Heartburn

Heartburn

If there ever was an ailment that sounds just like it feels, it’s heartburn. Coming hard on the heels of hearty meals, it’s a searing pain in the middle of the chest. Its fiery flames, at their worst, seem to blaze all the way up from belly to throat. As the final insult, the burning is often accompanied by an acidic taste, as if the stomach was making mockery of whatever flavorful foods you’ve just enjoyed.

About the only good thing you can say about heartburn is that at least it has nothing to do with the heart, says Martin Brotman, M.D., gastroenterologist at the California Pacific Medical Center in San Francisco.

Instead, the trouble starts lower. Heartburn develops during an episode of acid reflux. That’s when stomach acid works its way back up into the esophagus (the tube that carries food from the mouth to the stomach). While the stomach has a lining to protect its tender tissues from digestive acids, the esophagus wasn’t meant to handle that hotbed of reflux irritation. As soon as the stomach acids touch unprotected esophagus, the result is heartburn, says Chesley Hines, M.D., gastroenterologist at the Center for Digestive Diseases in New Orleans.

After the age of 50, nearly half of us have a condition called hiatal hernias, which may be a setup for heartburn. To get a picture of a hiatal hernia, envision a small water balloon—that’s your stomach—inside a big airbag, your abdomen. Tear a little hole in the top of your diaphragm in your abdomen, and your stomach will protrude. As it pokes up, that protrusion presses against the muscle that connects your esophagus to your stomach. The muscle allows acid to move into your esophagus, and you end up with the burning sensation of heartburn.

Having a hiatal hernia doesn’t automatically mean you’ll develop heartburn. You’re just at a greater risk for it. And fortunately, since so many of us are destined to have it, the hiatal hernia doesn’t cause any other problems, according to Dr. Hines. Unlike other hernias, a hiatal one doesn’t necessarily need to be repaired. All you have to worry about is taking care of the heartburn, if it strikes.

But whether the heartburn is caused by the hernia or originates from some other cause, prevention and treatment are the same. Here’s what experts have to say.

Try This First

Neutralize acid now. The quickest way to get relief is to chew a couple of antacid tablets like Tums, Rolaids, or Maalox. These over-the-counter medications can quickly relieve heartburn once it starts, because they contain components that neutralize existing acid. “I like Tums because it has calcium,’’ says Robert Charm, M.D., gastroenterologist and internist in Walnut Creek, California, and professor of gastroenterology and internal medicine at the University of California, Davis. Just be sure to take that Tums with your next meal, rather than on an empty stomach. Some people over 60 have trouble absorbing calcium carbonate on an empty stomach.

Other Wise Ways

Cut it off at the pass. Prevention is the best treatment for heartburn, says Roger L. Gebhard, M.D., gastroenterologist at the Veterans Affairs Medical Center and professor of medicine in the division of gastroenterology at the University of Minnesota, both in Minneapolis. “Pay attention to what foods seem to cause your heartburn, and avoid them in the future.’’

There are a number of foods that tend to relax the tight ring of muscle (the esophageal sphincter) that separates the vulnerable esophagus from the acid-producing stomach. These include fatty foods, peppermint, coffee with or without caffeine, alcohol, and chocolate.

Meanwhile, citrus juices, tomato-based foods and sauces, and spicy foods can irritate the esophagus. Very hot or very cold beverages can cause trouble and so can super-hot or icy food. In addition, beverages such as beer, cola drinks, and milk can stimulate the overproduction of stomach acids.

Don’t dine and recline. Lying down too soon after eating often aggravates heartburn, says Dr. Charm. So allow yourself a three-hour break between eating and lying down. “You can sip a cup of decaffeinated green tea if you want a bedtime snack,’’ he adds.

Rest the right way. When you do recline, try sleeping on your left side. “Some of my patients find that they are less likely to have reflux while lying on their left sides,” says Dr. Gebhard.

Take a stroll. Instead of sitting or reclining after a meal, take a leisurely walk. If you stay upright for a while after a meal, gravity helps keep acid down in your stomach where it belongs. Too cold or too late to walk around the block? “Stroll around the house,’’ suggests Dr. Gebhard. “Check out each room or look at the pictures on the walls.’’

Make gravity a friend, not a foe. If you have heartburn at night, elevate the head of your bed six to eight inches with blocks. “More pillows under your head won’t work, because that will fold your body in half and cause acid to reflux up into the esophagus,” explains Dr. Gebhard.

Lunch like a king. Then dine like a pauper. “Try eating a bit more for lunch and then have a smaller dinner,’’ says Dr. Charm. This will help avoid nighttime heartburn.

If it’s tight, it’s not right. “Abdominal pressure from tight clothing, like a tight belt, can cause heartburn,’’ notes Dr. Gebhard. Even constipation, bending over, or lifting heavy objects can contribute to abdominal pressure and lead to heartburn.

Make meals smaller. If you overeat or indulge in large meals, that, too, can lead to abdominal pressure and heartburn. “The more there is in the stomach, the more there is to go back up the esophagus,’’ says Dr. Charm. So try to eat smaller meals and space them more frequently throughout the day.

Wet your whistle. Drink water with your meals instead of other beverages. Water rinses acid out of the esophagus and helps dilute the acid in the stomach, according to Dr. Gebhard.

Stop the smoke, cure the fire. If there weren’t already enough reasons for you to quit smoking, add heartburn to the list. Smoking relaxes the esophageal sphincter, says Dr. Charm, so it can be a major contributor to heartburn.

Mind your table manners. If you swallow too much air, it can lead to belching and burping. During the process, reflux can be released into the esophagus and aggravate heartburn, says Dr. Gebhard. To avoid gulping down air, make sure you chew with your mouth closed. Also, avoid talking while chewing, and be sure you don’t gulp down your food. In general, if you take your time during meals, the payoff will be less heartburn.

Switch pain relievers. If taking aspirin seems to kick up your heartburn, try switching to acetaminophen, recommends Dr. Gebhard. All nonsteroidal anti-inflammatory drugs, including ibuprofen, are known to cause heartburn in some people.

Don’t worry. “As we get older, we tend to worry too much,’’ says Dr. Charm. If your mind is unable to relax, chances are, your stomach won’t be able to either, and that can lead to heartburn. “But with regular relaxation, every meal, every day, can be a celebration.’’

Try an acid blocker. A new over-the-counter class of acid- reducing drugs called H₂ (histamine-2) blockers actually stops the stomach from producing acid in the first place. Pepcid AC, Axid AR, Tagamet HB, and Zantac are all capable of halting the production of stomach acid. But if you already have heartburn, don’t expect relief from an H₂ blocker for about 45 minutes. “These medications should be taken one hour before a meal that you suspect might cause you heartburn,” recommends Dr. Charm.