If you haven’t experienced the signature burning sensation in your chest or throat associated with heartburn, then you’ve likely at least seen one of the countless television ads promising to remedy it. Also referred to as acid reflux or GERD (gastroesophageal reflux disease), heartburn affects about 20 percent of Americans weekly, and it’s especially common in pregnant women. Although the condition has nothing to do with the heart, the symptoms of heartburn can sometimes feel similar to those of a heart attack and can last anywhere from several minutes to several hours.
What causes heartburn?
The reason pregnant women so often experience heartburn is the same reason anyone who is obese, constipated, or suffering the effects of overindulgence experiences it: increased pressure on the stomach. The lower esophageal sphincter (LES) normally opens to allow food into the stomach, or to allow for belching. If it opens too often or doesn’t close tightly enough, stomach acid can seep back into the esophagus and create that fiery feeling in the chest and throat.
But stomach pressure isn’t the only cause of heartburn–certain foods can be just as problematic for people prone to the condition. Tomatoes, citrus, garlic, alcohol, and caffeine (even the small amount found in chocolate!) can all trigger heartburn, as can fatty, oily meals, and even certain medications. Stress, smoking, and lack of sleep are also common culprits for increasing acid production.
What can I do to prevent and reduce heartburn symptoms?
There are a number of natural ways to keep heartburn at bay or to ease symptoms when they do come on. If you often find yourself reaching for over-the-counter medication after meals, try some of these tactics:
Eat smaller meals more often to avoid a full stomach.
Eat slowly. Filling the stomach too fast puts too much pressure on the LES.
Sit upright after meals. Lying down puts pressure on the LES.
Avoid late-night eating. Again, lying down too soon after a meal puts pressure on the LES. Try finishing your last meal 2 to 3 hours before bed.
Don’t exercise right after meals.
Don’t drink carbonated drinks. This can cause belching, which promotes acid reflux.
Avoid trigger foods like those mentioned above.
Lose weight if you need to. Being overweight can put pressure on the LES.
Stop smoking. Nicotine weakens the LES.
Avoid alcohol and caffeine.
What do I do if it still doesn’t get better?
Heartburn that doesn’t respond to the above suggestions shouldn’t be ignored, nor should you dismiss it as “just one of those things I’ll have to learn to live with.” Although heartburn is rarely a sign of a serious underlying illness, if you have heartburn that simply won’t go away, it’s time to see your primary care physician. He or she will start by taking a careful history and a physical. Then, together, you’ll decide on a course of action. In many cases, that may consist of simply trying some medication. Proton pump inhibitors (PPIs) such as omeprazole can be very effective and often curative. If these fail, your PCP may test you for a gastrointestinal infection with Helicobacter pylori, which can cause symptoms of heartburn, and which is also treatable. Less commonly, your PCP may refer you to a gastroenterologist for an upper endoscopy, but typically this can be deferred until you’ve tried other management strategies first.
If I’ve had heartburn for several weeks, what do I do?
For most people, starting out with the lifestyle interventions discussed above is a great way to begin, and for many, this will relieve heartburn pain and prevent recurrence. If your symptoms persist, try an over the counter proton pump inhibitor like omeprazole. If, after several weeks, you’re still uncomfortable, or if you’re experiencing any troubling symptoms (like weight loss, fever, trouble swallowing, or coughing up or vomiting blood) that may suggest a more serious underlying disorder, see your PCP. The underlying cause can almost always be identified and treated.