Alicia Jacobs, MD, a family medicine physician, is medical director of Colchester Family Practice, and a clinical assistant professor of Family Medicine at the Larner College of Medicine at UVM

Heartburn, otherwise known as Gastro-Esophageal Reflux Disease (GERD), is very common, affecting up to 20% of adults. The troublesome symptoms occur when acidic stomach contents move backward up into the esophagus. This acid can irritate the esophagus all the way up to the voice box and back of the throat. Reflux can simply cause burning or pain, but can also lead to erosions and ulcers.

Why have I developed heartburn?
There are lots of factors that increase your likelihood of getting heartburn. First and foremost, extra weight can put increased pressure on your belly. Second, large meals increase the pressure in the stomach. All this pressure can push acid from the stomach back up the wrong direction. In addition, some people have decreased pressure in their lower esophageal sphincter, a hiatal hernia (the stomach pushed through the diaphragm into the chest), or delayed stomach emptying – all of which can make these symptoms worse. Less commonly, these symptoms can be from something more serious such as stomach or esophageal cancer.

How do I know I have it and what can I do about it?
Usually GERD can be diagnosed in the office. Some simple lifestyle modifications can really improve symptoms:

  • weight reduction to a Body Mass Index (BMI) of less than 30, or, more ideally, less than 25;
  • avoid fatty foods, which stay in your stomach longer, or acidic tomato or citrus, which are more irritating;
  • avoid chocolate, caffeine and mint, which can relax your esophageal sphincter;
  • limit eating and drinking fluids for at least two hours before bedtime; • eat smaller meals;
  • decrease alcohol intake and smoking, both of which can increase stomach acid; and
  • elevate the head of your bed approximately 4 inches, or 2 bricks or blocks, which helps keeps stomach acid in your stomach by gravity.

Are there medicines to try?
There are some medicines to try, if the above measures cannot control your symptoms enough. Simple over-the-counter (OTC) antacids such as TUMS, Mylanta or Rolaids can significantly help with symptoms. If symptoms are more severe or occurring daily, there are also some histamine blockers that work in the stomach by helping to block acid production such as famotidine (Pepcid) or ranitidine (Zantac). These are very safe to use, even on a daily basis, and are also available OTC. Last, there are the powerful acid-blockers which block the acid pumps in our stomachs. Most easily (and cheaply) available is omeprazole OTC, but there are also many similar prescription versions (that are frequently advertised). These medicines work quite well, but can have some long term effects like vitamin deficiency and decreased bone density.

Do I need to worry about anything else?
Heartburn is usually more irritating than life threatening. However, if symptoms are severe, suddenly different or chronic over many years, they can be associated with changes in the tissue in the esophagus that can lead to cancer. Chest pain or feelings of indigestion may be related to heart disease, as well. For all of these reasons, it is safer to make a visit with your doctor to review your symptoms and pursue further evaluation as needed. Your doctor can also calculate weight goals, review healthy eating and lifestyle modifications, and make recommendations on treatment with medicines.

Alicia Jacobs, MD, a family medicine physician, is medical director of Colchester Family Practice, and a clinical assistant professor of Family Medicine at the Larner College of Medicine at UVM.

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