Heartburn and Gastroesophageal Reflux Disease (GERD)
Heartburn and Pregnancy
Medical Author: Jay W. Marks, MD
Medical Editor: Melissa Conrad Stöppler, MD
"Doctor Jay! What can I do? I'm burning up!"
Linda was 7 months pregnant and the heartburn was overwhelming. To her, it
seemed constant. She couldn't lie down at night. The discomfort of her bulging
belly was nothing in comparison.
Linda has a lot of company. Heartburn (a symptom of gastro-esophageal reflux
disease or GERD) occurs in one-quarter to one-half of all pregnant women. It
usually begins in the first or second trimester of pregnancy and continues
throughout the remainder of the pregnancy. Fortunately, the heartburn is usually
mild and intermittent, but frequently enough, it is troublesome or severe.
Complications of GERD (esophageal bleeding, trouble swallowing, loss of weight,
etc.) are uncommon. In non-pregnant circumstances, heartburn is easily and
successfully treated since there are several types of medication that are highly
effective in relieving heartburn. The problem is that we do not know how safe
these medications are for the developing fetus, and no one is going to test them
in pregnant women to find out! About the best we can do is test them in pregnant
animals at doses much higher than would ever be used in humans.
Heartburn Facts
Despite its name, heartburn has nothing to do with the heart (although some
of the symptoms are similar to a heart attack). Heartburn is an irritation of
the esophagus caused by acid that refluxes (comes up) from the stomach.
Heartburn is also a symptom of more serious gastroesophageal reflux disease, or
GERD.
When swallowing, food passes down the throat and through the esophagus to the
stomach. Normally, a muscular valve called the lower esophageal sphincter (LES)
opens to allow food into the stomach (or to permit belching); then it closes
again. Then the stomach releases strong acids to help break down the food. But
if the lower esophageal sphincter opens too often or does not close tight
enough, stomach acid can reflux or seep back into the esophagus, damaging it and
causing the burning sensation we know as heartburn.
Not only can stomach acid in the esophagus cause heartburn, but it can also
cause ulcers, strictures (narrowing) of the esophagus, and
cancer of the
esophagus.
Most people have felt heartburn at one time or another. In fact, the American
Gastroenterological Association reports that more than 60 million Americans
experience heartburn/GERD symptoms at least once each month. Though
uncomfortable, heartburn does not usually pose a serious health problem for most
people.
However, if heartburn symptoms occur frequently and persistently, it may be a
sign of a more serious problem, such as gastroesophageal reflux disease (GERD).
GERD is a chronic reflux of acid into the esophagus. Left untreated, GERD can
cause a host of complications, including esophagitis, esophageal ulcers,
hoarseness, chronic pulmonary disease, and Barrett's esophagus (a change in the
lining of the esophagus that increases the risk of developing cancer of the
esophagus).
Heartburn Symptoms
Heartburn has several symptoms, including:
- A burning feeling in the chest just behind the breastbone that occurs after
eating and lasts a few minutes to several hours.
- Chest pain, especially after bending over, lying down, or eating.
- Burning in the throat -- or hot, sour, acidic, or salty-tasting fluid at the
back of the throat.
-
Difficulty swallowing.
- Feeling of food "sticking" in the middle of the chest or throat.
Reporting these symptoms to your doctor is usually all that is needed for
your doctor to diagnose heartburn. However, your doctor may perform special
tests such as endoscopy or pH monitoring to determine the severity of your
problem or to monitor your treatment.
