Heartburn

Heartburn is a burning sensation in the lower chest, behind the breastbone. It may be accompanied by nausea, bloating, belching, or a sour or bitter taste in the throat and mouth. Usually heartburn occurs while you are lying down or after you eat a large meal. Heartburn may also be a symptom of gastroesophageal reflux disease (GERD).

Causes

When you eat, a circular muscle that surrounds the lower end of your esophagus (called the LES) relaxes and opens to admit food to your stomach. The LES then closes to prevent stomach acid from washing back up the esophagus. Heartburn occurs when the LES does not close completely. Acid from the stomach then comes back up the esophagus, causing a burning sensation. A hiatal hernia may contribute to heartburn. In a hiatal hernia the upper part of the stomach is pushed through the diaphragm muscle. This makes it easier for stomach acid to enter the esophagus.

The following things can make heartburn worse:

• Cigarette smoking

• Coffee and other drinks that have caffeine

• Alcohol

• Citrus fruits

• Tomato products

• Chocolate, mints, or peppermints

• Fatty or spicy foods

• Onions

• Being overweight

• Aspirin, ibuprofen, or naproxen

• Other medications (check with your doctor)

Treatment

Heartburn can be treated with changes in diet, with over-the-counter medications, and, in some cases, surgery (see Decision Guide below). However, it can also be a sign of a more serious illness, such as ulcers, gastritis, esophagitis and stomach or esophageal cancer. Sometimes pain in the chest may be mistaken for heartburn when it's really a heart attack or heart disease.

Heartburn that is not treated properly can cause esophageal erosion , difficulties swallowing, scarring and narrowing of the esophagus, Barrett’s esophagus or other serious problems. If you have heartburn that won't go away, see your doctor.

Self-Care Steps for Heartburn

There are many things you can do that will reduce or relieve heartburn. Use the following self-care steps, and call your doctor if your symptoms do not improve after 2 weeks:

• Don't smoke.

• Don't overeat. Try more frequent, smaller meals, rather than large ones.

• Relax during mealtimes. Eat slowly and chew thoroughly.

• Lose weight if you are overweight. Your BMI should be between 18.5 and 25.

• Avoid tight-fitting clothes and tight belts.

• Don’t eat within 3 hours of bedtime. If you take naps, try sleeping in a chair.

• Avoid eating within two hours of planned exercise.

• Eat high-protein, low-fat meals. Fat delays the emptying of the stomach.

• Sleep with the head of your bed elevated. To do this, place 4- to 6-inch blocks under the legs at the head of the bed or put a foam wedge under the head of your mattress.

• Avoid foods and other things that can cause heartburn.

• Take antacids or acid controllers for temporary relief.

• Avoid chewing gum to decrease the volume of air you swallow.