The Cleveland Clinic

Digestive Diseases: Heartburn and Gastroesophageal Reflux Disease (GERD)

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.

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.

What causes 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 International Foundation for Functional Gastrointestinal Disorders reports that about 20%, or one in five, of Americans experience heartburn at least once a week. 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).

What Does Heartburn Feel Like?

  • 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.

What Causes Heartburn?

Various lifestyle and dietary factors can contribute to heartburn by relaxing the lower esophageal sphincter and allowing it to open, increasing the amount of acid in the stomach, increasing stomach pressure, or by making the esophagus more sensitive to harsh acids. These factors include:

Dietary habits

  • Eating large portions
  • Eating certain foods, including onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoes or tomato-based products
  • Drinking certain beverages, including citrus juices, alcohol, and caffeinated and carbonated drinks
  • Eating before bedtime

Lifestyle habits

  • Being overweight
  • Smoking
  • Wearing tight-fitting clothing or belts
  • Lying down or bending over, especially after eating
  • Stress

Medical causes

  • Pregnancy
  • Bulging of part of the stomach into the chest cavity, also called hiatal hernia .
  • GERD
  • Taking certain medications, especially some antibiotics and aspirin

How Is Heartburn Treated?

Treating heartburn requires adjustments to your lifestyle, medications, and possibly surgery if your heartburn is due to GERD.

Tips to alleviate your symptoms

  • Raise the head of your bed about 6 inches to allow gravity to help keep the stomach's contents in the stomach. (Do not use piles of pillows because this puts your body into a bent position that actually aggravates the condition by increasing pressure on the abdomen. Instead, put books under the legs of the bed to raise it up.)
  • Eat meals at least three to four hours before lying down and avoid bedtime snacks.
  • Eat smaller meals.
  • Maintain a healthy weight to eliminate unnecessary intra-abdominal pressure caused by extra pounds.
  • Limit consumption of fatty foods, chocolate, peppermint, coffee, tea, colas and alcohol -- all of which relax the lower esophageal sphincter -- and tomatoes and citrus fruits or juices, which contribute additional acid that can irritate the esophagus.
  • Give up smoking, which also relaxes the lower esophageal sphincter.
  • Wear loose belts and clothing.



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