Here’s a common scenario, often surfacing after enjoying an indulgent meal: “The flavors were robust and delightful; that food tasted great!” … But, minutes-to-hours later, regrets start to creep in as stinging and burning arrive in your chest and throat. Perhaps some of those flavors also revisit you in unpleasant ways. Heartburn, or gastroesophageal reflux disease (GERD), is a bothersome and sometimes painful condition affecting up to 30% of adults in the U.S.
Let’s start with definitions:
The American College of Gastroenterology (ACG) points out that, although the terms heartburn, acid reflux, and GERD are used interchangeably in conversation, their medical meanings differ:
- GERD is the name of a health condition, diagnosed by a medical professional after undergoing assessment for frequent symptoms (two or more times per week).
- Heartburn is one of many symptoms of GERD. Although GERD is the most common cause, occasionally heartburn has no relationship to GERD. For example, heartburn may also be caused by an esophageal muscle disorder or an allergic response of the esophagus.
- Acid reflux (gastroesophageal reflux) describes the reason for GERD, but actually, there may be non-acidic reflux from the stomach too!
The symptom of heartburn (in relation to GERD) happens when the muscles above the stomach are not able to contain digestive acids from your stomach after you eat. This feeling usually starts shortly after eating and can persist from minutes to hours. The acidic digestive fluids spill above the top of the stomach, creating a burning sensation along the lining of the esophagus. For this reason, the symptoms can feel worse when the stomach is able to empty into the esophagus more easily, such as bending over or lying down.
Many symptoms related to acid reflux may accompany heartburn, including:
- Sour taste
- Throat pain or irritation
- The feeling of food stuck in the throat
Symptoms of GERD can be made worse by situations that increase the stomach’s pressure, such as abdominal obesity and pregnancy. These anatomic aggravators push on the abdominal cavity and stress the muscle responsible for keeping the stomach closed to the esophagus during digestion. Another example of this is a hiatal hernia. Hiatal hernias occur when the top of the stomach migrates slightly above the diaphragm, creating unusual pressure that can cause or worsen acid reflux.
As suggested earlier, certain food and drinks are known to worsen heartburn and GERD symptoms. Coffee, tea, and carbonated beverages are shown to worsen GERD symptoms regardless of whether they contain caffeine. Acidic foods such as citrus or tomato-containing products, along with peppermint and chocolate are frequent offenders. Spicy and greasy foods, especially if eaten in large quantities or fewer than three hours before lying down, can also trigger heartburn. Similarly, some medicines may cause heartburn.
The harm from heartburn and other symptoms of GERD can range from psychological stress to physical damage. Complications from undertreated GERD have been linked to tooth decay, asthma, esophageal strictures, erosive esophagitis, and ear, nose, and throat problems. Barrett’s Esophagus is a condition resulting from long-standing GERD in which the cells lining the esophagus lose their protective characteristics, resulting in an increased risk for esophageal cancer, especially in those who smoke. Barrett’s Esophagus essentially links more severe and long-term GERD to adenocarcinoma of the esophagus.
Certain lifestyle changes are shown to lessen symptoms for those who experience acid reflux. A few examples include:
- Stop smoking
- Stop or significantly decrease alcohol
- Avoid foods and drinks that trigger symptoms
- Lose weight if you are overweight—even a modest weight loss of 5–10 pounds may make a world of difference!
- Avoid late meals and going to bed less than three hours after a meal
- Avoid large meals
- Avoid tight-fitting clothing
Most people will experience at least occasional heartburn. So, when do you need to pay attention to these symptoms and see your doctor?
One important rule of thumb is to see your doctor any time you have new chest pain. If you have any degree of doubt as to whether what you feel in your chest is heartburn, seek immediate medical attention. What may seem like acid reflux can sometimes be an emergent problem.
Other warning signs that heartburn may be a symptom of more serious causes include:
- Trouble or pain with swallowing
- Feeling as though you are choking
- No appetite or unexplained weight loss
- New stomach or abdominal pain
- Black tarry stools or bloody stools
- New symptom and over age 60
In circumstances where none of the warning signs above are present, but your heartburn occurs often, you may need to see a healthcare provider. Experts recommend that you see a medical provider if you find yourself using over-the-counter heartburn treatments more than twice per week because of your symptoms. Additionally, if you continue to have heartburn despite taking over-the-counter medicine and implementing lifestyle changes, you should see a medical professional for evaluation. You should always discuss your symptoms with your healthcare provider because they could be related to an underlying condition from heart disease, esophageal cancer, or other gastrointestinal diseases that require immediate attention.
Catiele Antunes, Abdul Aleem, Sean A. Curtis, “Gastroesophageal Reflux Disease,” StatPearls, July 18, 2021, https://www.ncbi.nlm.nih.gov/books/NBK441938/
American College of Gastroenterology, “Acid Reflux,” https://gi.org/topics/acid-reflux/
Cedars-Sinai, “Heartburn and Acid Reflux: What You Need to Know,” February 17, 2018, https://www.cedars-sinai.org/blog/what-causes-heartburn-and-acid-reflux.html
John Pandolfino, “4 important heartburn facts you should know about,” MedlinePlus, January 23, 2020, https://magazine.medlineplus.gov/article/4-important-heartburn-facts-you-should-know-about
Kristine Novak, “What Drinks Increase Risk of Reflux Symptoms?,” Digest This, September 1, 2020, https://journalsblog.gastro.org/what-drinks-increase-risk-of-reflux-symptoms/
Peter J Kahrilas, “Gastroesophageal reflux disease in adults,” UpToDate, April 6, 2020, https://www.uptodate.com/contents/gastroesophageal-reflux-disease-in-adults-beyond-the-basics