See also:

• Gastroesophageal Reflux Disease—Adolescent
• Gastroesophageal Reflux Disease—Child
• Gastroesophageal Reflux Disease—Infant
• Gastroesophageal Reflux Disease—Children with disabilities

Definition

Heartburn is a burning feeling behind the breastbone. Stomach acid and food back up from the stomach into the esophagus. It irritates the lining of the esophagus. The pain is often worse after eating, in the evening, or when lying down or bending over.

Heartburn that occurs often and gets in the way of day-to-day life may be gastroesophageal reflux disease (GERD). It can damage your esophagus. GERD can also cause Barretts esophagus, a change in the cells that can lead to cancer.

Gastroesophageal Reflux Disease Copyright © Nucleus Medical Media, Inc.

Causes

A muscular ring controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not close completely, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are a number of reasons that the ring may not close tightly including:

• Problems with the nerves that control the muscles of the ring
• Problems with muscle tone of the ring
• Muscles that move food down into the stomach are weak
• Abnormal pressure on the area
• Increased relaxation of the muscles
• Increased pressure within the abdomen—pushes up against the stomach

Heartburn Copyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase your chance of heartburn or GERD include:

• Obesity
• Smoking
• Alcohol use
• Exercising or strenuous activity immediately after eating
• Lying down, bending over, or straining after eating
• Pregnancy
• Prior surgery for heartburn
• Diabetes
• Scleroderma
• Certain nervous system disorders
• In-dwelling nasogastric tube

Foods and drinks that are more likely to cause symptoms include:

• Caffeinated products
• Carbonated drinks
• Citrus fruits
• Chocolate
• Fried foods
• Spicy foods
• Foods made with tomatoes, such as pizza, chili, or spaghetti sauce
• Large or fatty meals

Medications and supplements that cause symptoms may include:

• Anticholinergics
• Calcium channel blockers
• Theophylline, bronchial inhalers, and other asthma medications
• Nitrates
• Sildenafil
• Bisphosphonates

Symptoms

Heartburn often occurs after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

Common symptoms may include:

• Burning feeling that starts in the lower chest and moves up the throat—most common symptom
• Regurgitation—a feeling that food is coming back up
• Sour or bitter taste in the throat
• Burping
• Bloating

The repeated, regular episodes can lead to other symptoms such as:

• Sore throat
• Hoarseness
• Chronic laryngitis
• Chronic cough
• Feeling of a lump in the throat
• Waking up with a sensation of choking
• Difficulty swallowing

Long-term complications of GERD may include:

• Inflammation and scarring of the esophagus—esophagitis
• Bleeding and ulcers in the esophagus
• Narrowing of the esophagus— esophageal stricture
• Dental problems, which may occur because of the effect of stomach acid on tooth enamel
• Asthma attacks
• Vomiting blood
• Black or tarry stools
• Precancerous condition that can lead to esophageal cancer— Barrett esophagus
• Esophageal cancer

Diagnosis

The doctor will ask about symptoms and past health. Heartburn or GERD will be suspected based on your symptoms. Your doctor may do a trial with medicine. If your symptoms are managed with medicine it will confirm GERD.

Further testing is not always needed. Your doctor may order the following to better plan treatment:

• Upper GI series
• 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
• Manometry to test muscle strength in the lower esophagus

Treatment

Treatment will depend the cause of the heartburn. The goal is to prevent further symptoms and heal any damage.

Prevention

There are no current guidelines to prevent GERD.