Ask a Doc: Why do I have frequent heartburn?

Answer:
Heartburn is caused by acid in the stomach backing up into the esophagus. If you eat spicy, rich or highly acidic foods, they could be the culprits. Alcohol might cause it, too. While almost everyone experiences occasional heartburn, frequent bouts of it can be a sign of gastroesophageal reflux disease (GERD). If it continually occurs (more than a few times a week), this acid can cause a number of conditions and may require tests to determine the cause.

General heartburn can be treated with numerous over-the-counter antacids that work by neutralizing the acid. If heartburn persists, another class of drugs called proton pump inhibitors (PPIs) can be called upon to reduce the amount of stomach acid produced and help empty the stomach faster.  Talk with your doctor if symptoms of heartburn are not relieved with PPI treatment. Other treatments for GERD can be tested.

What does heartburn feel like?
It is most often described as a burning feeling in the chest or throat, but not everyone has this most common symptom. Other symptoms include pain in the chest, hoarseness in the morning or trouble swallowing. Some feel as though food is stuck in their throat or they have a feeling of tightness in the throat. GERD can also cause a dry cough, bad breath and sinus problems, so be aware of those signs as well.

What causes heartburn?
There are varying opinions on the cause. For some people, many of the foods and drinks most of us enjoy each day can cause heartburn. They include tomatoes, onions, citric fruits, caffeine, sodas, chocolate, alcohol, spicy foods (such as pizza), and fried and fatty foods.

There are other causes, too. Excess body fat can push on the stomach and increase gastric pressure. During pregnancy, hormone changes and the growth of the baby can place pressure on the stomach and trigger heartburn. Also, a hiatal hernia is one possibility because it allows acid to come up into the esophagus.

Can heartburn cause more serious problems?
Yes, and that’s why it is important to see your doctor if you suspect that you may have GERD. Your doctor will evaluate you for an esophageal stricture, which is a narrowing of the esophagus, making it harder to swallow foods or liquids. Your doctor may also test you for Barrett’s Esophagus (BE) and ulcers, both of which are caused by sustained exposure of the esophagus to stomach acid. Sometimes this can be a precursor to cancer of the esophagus.

What can I do to prevent heartburn?
Lifestyle changes are important, Dr. Attia points out, including:

• Eat smaller meals and avoid acidic, fatty and spicy foods.
• Don’t lie down after eating. Wait at least three hours. 
• Elevate your bed. Raising the head of your bed 6 to 8 inches can allow gravity to keep the gastric acid in your stomach. Extra support pillows can help too.
• Check your medications. Some anti-inflammatory drugs, high-blood pressure medications, asthma controllers and pain medications can increase GERD by interfering with the digestive process. (Be sure to consult your doctor before stopping medication.)
• Avoid mint if you have GERD.  Peppermint can relax the muscle between the stomach and esophagus, allowing stomach acids to flow back into the esophagus, making symptoms of heartburn worse.

Learn more about heartburn and how to best treat it by visiting chpnyc.org or calling 1-855-411-LWNY (5969).