Heartburn/Reflux

Heartburn is the burning that a person feels in the chest or throat when stomach acid and food get into the esophagus.

• Heartburn is also called acid reflux or acid indigestion.

• More serious acid reflux is called gastroesophageal reflux disease or GERD.

Signs of GERD include:

• Heartburn at least 3 times per week

• Heartburn that is severe enough to interfere with your day to day function or ability to sleep

  For more information on weak LES, weak esophagus muscle, weak stomach muscles and hiatal hernia, please explore the heartburn/reflux educational videos.

Heartburn refers to a burning feeling in the chest or throat.

Sometimes people with heartburn:

• Regurgitate their food. When the lower esophageal sphincter (LES) opens, food can move out of the stomach and into the esophagus. The food can then rise into the chest, throat, or mouth.

• Have chest pain. Some people with heartburn will feel chest pain or pressure because of acid reflux.

• Have trouble swallowing. Some people with heartburn also have trouble swallowing. This is because of the injury and scarring that can occur from long-term acid reflux.

• Belch more than usual because the LES opens more often.

• Feel like gas or air is trapped inside their chest. Some people even describe a “fizzing” sensation, like bubbles popping inside their chest.

• Feel nausea or queasiness.

• Develop head and neck symptoms like sore throat, a nagging cough, or earaches.

If you plan to see a doctor for heartburn or acid reflux symptoms, then it will be important to describe the symptoms you are experiencing. The “My History” function of MyGiHealth asks more about heartburn, reflux, and regurgitation, and can help you describe translate your symptoms into “doctor talk” should you plan to see a healthcare provider.

The most common reason people get heartburn is because acid from the stomach rises into the esophagus. There are several reasons why this can happen:

• Weak esophagus muscles. A weak esophagus may not move food or liquids through the esophagus into the stomach. This can happen when the esophagus muscles don’t squeeze normally, don’t squeeze strongly enough, or the muscles don't work together in a coordinated way.

• Weak LES. The muscular ring at the bottom of the esophagus, called the lower esophageal sphincter (LES), may be weak or open too often. This allows food to rise up, or reflux, from the stomach to the esophagus.

• Weak stomach muscles. Stomach muscles are too weak to grind up food and move it into the small intestine. This allows stomach contents to move back up into the esophagus.

• Hiatal hernia. This is when the top of the stomach bulges, or “herniates”, above the diaphragm. This weakens the barrier that keeps food from rising out of the stomach into the esophagus.

• Obesity. Obesity is more likely to cause heartburn because:

  • The LES opens more often

  • Extra weight may cause a hiatal hernia

  • Extra belly fat puts pressure on the stomach, causing acid reflux

Food can cause heartburn in three ways:

1. Foods high in acid can irritate the esophagus.
2. Certain foods, like fatty or greasy foods, can cause the lower esophageal sphincter (LES) to relax more often than normal.
3. Eating too much food stretches the stomach and causes the LES to relax more often than normal.

One of the most important ways to prevent heartburn is to avoid overeating. But there may also be specific foods that cause heartburn more than others, like:

• Rich, fatty, or fried foods
• Chocolate
• Peppermint
• Coffee
• Fizzy drinks
• Vinegar
• Tomato sauce
• Citrus fruits and juices, like lemons, oranges, or grapefruit
• Ketchup and mustard
• Alcoholic drinks, like red wine
• Spicy foods, like salsa, peppers, or hot sauce

Everyone is different. It’s important to listen to your body and learn which foods cause your heartburn.

Some ways to help control heartburn are:

• Don't overeat at mealtimes.
• After eating, wait 2 to 3 hours before lying down.
• Raise the head of the bed 3 to 6 inches with a brick or boards. (Or raise your head AND upper body 3 to 6 inches using pillows when lying down.)
• Maintain a healthy weight. (Losing weight will help overweight patients.)
• Avoid doing exercises that put extra pressure on your belly (like sit ups) if they make symptoms worse.
• Don’t smoke. Smoking can weaken the LES muscle and increase your risk of esophageal cancer.

PROS AND CONS OF THE DIFFERENT TYPES OF ACID REDUCERS

Antacids (Acid Neutralizer):

• How well it works: weak effect
• How long it works: weak effect
• How quickly it works: strong effect
• When to take: Mild, infrequent heartburn

H2 Blocker (Acid Reducer):

• How well it works: weak effect
• How long it works: medium effect
• How quickly it works: medium effect
• When to take: Mild - moderate heartburn

Proton Pump Inhibitor (PPI):

• How well it works: strong effect
• How long it works: strong effect
• How quickly it works: weak effect
• When to take: Moderate - severe, frequent heartburn

Antacids (for mild, infrequent heartburn)

Antacids neutralize acid in the stomach. This helps to ease heartburn and acid indigestion.

There are different types of antacids, which include:

• Aluminum
• Calcium
• Magnesium
• Sodium
• Combinations

Common names:

• Alka-seltzer™
• Maalox™
• Tums™
• Rolaids™

H2 Blockers (for mild to moderate heartburn)

• H2 blockers reduce the amount of acid made in the stomach. They are often called “acid reducers."
• They are used to treat heartburn caused by gastroesophageal reflux disease (GERD) and ulcers.
• Lower strengths are available over the counter. Higher strengths have to be prescribed by a doctor.

Common names:

• Tagamet™
• Pepcid™
• Axid™
• Zantac™

Proton Pump Inhibitors (for moderate to severe heartburn)

• Proton Pump Inhibitors (PPIs) stop the release of acid in the stomach.

• They are used to treat heartburn and ulcers. They're also used to heal damage in the esophagus caused by stomach acid.

• PPIs are better at treating heartburn than H2 blockers, but they do not relieve heartburn right away.

• Most PPIs are available over the counter, but a few still require a prescription.

Common names:

• Prevacid™
• Prilosec™
• Zegerid™
• Protonix™
• Aciphex™
• Nexium™

Common names:

• |Aspirin, sodium bicarbonate, and citric aci - Alka-Seltzer™
• Calcium carbonate - Tums™
• Aluminum hydroxide and magnesium hydroxide - Maalox™
• Calcium carbonate and magnesium hydroxide - Rolaids™

Caution:

Antacids can affect how other medicines work. It is best to take the medicines listed below about 2 hours before or after taking an antacid:

• Aspirin
• Chlorodiazepoxide (Librium™)
• Diazepam (Valium™)
• Digoxin (Lanoxin™)
• Ibuprofen (Advil™, Motrin™)
• Indomethacin (Indocin™)
• Iron
• Isoniazid
• Milk or foods that contain calcium
• Naproxen (Aleve™, Midol™, Naprosyn™, Pamprin™, Anaprox™)
• Pseudoephedrine
• Tetracyclines (like doxycycline, minocycline, and tetracycline)

• Aluminum carbonate
• Aluminum hydroxide
• Aluminum magnesium hydroxide
• Dihydroxyaluminum sodium carbonate

Caution:

Aluminum may cause constipation.

• Calcium carbonate

Caution:

• Calcium may cause constipation
• Calcium may cause more acid to be released if used for a long period of time

• Magnesium carbonate
• Magnesium hydroxide
• Magnesium oxide
• Magnesium trisilicate

Caution:

Magnesium may cause diarrhea.

• Sodium bicarbonate

Caution:

• Sodium may cause distension or gas
• Sodium should not be used by people with congestive heart failure, kidney failure, swelling, liver conditions, or who are on low-sodium diets

• Aluminum hydroxide and magnesium carbonate
• Aluminum hydroxide and magnesium hydroxide
• Aluminum hydroxide and magnesium trisilicate
• Calcium carbonate and magnesium carbonate
• Calcium carbonate and magnesium hydroxide
• Potassium bicarbonate and sodium bicarbonate

Generic Names:

• Cimetidine™ - Tagamet™
• Famotidine™ - Pepcid™|
• Nizatidine™ - Axid™
• Ranitidine - Zantac™

Caution:

Cimetidine affects how many other drugs work. It's best to talk to a health care provider before taking cimetidine.

Generic Names:

• Lansoprazole - Prevacid™
• Omeprazole - Prilosec™ Zegerid™
• Pantoprazole - Protonix™
• Rabeprazole - Aciphex™

Caution:

PPIs should not be taken by people with serious liver disease or low levels of magnesium.

To learn more about heartburn and reflux, please visit these websites:

• The American College of Gastroenterology

• The American Gastroenterological Association

• The International Foundation for Functional Gastrointestinal Disorders

• The National Digestive Diseases Information Clearinghouse