Heartburn can be an occasional dining companion or just the price you pay for eating your favorite spicy foods.
But it can also sometimes be a sign of an underlying issue. If you find yourself reaching for the antacids more frequently than usual, you should be aware of the health conditions that could be at play.
What is heartburn?
Heartburn is a feeling of discomfort under the breastbone, usually described as a “burning” or “fiery” sensation. The medical name for what most people call heartburn is pyrosis, or acid indigestion.
Heartburn is typically caused by acid reflux, when stomach acid flows back into the esophagus — which is why it’s often experienced while lying down, bending over or taking a position that makes it physically easier for the acid to flow upward.
The most common symptoms of heartburn are:
A burning sensation in and around the middle of the chest
Sour breath
Excessive burping
When is heartburn a cause for concern?
Heartburn can often be treated without medical care, but the burning sensation can sometimes feel similar to a heart attack — so don’t wait to seek care if symptoms are severe.
Additionally, frequent or severe heartburn should not be dismissed because it can be a symptom of gastroesophageal reflux disease (GERD) or even gastrointestinal cancer. Dr. Albert Heo, a primary care physician at Houston Methodist, recommends that people who are concerned about GERD should talk with a primary care doctor or gastrointestinal specialist.
“If you’re having heartburn symptoms more than a couple times per week and for more than a few weeks, I would seek some medical help to find out what's going on," says Dr. Heo.
Dr. Heo also cautions patients to be aware of more concerning symptoms, sometimes called “red-flag symptoms” or “alarm features.” These include:
Unintentional weight loss
Loss of appetite
Blood in the stool
Dark tarry stools
Difficulty or pain with swallowing
Sudden, new symptoms, especially in people 60 and older
Heartburn can mimic heart attack symptoms
Heartburn can sometimes be very similar to heart attack symptoms. The symptoms that Dr. Heo warns can point to a cardiac issue rather than just heartburn are “a pressure-like chest pain or discomfort rather than a burning sensation, any shortness of breath or any pain or chest discomfort that radiates to your neck, jaw, arm or back.”
Dr. Heo offers another key differentiator between heartburn and heart attack: “pain that gets worse with exertion.” While heartburn does not usually increase in intensity along with an increased heart rate, heart attack pain will.
Additional risk factors that increase heartburn concern
Heartburn can also be especially concerning when it occurs in patients who are older than 60, or who have a history of other conditions including:
Ulcers
Barrett’s esophagus
Long-term use of nonsteroidal anti-inflammatory medications such as ibuprofen
Patients who have had any of these conditions or other severe gastrointestinal symptoms should be especially vigilant about frequent heartburn.
Treatment options for chronic heartburn
Depending on your medical history and the nature of your symptoms, you have a range of potential treatment avenues to address chronic heartburn. For some people, simple changes can make all the difference, while others require more serious interventions.
Lifestyle and dietary changes
Some people with mild heartburn can treat it with home remedies and lifestyle adjustments, such as weight management and changing the size and frequency of meals.
Dr. Heo says that “the main thing everyone with heartburn should try first is dietary modification.” And it’s not just eating less spicy or greasy food. In fact, dishes that are higher in acid or fat are the typical “trigger foods” for heartburn.
Dr. Heo also suggests that individuals with heartburn consider the size of their meals. Larger meals can cause acid reflux. And while a post-meal nap can be appealing, lying down after eating is another behavior to avoid if you are experiencing consistent heartburn.
Medications for chronic heartburn
Heartburn can also be treated with many over-the-counter medications, which generally fall into three categories: antacids, H2 blockers and proton pump inhibitors (PPIs).
Antacids provide quick relief for occasional heartburn by neutralizing the stomach acid. These include familiar brand-name medications like Tums, Rolaids, Mylanta and Alka-Seltzer.
H2 blockers reduce stomach acid production by inhibiting the chemical that stimulates gastric acid release. The most common H2 blocker is famotidine, the generic version of brand-name medications such as Pepcid and Zantac.
Proton pump inhibitors (PPIs) block the enzyme system that produces acid in stomach cells. They can be a more effective treatment for severe heartburn or GERD. The most common PPIs are omeprazole (Prilosec), esomeprazole (Nexium) and lansoprazole (Prevacid).
Each of these medications can offer relief, but medical experts agree that antacids, H2 blockers and PPIs are not long-term solutions to frequent heartburn. PPIs in particular can be a seemingly effective medication with risks that people may not be aware of.
“Taking PPIs for longer than your doctor suggests without addressing the underlying condition can mask issues,” Dr. Heo says, “PPIs have also been linked to nutritional deficiencies in the long term, including iron deficiencies and low bone density in older people.”
People who are dependent on antacids, H2 blockers or PPIs to treat frequent or severe heartburn should talk with a doctor about more effective long-term treatment.
Surgery for heartburn
In severe cases of heartburn or GERD — where lifestyle and diet changes are insufficient and other interventions are ineffective — surgery to reinforce the esophagus can be an effective treatment. The procedure uses tissue from the stomach and alters digestion for life, so surgery is typically used only when other treatments alone aren’t effective.
If you have severe or frequent heartburn symptoms, don’t wait to get help. While some people are accustomed to suffering through the discomfort, Dr. Heo assures that it’s reasonable and recommended to seek treatment for heartburn symptoms.
“I see at least one person with heartburn or GERD every single day,” says Dr. Heo. “For most people, we can find a workable, effective way to get their symptoms and condition under control.”
