Heartburn

WHEN TO SEE YOUR DOCTOR

* You persistently suffer from heartburn.

* If you're suffering from sudden, severe chest pain, treat it as a medical emergency and get help immediately.

What Your Symptom Is Telling You

For all its fiery bluster, heartburn often amounts to nothing more than a false alarm. That's because most heartburn is just a couple of spoonfuls of stomach acid seeping back into your esophagus.

Of course, heartburn isn't a big concern as long it is heartburn—and not a heart attack.

"I can't tell you how many people show up in a hospital emergency room thinking they are having heartburn when they're really having a heart attack," says Jorge Herrera, M.D., assistant professor of medicine at the University of South Alabama College of Medicine in Mobile and member of the American Gastroenterological Association and the American College of Gastroenterology. "If it seems like you're having chest pain or pain unlike any heartburn you've ever experienced before, it could be a heart attack, especially if you're experiencing other symptoms, like shortness of breath, pain in your left arm or sweating."

But more often than not your pain isn't because your heart is starving for oxygen. It's because your esophagus (the food tube that leads to the stomach) is being painted with acid. How did that acid get there? There's a little "door" between your esophagus and your stomach. That door is called the lower esophageal sphincter (LES), and it opens to let food in and shuts to keep it there. Sometimes the LES swings back open and acid escapes.

A lot of different factors can reopen the door. There are foods that don't agree with you (citrus, peppermint, chocolate and fatty and spicy foods top the list). Or just eating too much food of any kind. (In fact, overweight people are more prone to heartburn than thinner people, probably because they overeat). Caffeine, smoking and alcohol are common causes. Certain medications can cause distress when taken with food. And some, like aspirin, are simply hard on the stomach. Even wearing too tight a belt can force stomach acid upward. Heartburn is also a common complaint among pregnant women.

If your heartburn is persistent and you can't connect it with anything you're putting into your mouth, it could be the symptom of an ulcer. Or it could be the result of a hiatal hernia, which is actually a small portion of the stomach that has slipped through an opening in the diaphragm, says Andrew H. Soll, M.D., a professor of medicine and director of the affiliated training program for gastroenterology at the University of California at Los Angeles and chief of gastroenterology at Veterans Administration Hospital.

Symptom Relief

If you have any hint that what you're experiencing is something other than heartburn, seek medical help right away. Also, if taking an over-the-counter antacid doesn't calm the fire within 15 minutes, you should make an appointment with your doctor for a checkup.

You should also see a doctor if your heartburn is chronic or your stomach is so sensitive that anything you eat makes you feel ill. He will evaluate you for a possible ulcer or hiatal hernia. Both can be treated with drugs, although sometimes surgery is necessary. (For more information on ulcers, see page 497.)

But if it's obvious that you've had heartburn, and you're having it again, here's what you can do.

Take an antacid. Most antacids contain chemicals that quickly absorb excess stomach acid, vanquishing a case of heartburn in no time, says Dr. Herrera.

Grab a glass of moo. Relief is as close as your refrigerator. Drinking three to four ounces of skim milk temporarily neutralizes stomach acid, says Dr. Herrera. If you're out of milk, try a glass of water. It might temporarily wash the acid out of your esophagus, he says.

Monitor your medicine. A number of medications can kick your stomach's acid production into high gear, says Dr. Soll. These include aspirin, other nonsteroidal anti-inflammatory painkillers (NSAIDs), certain heart and blood pressure medications and asthma medications. "It's unlikely that the drug alone will give you heartburn," says Dr. Herrera. "But if you are already suffering from occasional heartburn, your drugs may push you into frequent bouts."

If you suffer recurring heartburn, make a list of all prescription and over-the-counter medications you are currently taking and show it to your doctor. Your doctor may be able to suggest some alternatives.

Kick those butts. Lighting up increases stomach acid production and weakens the muscle at the end of the esophagus that is supposed to prevent stomach acid from creeping in, says Dr. Herrera.

Round up the usual suspects. Need another reason to avoid fat and alcohol? Working independently or together, the members of this double health threat can weaken the muscles that open and close your stomach, says Wendell Clarkston, M.D., assistant professor and director of the Fellowship Training Program in Gastroenterology and Hepatology at the Saint Louis University School of Medicine. "If you want to really suffer, have a double cheese pizza, a couple of beers and a few peppermints," he says.

Lose some weight. Pressure from excess weight can push stomach acid where it doesn't belong, says Dr. Soll.

Sit up straight. When you lie down within a few hours after eating a meal, stomach acid has a way of creeping into your esophagus and attacking sensitive nerve endings there, causing pain, says Dr. Clarkston.

Prop yourself up. Eating just before bed is never a good idea, but if you can't help it, you can avoid an upset stomach if you prop the head of your bed up about six inches with a couple of bricks or wooden blocks. Gravity will help prevent stomach acid from working its way into your esophagus, says Dr. Clarkston. This is a particularly helpful technique for women in the late stages of pregnancy.

Using an extra pillow will not work, by the way. It will make you bend at the middle and increase pressure on your LES.

Loosen up. Because skin-tight clothes and severely cinched belts can also push acid from the stomach into the esophagus, you should steer clear of tight-fitting outfits, says Dr. Clarkston.