning sensation in the chest. There are those who feel bitterness in the mouth. Someone has an eructation and even a cough, sore throats …

Important! Sometimes heartburn can masquerade as angina pectoris, or maybe it really is a burning sensation in the chest – this is a heart disease.

Should heartburn be treated?

Heartburn must be treated. If you have symptoms of heartburn, you should contact a gastroenterologist. A persistently irritated esophagus can eventually lead to Barrett’s syndrome (precancerous condition), in 2% of cases it can even lead to cancer. Also, heartburn can be a symptom of stomach ulcers, gallbladder disorders, etc. In addition, heartburn, of course, affects the quality of life. A person is not comfortable playing sports, he cannot afford much from food and drinks.

What causes heartburn?

Coffee, alcohol, especially red wine, hot tea, kefir, citrus fruits, vinegar, fatty foods, spicy foods, overeating. In addition to drinks and food, stressful situations are a provocateur of heartburn.