Heartburn, what to know


We all know it, at least have felt it. The burning feeling in your chest and throat with a hiccup is called heartburn. This is not a disease, more likely a symptom resulting from a number of conditions like eating some hot jalapenos to the chronic Gastroesophageal reflux disease. What happens is some acidic stomach content crawling its way back up to esophagus and lower pharynx giving the characteristic burning sensation. An occasional heartburn is very common and no need to worry but if you are experiencing it on a regular basis, you might need to consult your physician.

How common is it?

It is very common as around 15 million Americans are experiencing heartburn every day. According to statistics, more than 22 percent of primary care visits are for heartburn and the number seems to increase every year. There is no man or a woman who hasn't experienced heartburn at least once in their life.

Food is supposed to go down, not up, right?

Yes, it is. Our GI system is designed for a ‘uniflow' of ingested food, unlike several animals. So in any impairment, it's bound to cause some problems. The food we eat enters into the stomach through our food pipe (esophagus) and gets mixed with the acidic gastric juices which are essential for digestion and killing microbes. Our stomach lining is highly resistant to the acidity but not our food pipe. The epithelium in the esophagus is susceptible to be eroded by regular exposure to gastric juices leading to stimulation of the nerves in the epithelium, thereby giving the typical burn. When this occurs repeatedly, the condition is called GERD (Gastro esophageal reflux disease).

What else can feel like heartburn? How to differentiate?

Everybody must know this, as a heart attack also may feel like a typical heartburn that can be neglected resulting more cardiac muscle damage. A heart attack must be treated quickly with anticoagulants and thrombolytics (e.g., streptokinase) as ‘minutes means muscle'. However, a person who frequently gets heartburn can ignore the symptoms as all heart attacks are not always excruciating. The reason behind this is the heart and esophagus are innervated with the same nervous supply. Due to this, if you having a persistent chest pain but not sure what it is, dial 911.

However, there are some clinical signs that can be used to differentiate heart attack from heartburn. Few are mentioned below.

  • Dizziness/lightheadedness common in heart attacks
  • Classical heat attack pain: Tight, squeezing or grabbing pain that radiates to left arm and sometimes to lower jaw and back. Heartburn pain is a centralized pain without radiation.
  • Cold sweats are common in a heart attack.

Nevertheless, taking patent's history and physical examination usually cannot differentiate and might need a number of investigations.

Any home remedies for heartburn?

For an infrequent heartburn, medical treatment is not needed at all. Lifestyle changes and home remedies can reduce the frequency of episodes drastically.

  • Baking soda: A spoon full of baking soda can make the heartburn go away. The sodium bicarbonate in it is a good antacid that will neutralize some of the gastric juices and when they hit your food pipe you won't get burned like before.
  • Licorice: Licorice tablets before meals can significantly reduce the reflux although it doesn't neutralize the contents.
  • Aloe: Due to its powerful anti-inflammatory properties, this soothing plant can reduce the inflammation in esophagus resulted by acid. However, it is a mild
  • Ginger root tea: Has powerful buffering effect against acid and it's ideal to take 20 minutes before meals.
  • Chamomile tea: The stress-busting ability of soothing chamomile can reduce the incidence of stress-induced

Any other lifestyle modifications?

The ugly truth is, for most episodes of heartburn poor lifestyle choices are responsible.

  • If you are getting regular heartburns it's time to cut off smoking and drink less alcohol as they can weaken the lower esophageal sphincter (LES) which acts as a valve between your food pipe and stomach causing reflux.
  • Overweight people are more prone to GERD due to the increased pressure on LES. So, try to lose some pounds through dieting and exercise.
  • No tight clothes: Seriously? Yes, tight clothes can exert more pressure on LES just like in obesity.
  • Avoid fatty and spicy foods: Limit acidic fruits and vegetables like tomatoes and oranges. Mexican and Asian cuisines may not be your type as they use chilies, peppers, and spices a lot. Avoid greasy food like hamburgers and fries as fat can trigger heartburn.
  • Avoid fizzy carbonated drinks: Carbonated drinks make carbonic acid. Which is an acid. You get it right?
  • Avoid sleeping on a full stomach: After 2 to 3 hours most of your food will be digested and moved into the duodenum (small intestine) through the pylorus. So, less reflux.
  • A diary for heartburn triggers.

Like I have emphasized, if you are feeling persistent chest pain and you are not sure, it's better to seek medical care immediately.