Heartburn

Heartburn

Help to Cool the Fire

That late-night indulgence tasted so good: pepperoni pizza, cola and a bowl of mint chocolate chip ice cream. But now it's midnight, and you hurt so much it's as if your chest's on fire.

Small wonder--you consumed the perfect heartburn meal: late, large and laden with fat.

"What people eat and when they eat it are the usual causes of heartburn," says Malcolm Robinson, M.D., a gastroenterologist at the University of Oklahoma Health Sciences Center in Oklahoma City and director of the Oklahoma Foundation for Digestive Research. "And often, a change in habits can prevent it."

Heartburn is really just a teaspoon or two of stomach juices backwashing up from the stomach and into the esophagus--the tube that carries food from your mouth to your stomach. Laced with harsh hydrochloric acid, the juices burn the tender lining of the esophagus. Acid reflux, as it's known, can carve deep ulcers, lead to narrowing or even obstruction of the esophagus and cause bleeding. In rare cases, frequent reflux leads to a precancerous condition called Barrett's esophagus.

For 75 million Americans, feeling this unwelcome burn is a once- or twice-a-month experience. Another 14 million get heartburn every day, which fuels $2 to $3 billion in antacid sales every year.

The Causes of Heartburn

Usually, women and men are equally prone to heartburn. If you're pregnant, the odds are as high as 50-50 that you will experience acid reflux by your third trimester. Pregnancy, in fact, is a double whammy for heartburn--higher hormone levels relax the muscle that's supposed to keep stomach acid where it belongs, while your growing baby presses upward on your stomach.

"I've had women who end up sleeping in recliner chairs to try to control heartburn," says Deborah Gowen, a certified nurse-midwife with the Harvard Community Health Plan in Wellesley, Massachusetts, and Brigham and Women's Hospital in Boston. "And some get heartburn eating even the smallest thing. It can be tough." Luckily, it usually subsides after childbirth.

Symptoms of acid reflux--a burning sensation, chest tightness and a feeling of warmth sweeping upward into the throat--can mimic a heart attack. In fact, doctors say you should visit the emergency room, pronto, if the pain is new or especially intense. Forget what you've heard about heart attacks happening mostly to men.

"Women, like men, should go to the hospital with any strong chest pain," says Frank Hamilton, M.D., director of the Gastrointestinal Diseases Program at the National Institutes of Health in Bethesda, Maryland. "We're seeing more and more females who have increased risk factors for heart disease, so this isn't something to take lightly."

If it's just heartburn, your own habits and tastes could be the cause. Fat, alcohol, smoking and even mints and chocolates can weaken the muscle, called the lower esophageal sphincter (LES), that controls the opening between your stomach and esophagus. Carrying extra weight around your midsection and wearing tight clothing can also make the LES work less efficiently.

Meal size and timing also play a role. Gobbling hefty portions and dropping into bed is an invitation to heartburn. A full stomach puts pressure on the LES, while lying flat makes it easy for acid to flow backward.

But lifestyle doesn't always explain heartburn. Aspirin, prescription drugs, a stomach ulcer or straining to cough or have a bowel movement can also be the cause.

How to Smother the Flames

"For quick relief, nothing beats an antacid," says Dr. Robinson. "That's the best way to neutralize the acid burning inside your esophagus. But it's not a long-term solution."

Pharmacists recommend seeing your doctor if you've been popping antacids for more than two weeks. She will likely recommend changes in your lifestyle and eating habits.

For stubborn heartburn, treatment may include a prescription drug to slow the production of stomach acid. "In about 90 percent of cases, that's enough," says Dr. Hamilton. "But some people need surgery to strengthen the LES muscle. Surgeons actually pull part of the stomach up and wrap it around the lower esophagus."

There's plenty you can do to cope with heartburn at home. Here are some tips.

Reach for the right antacid. Which one? There are caplets and liquids, chewable tablets and even lozenges. But researchers at the Oklahoma Foundation for Digestive Research found that because antacids actually perform their acid-neutralizing routine most effectively in the esophagus--not in the stomach--chewables or thick liquids may be best.

"The kind that work best are the ones that stay in the esophagus as long as possible," says Dr. Robinson, who led the study. Even pregnant women can take antacids, says Gowen. "I would take one with calcium in it, like Tums, and avoid those with aluminum," she says. "Aluminum is a heavy metal that can be toxic."

Choose foods wisely. Foods and beverages that make reflux worse should be avoided. Among the bad guys are onions, chocolate, peppermint, spearmint and any fatty foods, which actually relax the LES and promote reflux. Citrus juices and fruits, tomatoes and tomato juice, spicy dishes and coffee--either decaffeinated or regular--irritate the esophagus and make the burning sensation more intense, says Dr. Robinson.

Be an early bird. Sitting down to supper three to four hours before bedtime ensures that your stomach will be empty by the time you go to sleep. "So often, people with heartburn tell me they get home late from work, eat a late dinner and fall into bed," Dr. Hamilton says. "They awake hours later with terrible burning pains. When you lie down, stomach acid flows more easily into your esophagus. If your stomach's empty, there's less acid there."

Go small and frequent. Gowen tells her pregnant patients to eat four or five small meals a day instead of three big ones. The advice can work for anyone, however. "There's less pressure to cause reflux that way," she says.

Pick a papaya. This tropical fruit contains papain, an enzyme that soothes the stomach, Gowen says. If fresh papaya isn't available, try chewable papaya tablets, available at health food stores. "Dried papaya has the enzyme, too, but since it also contains a lot of concentrated sugar, your best choice is the tablets," she says.

Hold your head up. Raising the head of your bed on cinder blocks or 6- to 12-inch wooden blocks puts gravity on your side in the nighttime battle against heartburn. Sleeping on such an incline will make it harder for stomach juices to fight gravity and climb uphill into your esophagus, says Dr. Hamilton.

Or try one of the wedge-shaped foam pillows available at stores that sell home health-care products. These pillows are long and gradually taper from a height of about six inches at your head to an inch or less below your hips. "These are good if your partner doesn't want the whole bed raised or if you sleep on a waterbed, which you cannot raise," says Dr. Robinson. "You can even take them traveling with you."

But shoving an extra pillow under your head is less effective--chances are you'll be bent in the middle and put extra pressure on your abdomen, which can cause reflux.

Lie on your left. If you must lie down after a big meal but are prone to heartburn, try lying on your left side. Studies at Thomas Jefferson Medical College in Philadelphia measured how long reflux lasted in 15 people who consumed a high-fat meal and then hit the hay--or at least the sofa. Reflux time was "significantly greater" among those resting on their right sides. Researchers speculate that lying on the right side puts the junction of the stomach and esophagus lower than the gastric pool in the stomach, making it easier for acid to seep into the esophagus.

Deflate your spare. "Even a reduction of five to ten pounds can significantly alleviate heartburn," says Dr. Hamilton. Extra weight around the midsection acts like a belt or a too-tight skirt, squeezing the esophagus and making the LES relax. "So when the muscle should be turning off the flow of acid, it's really ineffective," he says. "It can't shut as tightly as it should."

Banish the butts. Smoking weakens the LES, so "smoking can be a significant cause of reflux," says Dr. Hamilton. "When patients review their habits and work on lifestyle changes to control heartburn, a stop-smoking program is something that's always important."

Deny that drink. Alcohol can also make the LES work inefficiently, in addition to irritating an esophagus that's already burned by stomach acids. Those are two good reasons that limiting--or eliminating--beer, wine and mixed drinks is usually one of the first actions a doctor will ask you to take to control heartburn.

Loosen up. Girdles, tight belts and constricting waistbands increase the pressure on your abdomen and weaken the LES, doctors say.

Consider your medicines. Searching for the true cause of your heartburn? Don't overlook aspirin, as well as the prescription anti-asthma drug theophylline, anticholinergic medicines used to treat bowel spasms, heart medications like calcium channel blockers, and antidepressants. All can weaken the LES and cause heartburn, doctors say. Try to cut down on aspirin, and ask your doctor about dosages of the other drugs.