Putting Out the Fire of Heartburn

Heartburn is a digestive problem that brings on a painful, burning sensation in the chest. But people at risk of heart attacks experience similar symptoms. So, if you suffer frequent heartburn, it's vital to find out if your problem is tied to your digestion or your heart.

"You can get one important clue by noticing when the symptoms occur," says Steven Katzman, M.D., a gastroenterologist in Livonia, Mich. "If you get heartburn right after you eat, it's probably digestive in nature. But if you have the same pain during or after exercise, it may be heart-related."

Gastroenterologists refer to heartburn as gastroesophageal reflux. It's a daily problem for about 10 percent of Americans. About twice that many have occasional bouts of reflux. Reflux occurs when hydrochloric acid produced by the stomach comes back up into the esophagus. The acid inflames the sensitive tissue there. Over time, the acid erodes the lining of the esophagus. It can also cause excessive growth—called hyperplasia—and scarring of the esophagus lining. The esophagus lining can change into a type of tissue normally found in the intestine. This is a condition called Barrett's esophagus. This condition is a precursor to cancer of the esophagus. 

Causes and cures

Reflux often is a mechanical problem, Dr. Katzman says. Reflux is more likely if the stomach is slow to empty itself of food and acid. This causes pain and discomfort. In some people, the angle at which the esophagus meets the stomach is the problem. Lying down after eating too much can cause heartburn.

Wearing tight clothing or being overweight can increase pressure within the abdomen, triggering reflux. Finally, some people produce excess stomach acid, which causes their symptoms.

Standard remedies for reflux are easy to follow. "The two most important things to avoid are alcohol and tobacco," Dr. Katzman says. "You should stay clear of tomato- and citrus-based foods, caffeine, aspirin, chocolate, and peppermint. But instead of just telling you what not to do and not to eat, your doctor should work with you to come up with a roster of substitute foods you can eat."

Home remedies that work

These preventive steps can further reduce the incidence of heartburn:

• Eat four or five small meals a day instead of three big ones.

• Drink lukewarm—not cold—water with your meals.

• Raise the head of your bed six inches to let gravity help your digestion.

• Avoid lying down after eating.

• Eat dinner at an early hour preferably four or more hours before going to bed.

• Use OTC antacids for rapid but temporary relief of occasional heartburn

• Use OTC medications such as H2 blockers or proton pump inhibitors. If symptoms persist beyond two weeks, talk with your doctor.

At the doctor's office

Many people assume they can cure heartburn themselves with over-the-counter antacids. But antacids treat the symptoms. They don't address the cause of the problem.

If your best efforts at controlling your symptoms have failed, it may be time to schedule a visit with your doctor. He or she will probably prescribe medication and ask you to make some temporary lifestyle changes, as a trial. You may need to try a different diet, avoid eating just before bedtime, and limit the size of meals. That's all it takes for many patients to see immediate improvement.

Recurrent heartburn is a symptom. Only your doctor can help you determine what your body is really trying to tell you.