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Heartburn - Hints on dealing with the discomfort

Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is heartburn?

Despite its name, heartburn doesn't affect the heart. Heartburn is a burning sensation in the lower chest that may move up, along with a sour acid or bitter taste in the throat or mouth. It usually occurs after eating a big meal or while lying down. The sensation can last for as short a time as a few minutes or as long as a couple of hours.

What causes heartburn?

When you eat, food passes from your mouth down a 10-inch tube, called the esophagus. To enter the stomach, the food must pass through an opening from the esophagus to the stomach. This opening acts like a gate to allow food to pass into the stomach.

This opening to the stomach closes as soon as food passes through. If the opening doesn't close, acid in the stomach goes through the opening and up the esophagus. This is called reflux. The stomach acid can irritate the esophagus. It's the cause of heartburn.

What is hiatal hernia?

Hiatal hernia is a condition in which part of the stomach is pushed up through the diaphragm (the muscle wall between the abdomen and chest) and into the chest. Sometimes this causes heartburn but because hiatal hernia is common in people with or without heartburn; it's not the only source of heartburn.

Things that can make heartburn worse

Smoking
Coffee (both regular and decaffeinated) and other drinks that contain caffeine (i.e. colas)
Alcohol
Citrus fruits
Tomato products
Chocolate
Mints or peppermints
Fatty foods
Onions
Spicy foods (pizza, chili, curry)
NSAIDS such as ASA (an example is aspirin), Ibuprofen (examples Advil, Medipren, Motrin), COX-2 Inhibitors (an example is Celebrex)
Some other medicines (check with your doctor to find out if any apply to you)

What factors add to heartburn?

Many things can make heartburn worse. Heartburn is most common after eating too much, when bending over or when lying down. Other things that might worsen heartburn include pregnancy, being overweight, clothing that's so tight it puts pressure on your stomach, stress, certain foods and other things (see the box above).

Can heartburn be serious?

Just about everyone has heartburn now and then, but if it's left untreated, you can have severe symptoms. If heartburn goes on long enough, it can lead to esophagitis (an inflamed lining of the esophagus). If the esophagitis becomes severe, your esophagus might narrow and you might have bleeding or trouble swallowing. Heartburn can also be a sign of something more serious, such as ulcers.

What can I do to feel better?

You might be able to avoid heartburn by making some changes in your lifestyle. The box below lists some tips on how to prevent heartburn.

Tips to prevent heartburn

Raise the head of your bed by placing 4 to 6-inch blocks under the legs at the head of the bed.
Try to eat two to three hours before lying down. If you take naps, try sleeping in a chair.
Lose weight if you're overweight.
Don't overeat.
Eat high-protein, low-fat meals.
Avoid tight clothes, such as girdles and tight belts.
Certain foods bother certain people. Avoid foods and other things that give you heartburn.
Avoid tension and stress.

Will antacids take care of heartburn?

Most people get fast, short-term relief with antacids. Antacids reduce the acid that your stomach makes. Antacids can cause diarrhea or constipation. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide. (They cause diarrhea and constipation respectively, therefore counteracting each other.) Some names of antacids include Diovol, Maalox, Mylanta and Gaviscon. Follow the directions on the package. In general, take a dose of antacid about an hour after meals and at bedtime. You may want to discuss the timing of antacids with your family doctor if you are on other medications.

What if my symptoms get worse?

If lifestyle changes and antacids don't help your symptoms, talk with your doctor. Your doctor may want you to take a prescription medicine for four to eight weeks or schedule you for some tests. Tests might include x-rays to check for ulcers, tests to check for acid in the esophagus or an endoscopy to check for other conditions. For an endoscopy, a long, thin tube is inserted down your esophagus to look at it. Your doctor may also order a blood test or take a sample of your stomach lining to check for H.pylori, a bacteria that can cause ulcers.

What about other medicines?

Several kinds of medicine can be used to treat heartburn. From time to time you can use antacids for simple cases of heartburn. Acid blockers called H2 antagonists can help heartburn. Some of these are over the counter. Examples of these are rantidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid) and nizatidine (Axid). If one of these drugs doesn't control your heartburn, another good choice is proton pump inhibitors or PPI's. These medicines stop your stomach from making acid. They include omeprazole (Losec), pantoprozole (Pantoloc), lansoprazole (Prevecid), esomeprazole (Nexium) They are costly, but often work when others don't. Some people also need treatments to empty the stomach such as metoclopramide (Maxeran) or domperidone (Motilium) which are called motility agents. To find out what medicine is right for you, talk to your doctor.

Call your doctor if:

You begin having heartburn at age 50 or more
You have trouble swallowing or pain when swallowing.
You're vomiting blood.
Your stools are bloody or black.
You lose weight (greater than 5% of your usual weight) unintentionally
You feel a mass in your belly
You're having shortness of breath.
You're dizzy or lightheaded.
You have pain going into your neck, jaw, shoulder or arm.
You break out in a sweat when you have the pain.
You have heartburn often (two or more times a week)

Is heartburn associated with heart attacks?

No, not heart attacks. But sometimes pain in the chest may be mistaken for heartburn when it's really a sign of heart disease. It's also possible for heartburn to be the first sign of a complication like a bleeding ulcer. If you have any of the symptoms in the box above when you think you're just having heartburn, please call your doctor.

Revised 2007
The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor.

This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada:

The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages.

This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.