How to handle a heartburn

The meal tastes great … until you lie down and your chest starts burning. If you’re like many people, you have some antacids or another medication on hand for heartburn  a problem so common that it has become a multibillion-dollar business worldwide.

Heartburn, also referred to as acid reflux, happens when stomach fluid flows back (refluxes) into your esophagus (see diagram). The burning sensation often begins in your chest and spreads towards your throat. Acid regurgitation also may occur and can lead to a sour or bitter taste in your mouth. Heartburn often follows a large meal and particularly may occur while you’re lying down or bending over. Many women first experience heartburn during pregnancy, as a result of hormonal changes and pressure from the baby.

Often, occasional heartburn can be controlled with diet and lifestyle changes. Frequent heartburn may signal a more serious problem. Before you take a heartburn medication, however, take time to learn about the options. Heartburn drugs may be overused  and aren’t always needed or helpful.

A symptom, not a disease

 Heartburn isn’t a disease in itself, but rather a symptom of various conditions  most commonly, gastroesophageal reflux disease (GERD). Normally, the valve between your stomach and esophagus closes quickly after you swallow food to prevent stomach contents from coming back into the esophagus. With GERD, problems with this valve may prevent it from closing all the way, allowing stomach acids to flow backward (reflux) into the esophagus and irritate it.

Other conditions associated with heartburn include an inflamed stomach lining (gastritis), peptic ulcer, chronic abdominal discomfort (dyspepsia), and hiatal hernia, which occur when part of the stomach pushes into the chest.

Diagnosing the problem

Frequent heartburn or acid regurgitation can lead to more serious health problems if untreated. If you experience heartburn twice a week or more, have difficulty swallowing, or have accompanying nausea or unintentional weight loss, see your doctor. GERD can often be diagnosed based on signs and symptoms alone.

Chest pain from heartburn can be difficult to distinguish from pain caused by a heart problem. Get emergency medical help if you experience these warning signs of a heart attack, which may mimic a heartburn:

• Sudden pressure, tightening, squeezing or crushing pain in the center of your chest that lasts more than a few minutes or goes away and comes back.

• Pain spreading to your back, neck, jaw, shoulders or arms.

• Chest discomfort accompanied by shortness of breath, sweating, dizziness, nausea or vomiting.

• Pressure or tightness in your chest during physical activity or when you’re under emotional stress.

 Also seek prompt medical attention if: your heartburn seems worse or different from normal; you experience new chest pain; you have trouble swallowing or pain when swallowing; you’ve unintentionally lost weight or have less appetite; and you’re vomiting blood or have black stools.

Tests may be done if your signs and symptoms indicate a more serious condition, if the diagnosis isn’t clear or if your heartburn doesn’t go away with treatment. For example, your doctor may do a procedure called endoscopy  which uses a thin flexible tube with a light and camera on the end  to examine your esophagus for changes or signs of damage and take biopsy samples, if needed.

Treatment with lifestyle changes

 If you get a heartburn just once in a while, changes in your diet and lifestyle might help prevent or control your signs and symptoms. Use a diary to track whether certain foods or activities trigger or worsen your heartburn. Try these strategies, as appropriate:

• Raise the head of your bed by putting blocks under the bedposts.

• Ask your doctor to help you quit smoking. Cigarettes aggravate heartburns.

• Work on shedding excess pounds.

• Avoid foods and beverages that give you heartburns. Common triggers include coffee, alcohol, fatty and fried foods, chocolate, carbonated drinks, and mint.

• After meals, wait at least three to four hours before you lie down.

• Eat smaller meals.

• Ask your doctor if any medications you take might cause or worsen heartburn.

• Avoid tightfitting clothes, such as body shapers and belts at the waists.

Treatment with medications

If lifestyle changes don’t help, you might benefit from medication. Three main types of drugs can relieve heartburns.

• Antacids. Over-the-counter antacids, such as Maalox, Phillips Milk of Magnesia, and Tums (or abroad, Mylanta, Pepto-bismol, Rolaids, and others), are usually the first type of medication recommended for heartburn. They use different combinations of magnesium, calcium, and aluminum with other substances to neutralize the acid in your stomach. Antacids provide rapid relief that lasts about 30 minutes. They can be helpful when taken after meals or at bedtime. Side effects may include diarrhea or constipation.

• H-2-receptor blockers. Histamine-2 (H-2) receptor blockers reduce the amount of acid your stomach produces. Brand names include nizatidine (Axid), famotidine (H2 Bloc and others; in the US, Pepcid), cimetidine (Tagamet), and ranitidine (Zantac and others). These drugs take longer to work than antacids do, but can provide relief for four to 10 hours. They don’t work well for people with GERD, however, and they aren’t recommended for long-term use. Side effects may include headache, dizziness, diarrhea, and fatigue.

• Proton pump inhibitors (PPIs). This class of drugs also reduces stomach acid. They’re generally more effective and longer lasting than are the other types of heartburn drugs. Prescription PPIs include omeprazole (Losec, Omepron, Risek, and others), lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Pantoloc, Ulcepraz), rabeprazole (Pariet), and dexlansoprazole (not available in the Philippines).

 PPIs are usually taken once or twice a day (depending on the dose of the drug) about 30 minutes to an hour before you eat. Follow your doctor’s instructions for use. Usually, you should stop using the medication after 14 days, unless your doctor advises you differently. Side effects of PPIs may include headaches, abdominal pain, diarrhea, nausea, dizziness, rash, and constipation.

A more serious issue for women who take PPIs for a prolonged period of time is a possible increased risk of fractures in the hip, wrist, and spine due to decreased absorption of calcium and vitamin D. People who take PPIs for a year or more are at greatest risk. Older adults who take PPIs may also be more vulnerable to certain infections, such as pneumonia. Finally, evidence suggests that some PPIs may reduce the effectiveness of the blood-thinning drug clopidogrel (Plavix).

Usually a temporary problem

Almost everyone experiences mild heartburn from time to time. Talk to your doctor if you have heartburn more than twice a week or if it persists despite the use of medications. Heartburns shouldn’t be an everyday part of your life.