Heartburn

Heartburn usually gets worse at night, especially after eating a large meal and laying down soon after. Symptoms include:

• Bad breath
• Bitter or sour taste in the throat and mouth
• Burning sensation or pain in the chest
• A lump in your throat
• Nausea
• Pain worsens when bending over or lying down
• Sleep problems
• Vomiting

The lower esophageal sphincter (LES) is a small valve that separates the esophagus (the tube which carries food from the mouth) from the stomach. This valve usually stays closed when food is digesting in the stomach. Heartburn occurs because the esophageal sphincter becomes loose and does not close properly. This laxity allows stomach acid to travel up the esophagus, which causes the burning sensation. Certain foods (e.g., spicy foods, chocolate, alcohol, tobacco, and coffee) are associated with heartburn more so than others.

Heartburn can be a symptom of GERD (gastroesophageal reflux disease) – a gastrointestinal disorder caused by a motor abnormality in the LES, delayed stomach emptying, and anatomical factors like obesity or a hiatal hernia. Researchers have linked genetic factors to GERD.

 

• Obesity
• Increased stress levels
• Smoking
• Drinking alcoholic beverages
• Eating a heavy meal with high-fat foods
• Acidic foods
• Exercising soon after eating
• Laying down after eating a large meal
• Trigger foods – Onions, chocolate, spicy foods, citrus, peppermint, fried foods, etc.
• Medications – Tricyclic antidepressants, anti-inflammatory pain medicine, estrogen

Your physician will take a medical history, ask you about your lifestyle and dietary habits, and rule out any underlying conditions that may be causing the heartburn. Tests your physician may ask for include:

Ambulatory acid probe (pH). This involves the placement of an acid monitor into your esophagus to record when and for how long the stomach acid backs up into your esophagus. The probe is usually attached to a wireless pH monitor and, if it is in pill form, will fall off naturally and pass through your stool. You may be asked to record your symptoms, meals, and sleep patterns for a set time (usually 24 hours).

Endoscopy.  This is a nonsurgical procedure in which your physician will pass an endoscope through your mouth and throat and into your esophagus. An endoscopic exploration check for any abnormalities and a small tissue sample (biopsy) will be taken to the pathologist for analysis.

Esophageal motility testing. This test measures the movement and pressure of the muscles that move food and liquid through the esophagus and your coordination when swallowing food.

X-ray. Your physician asks for an x-ray to look at the shape and condition of your stomach and esophagus.

If your heartburn is mild, treatment involves over the counter antacids or prescription pills. If your symptoms persist and occur more than twice a week, make an appointment with your doctor. If your physician diagnoses you with GERD, treatment involves prescribing medication that cuts down the reflux to stop the damage to the lining of your esophagus. Medications include:

Antacids. Over the counter (OTC) antacids can help relieve mild cases of heartburn. You should not use OTC antacids every day or to treat severe symptoms unless ordered by your doctor. Side effects of this medicine are diarrhea or constipation.

H2 blockers. These lower the acid levels in your stomach which can help to heal the esophagus. These are available over the counter and in prescription form.

Prokinetics. Your physician may prescribe these drugs, but it is unlikely. Prokinetics cause the stomach to empty faster so there is not much acid left in the stomach after digestion. Side effects of this drug are bloating, nausea, and vomiting. They are usually prescribed for short periods because of more serious side effects.

Proton pump inhibitors (PPIs). Like H2 blockers, PPIs lower the amount of acid in your stomach by inhibiting production. These are more effective in healing the lining of your esophagus than H2 blockers. These are available over the counter and in prescription form.

In extreme cases of GERD, surgery is indicated. In these cases, a surgeon sews the top of your stomach around the end of the esophagus to stop reflux from occurring. If the reflux is related to obesity, your doctor may recommend bariatric surgery or gastric bypass.

Diet. Diets high in fiber may decrease symptoms of GERD and help you feel full and not overeat. Whole grains, root vegetables (sweet potatoes, carrots, beets), and green vegetables all are healthy high-fiber, and nutritious foods. Low acid or alkaline foods help to balance acidic stomachs. Bananas, cauliflower, fennel, melons, and nuts are all alkaline foods. Watery foods like celery, watermelon, and cucumbers help to dilute stomach acid and reduce reflux symptoms.

Chamomile. This pretty white flower is a renowned herbal relaxant and sleep remedy. A cup of chamomile tea can help fight inflammation and calm the stomach.

Licorice. This demulcent herb can relieve stomach upset and pain while soothing irritated mucus membranes and promote healing.

Marshmallow. This herb can help relieve symptoms of acid reflux. Traditionally, the tea is made from the leaves or root and used to treat sore throat, cough, and promote wound healing. Marshmallow is a demulcent, which means it protects the mucus membranes while reducing swelling and inflammation in the lining. Like slippery elm, it should not be taken with other medications.

Mind-body therapy. Stress can increase acid production in your stomach and cause acid reflux. Practicing relaxation techniques can help improve your uncomfortable symptoms and relax your mind. UW Integrative Health has a resource for breathing exercise here.

Slippery elm bark. Taken in a root bark powder form. Slippery elm bark can be mixed in water to be taken after meals and before you go to sleep to help promote gentle digestion and reduce inflammation. Do not take with other medications as the fiber in slipper bark can bind to the pill and lower efficacy.

Traditional Chinese medicine (TCM). This ancient form of medicine combines diet, herbal medicine, lifestyle changes, and acupuncture/acupressure to treat illness and disease. Consult a local acupuncturist or TCM practitioner to discuss possible approaches to treating your heartburn symptoms.

• Eat slowly with smaller servings of food
• Avoid trigger foods and beverages
• Quit smoking
• Chew your food completely
• Elevate your head while resting or sleeping by using a wedge
• Wear loose clothing
• Maintain a healthy weight
• Do not lay down right after eating

Prolonged exposure to stomach acids can cause the esophageal lining to erode and the development of painful ulcers. Chronic heartburn can also cause the esophagus to scar and narrow, which will lead to difficulties in swallowing. These damaged tissue areas are called esophageal strictures and can prevent food and liquid from reaching the stomach. Surgery is indicated in these cases in a procedure that stretches the strictures to open the esophagus.

Common triggers are:

• Alcohol
• Smoking
• Coffee
• Citrus drinks
• Tea
• Spicy foods
• Onions
• Tomato-based food and drink
• Cow’s milk
• Chocolate
• Fat
• Peppermint or spearmint
• Arginine dietary supplement
• Excessive stress

 

You may have trigger foods and beverages not listed here. You can make a diet diary that lists foods you eat to rule out what may be causing the acid reflux.

Argyrou, A., et. al. (2018, August 16). Risk factors for gastroesophageal reflux disease and analysis of genetic contributors. World Journal of Clinical Cases, 6(8), 176-182. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107529/

Gupta, E. (2020). GERD diet: Foods that help with acid reflux (heartburn). Retrieved from John Hopkins Medicine: https://www.hopkinsmedicine.org/health/wellness-and-prevention/gerd-diet-foods-that-help-with-acid-reflux-heartburn

Harvard Medical School Writing Staff. (2019, September 10). 9 ways to relieve acid reflux without medication. Retrieved from: https://www.health.harvard.edu/digestive-health/9-ways-to-relieve-acid-reflux-without-medication

Mayo Clinic Writing Staff. (2020, April 17). Heartburn. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/heartburn/diagnosis-treatment/drc-20373229#:~:text=Diagnosis%20To%20determine%20if%20your%20heartburn%20is%20a,Endoscopy%2C%20to%20check%20for%20abnormalities%20in%20your%20esophagus.

Luchterhand, C. (2012, March). An integrative approach to GERD (gastroesophageal reflux disease). Retrieved from University of Wisconsin Integrative Medicine: https://www.fammed.wisc.edu/files/webfm-uploads/documents/outreach/im/module_gerd_patient.pdf

National Institute of Diabetes and Digestive and Kidney Diseases. (2020, July). Treatment for GER and GERD. Retrieved from National Institute of Diabetes and Digestive and Kidney Diseases: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment

Oliveria, S. A., et. al. (1999, July 26). Heartburn risk factors, knowledge, and prevention strategies: A population-based survey of individuals with heartburn. Archives of Internal Medicine, 159(14), 1592-1598. Retrieved from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485088