A Guide to Heartburn

By Charles Stuart Platkin

According to the British medical journal the Lancet, heartburn is pretty common. In fact, 25 percent of Americans report experiencing heartburn at least once a month, 12 percent at least once per week and 5 percent daily. So what is heartburn? And what about gastroesophageal reflux disease (GERD)? Well, here’s a guide to provide a bit more understanding of that burning sensation in your chest.

>Why is it called heartburn?

“Heartburn is often sensed as a burning feeling behind the middle of the lower to middle of the chest, giving the sense that it may be coming from the heart,” says Philip Jaffe, M.D., an associate professor of medicine at Yale University School of Medicine.

>What is happening, biologically speaking?

According to David A. Peura, M.D., a professor of medicine at the University of Virginia Health System, “Acid that’s normally produced by the stomach is washing back up into the esophagus [the swallowing tube that carries food from the mouth to the stomach] and irritating [burning] its lining. This is generally because the muscle between the stomach and esophagus is weak or not working properly.”

>What causes heartburn?

According to Jaffe, there are a variety of causes, but anything that either weakens or overwhelms the lower esophageal sphincter (the ring of muscle or “valve” at the lower end of the esophagus), decreases stomach emptying (a condition called “gastroparesis” or mechanical gastric outlet obstruction) and/or reduces the ability of the esophagus to push food down to the stomach can cause heartburn. Common causes are obesity, excessive alcohol use, fatty food intake, eating late at night, smoking, medications, hernias, pregnancy, diabetes mellitus and scleroderma.

>What is GERD?

This is the condition that causes heartburn. It occurs when the lower esophageal sphincter does not close properly and stomach contents leak back into the esophagus.

>Is it possible to have GERD without heartburn?

The primary symptoms are continual heartburn and “acid regurgitation”; however, you can have GERD without heartburn. Some can have pain in the chest, hoarseness in the morning, a cough or trouble swallowing, adds Jaffe.

>Do spicy foods cause heartburn and/or GERD?

Spicy foods can further irritate an esophagus that has been damaged by acid reflux, and irritation of the lining of the esophagus is what causes the symptoms of heartburn, says Stuart Spechler, M.D., a professor of medicine at University of Texas Southwestern Medical Center at Dallas.

>Can heartburn be dangerous?

“Severe heartburn that does not improve with over-the-counter medication and/or is associated with ‘warning signs or symptoms,’ including weight loss, difficulty or painful swallowing, vomiting blood, associated hoarseness or persistent cough or sore throat, abrupt onset at an older age, usually over 50, should be evaluated by a health care provider,” says Peura.

>Is it dangerous to take antacids every night?

Probably not, except in situations where the patient has renal or liver disease, says Michael D. Holzman, M.D., M.P.H., of the Vanderbilt University Medical Center.

>Are there different types of heartburn?

Various distinctions have been made: erosive vs. nonerosive disease (i.e., those who have damage to the esophagus vs. those who have symptoms without esophagitis), upright vs. nocturnal (daytime vs. nighttime), and acid vs. nonacid (typically untreated vs. those who have bile and other nonacid material that continues to reflux after treatment with acid blockers) to name a few, says Jaffe.

Are you more likely to experience GERD or heartburn as you get older?

As you age, the lower esophageal sphincter may weaken. Plus, you tend to gain weight and become less physically active, all of which can increase the likelihood of reflux.

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