Heartburn; Non-cardiac chest pain
Heartburn is a painful burning sensation in the esophagus, just below the breastbone. The pain often rises in your chest and may radiate to your neck or throat.
Almost everyone has occasional heartburn. If you have frequent, ongoing heartburn, you may have gastroesophageal reflux disease (GERD).
Normally, when food or liquid enters your stomach, a band of muscle at the end of your esophagus (called the lower esophageal sphincter or LES) closes off the esophagus. If this muscle fails to close tightly enough, stomach contents can back up (reflux) into the esophagus. This partially digested material is usually acidic and can irritate the esophagus, causing heartburn and other symptoms.
Sometimes GERD is related to a hiatal hernia. This is when part of the stomach protrudes upward through a hole in the diaphragm, putting pressure on the LES. Heartburn can also be a side effect of many different medications.
Such drugs include:
- Calcium channel blockers for high blood pressure
- Bisphosphonates for osteoporosis
- Progestin for abnormal menstrual bleeding or birth control
- Anticholinergics (e.g., for sea sickness)
- Aspirin or ibuprofen
- Certain bronchodilators for asthma
- Tricyclic antidepressants
- Dopamine for Parkinson’s disease
- Sedatives for insomnia or anxiety
- Beta blockers for high blood pressure or heart disease
If you suspect that one of your medications may be causing heartburn, talk to your doctor. NEVER change or stop medication you take regularly without talking to your doctor. If you take an occasional aspirin or ibuprofen for headache or mild pain, try acetaminophen instead.
Heartburn can also be caused by esophageal spasm.
Pay attention to heartburn and treat it, especially if you feel symptoms often. Over time, ongoing reflux can damage the lining of your esophagus and cause serious problems. The good news is that making changes to certain habits can go a long way to preventing heartburn and other symptoms of GERD.
The following tips will help you avoid heartburn and other GERD symptoms. If these measures are not working, talk to your doctor.
First, avoid foods and beverages that can trigger reflux, such as:
- Caffeine, carbonated beverages
- Citrus fruits and juices
- Tomatoes and tomato sauces
- Spicy or fatty foods, full-fat dairy products
- Peppermint and spearmint
Next, try changing your eating habits:
- Eat smaller meals. A full stomach puts extra pressure on the lower esophageal sphincter (LES), increasing the chance that food will reflux.
- Avoid eating or lying down within 2-3 hours of bedtime. Lying down with a full stomach results in stomach contents pressing harder against the LES.
- Avoid bending over or exercising just after eating.
- Drink plenty of fluids, especially when taking medications.
Make other lifestyle changes as needed:
- Lose weight if you are overweight. Obesity increases abdominal pressure, which can push stomach contents up into the esophagus. In some cases, GERD symptoms disappear completely after an overweight person loses 10-15 pounds.
- Stop smoking. Chemicals in cigarette smoke weaken the LES.
- Sleep with your head raised about 6 inches. Sleeping with the head higher than the stomach reduces the likelihood that partially digested food will reflux into the esophagus. Place books, bricks, or blocks securely under the legs at the head of your bed. Or use a wedge-shaped pillow under your mattress. Sleeping on extra pillows does NOT work well for relieving heartburn.
- Avoid tight-fitting belts or garments around the waist. They squeeze the stomach, and may force food to reflux.
- Reduce stress. Try yoga, tai chi, or meditation.
If you still do not have full relief, try over-the-counter medications:
- Antacids, like Maalox or Mylanta, work by neutralizing stomach acid.
- H2 blockers, like Pepcid AC, Tagamet, and Zantac, reduce stomach acid production.
- Proton pump inhibitors, like Prilosec OTC, nearly stop all stomach acid production.
Call your health care provider if
Call 911 if:
- You vomit material that is bloody or black like coffee grounds.
- Your stools are black (like tar) or maroon.
- The burning sensation is accompanied by chest squeezing, crushing, or pressure. Sometimes a heart attack is mistaken for heartburn.
Call your doctor if:
- The problem becomes frequent or doesn’t go away with a few weeks of self-care.
- You start losing weight unintentionally.
- You have difficulty swallowing (food feels stuck as it goes down).
- You have a persistent, unexplained cough or wheezing.
- Your symptoms get worse with antacids or H2 blockers.
- You think that one of your medications may be causing heartburn. DO NOT change or stop your medication on your own, without discussing with your doctor.
What to expect at your health care provider’s office
If your heartburn is from GERD, it is generally not difficult to diagnose. Your symptoms, what you eat and drink, medications you are taking, and your lifestyle are usually enough to make a clear diagnosis. If the diagnosis is unclear to your doctor, one or more tests may be performed.
First, your doctor will perform a physical examination and ask questions about your heartburn, such as:
- When did it begin?
- How long does each episode last?
- Is this the first time you have had heartburn?
- What do you usually eat at each meal? Before you feel heartburn, have you eaten a spicy or fatty meal?
- Do you drink a lot of coffee, other caffeinated beverages, or alcohol? Do you smoke?
- Do you wear clothing that is tight in the chest or abdomen?
- Does the pain also appear in the chest, jaw, arm, or elsewhere?
- What medications are you taking?
- Are you vomiting blood or black material?
- Do you have blood in your stools?
- Do you have black, tarry stools?
- Are there other symptoms accompanying your heartburn?
The following tests may be performed:
- Upper GI series
- Esophageal motility to measure the pressure of your LES
- Upper endoscopy to look at the inside lining of your esophagus and stomach
If self care has not been successful, your doctor may consider prescribing you medications to reduce acid secretion. These are stronger than the medications available over the counter. Any sign of bleeding will require a more complicated treatment plan. For hiatal hernia, surgery may be necessary.
by Arthur A. Poghosian, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.