CONDITIONS

What Is Heartburn/GERD

Heartburn, also known as acid reflux, is a burning sensation in the chest, behind the lower breastbone, that often intensifies when a person is lying down or bending over. The pain usually occurs shortly after eating or at night.

Heartburn is a common symptom of a digestive disorder known as gastroesophageal reflux, or GERD, in which acid that is normally confined to the stomach backsplashes into the esophagus, a muscular passage that connects the oral cavity with the stomach. GERD is a very common problem – according to the American Gastroenterological Association, about 30 to 40 percent of Americans are affected by the disorder. The Patient Education Center at Harvard Medical School reports that about 10 percent of those suffering with the disease experience symptoms. Heartburn and GERD can affect all ages – even infants and children may develop the condition.

What Causes Heartburn/GERD

Heartburn is caused by a backup of acid from your stomach. Usually, when you swallow, a circular muscle band around your lower esophagus (called a sphincter) temporarily relaxes to let food and liquid enter your stomach, and then closes again. But when that sphincter is weak, or relaxes at the wrong time, stomach acid can travel upward into your esophagus. In infants, immature muscles may also be the reason for the condition.

Risk Factors For Heartburn/GERD

What you eat can play a major role in episodes of heartburn. The following foods and beverages are common triggers:

  • Alcohol
  • Coffee
  • Orange juice
  • Soft drinks
  • Vinegar
  • Black pepper
  • Fatty and fried foods
  • Chocolate
  • Onions
  • Ketchup
  • Mustard
  • Peppermint
  • Tomato sauce

Some of these foods, such as tomato sauce and citrus products, are acidic and cause excess acid in the stomach. Caffeinated drinks boost acid production, while alcoholic beverages relax the esophageal sphincter too much, thus making it easier for acid to backsplash into the esophagus.

In babies, GERD may occur when thickeners are added to formula or breast milk, or an infant drinks a large amount all at once, or swallows air during a feeding.

Diagnosing Heartburn/GERD

Lots of people have occasional heartburn. But if your symptoms seem persistent, speak to your doctor. According to the University of Maryland School of Pharmacy, 60% of all sufferers never consult their doctor or pharmacist, which is unfortunate, since chronic heartburn can cause complications ranging from asthma to Barrett’s Esophagus, a precursor to esophageal cancer.

Reach out to your healthcare provider: often, she’ll be able to diagnose GERD just from hearing your symptoms. Additional tests may help her determine the severity of your condition.

These tests include:

  • Upper GI endoscopy – a procedure in which a flexible tube with a tiny camera is inserted through the mouth to examine the esophagus, stomach, and upper portion of the small intestines.
  • An upper gastrointestinal series – a series of X-rays of the esophagus, stomach, and small intestine. Before the X-rays are taken, the patient must swallow a barium drink, which coats the gastrointestinal tract and makes the images easier for a radiologist to read.
  • Esophageal manometry – in this test, a thin tube is threaded through the patient’s nose into the stomach, to measure how well the esophageal sphincter is functioning.
  • PH testing, the insertion of a small tube into the esophagus to measure its acidity over 12 to 24 hours
  • A gastric emptying study to see how efficiently the stomach empties. Patients are given a meal, then imaging is performed over the next several hours by a radiologist.

When infants or children seem to be experiencing GERD, doctors sometimes order the following tests:

  • An X-ray of the chest to check for pneumonia or aspiration
  • An upper gastrointestinal series – see above
  • An endoscopy – see above
  • PH testing -see above

Symptoms of Heartburn/GERD

Heartburn feels like a burning sensation in the chest, behind the lower breastbone. It often gets worse when a person lies down or bends over. The pain usually occurs shortly after eating or at night.

Heartburn can be an occasional event, however when it’s persistent, it can be a sign of gastroesophageal reflux disease, a condition in which acid from the stomach chronically backs up into the esophagus. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), some other symptoms of GERD include:

  • Hoarseness
  • Sore throat and/or the sensation of a lump in the throat
  • A cough that won’t go away
  • Chest pain
  • Asthma

In infants, common GERD symptoms can include:

  • Spitting up or vomiting often
  • Refusing to eat
  • Acting fussy during feedings
  • Difficulty sleeping
  • Frequent crying
  • Hiccupping
  • Choking
  • Gagging
  • Wheezing or coughing repeatedly at night

Prognosis

Fortunately, the prognosis for heartburn and GERD is extremely good; most cases can be controlled with medication. A wide variety of medicines are available, as well as surgical procedures when medication doesn’t help. In infants, GERD often resolves on its own, though medication or surgery is required in rare cases.

Living With Heartburn/GERD

Making certain changes to your lifestyle and habits may help cut down on how often you suffer from heartburn and GERD. Some smart moves:

  • Maintain a healthy weight. Being overweight puts pressure on your abdomen that pushes your stomach upward, causing acid to wash into your esophagus.
  • Avoid trigger foods including alcohol, coffee, orange juice, soft drinks, vinegar, black pepper, fatty and fried foods, chocolate, onions, ketchup, mustard, peppermint, and tomato sauce.
  • Wear clothes that fit comfortably. Tight-fitting outfits squeeze your waist, putting pressure on your abdomen and lower esophagus.
  • Downsize your meals. Eating smaller ones will cut down on the pressure on your stomach.
  • Don’t lie down directly after you’ve eaten. Wait at least three hours. Stay upright for at least two hours before going to bed. Lying down makes it easier for acid to back up into your esophagus.
  • Raise the head of your bed if you often suffer heartburn in the night. If your feet are lower than your head, gravity will help prevent acid backup as you digest.
  • Quit smoking. Smoking impairs the function of the muscle band in your lower esophagus and raises the risk of heartburn.

When infants have GERD, physicians often recommend making the following changes to feedings:

  • If bottle feeding, providing smaller portions and feeding more often
  • Hold the baby semi-upright while he’s eating
  • Burp frequently throughout feedings
  • Keep the bottle nipple filled with formula or milk so the baby doesn’t swallow excess air
  • Don’t prop the bottle or add cereal or other thickeners to the liquid unless directed
  • Hold the baby upright for at least a half-hour after a feeding, and keeping him relaxed
  • Place rolled towels under the head of the crib mattress to raise it, so the baby’s head is higher than his feet as he sleeps
  • Keep the baby away from secondhand smoke, which can cause irritation

For older children, these changes may help reduce GERD:

  • Serve smaller portions at meals and urge the child not to overeat
  • Have dinner at least two hours before the child’s bedtime

Screening

If you think you or your child suffers from frequent heartburn, speak to your doctor or pediatrician. She may be able to diagnose it based on your description of the symptoms, or may order further tests.

Prevention

While there’s no way to prevent all instances of GERD, you can cut down on symptoms by making certain lifestyle changes, like avoiding trigger foods, and maintaining good health habits.

Medication And Treatment

Many medications are available for treating heartburn and GERD in adults. These include:

Antacids containing magnesium, calcium, aluminum, or some combination of these. For mild cases, they’re the medication of choice. Speak with your doctor before taking them, though, as some can interact with other medications. These include:

  • Gaviscom
  • Milk of Magnesia
  • Mylanta
  • Maalox
  • Tums

Protein pump inhibitors inhibit the production of stomach acid. Leading brands include the over-the-counter medication Prilosec, as well as prescription drugs including Nexium, Prevacid, AcipHex, Protonix and Kapidex.

H2 Blockers interfere with histamines, a chemical that encourages stomach acid formation. There are four kinds:

  • Famitodine
    • Pepcid AC
    • Pepcid Oral
  • Cimetidine
    • Tagamet
    • Tagmet HB
  • Ranitidine
    • Zantac
    • Zantac 75
    • Zantac EFFERdose
    • Zantac injection
    • Zantac Syrup
  • Nizatidine
    • Axid AR
    • Axid capsules
    • Nizatidine capsules

Sucralfate (Carafate) protects the gastrointestinal tract’s mucus lining, helping ease symptoms in people with mild or moderate GERD.

Metoclopramide (Reglan) improves gastric emptying into the duodenum, which is the first part of the small intestine.

Surgery. When other strategies fail, a surgical procedure called fundoplication may be considered—which tightens the muscle band in the lower esophagus. Other less invasive procedures are currently being tested.


Standard treatments for GERD in babies and children include:

  • Antacids such as Zantac, Prilosec, and Prevacid
  • Raglan – see above
  • Rice cereal added to formula (if formula-feeding), if the child isn’t gaining weight due to frequent vomiting. If the baby is breastfeeding, a different supplement may be recommended.
  • Formula switches, if the physician suspects the baby is allergic to the current formula being offered
  • Tube feedings, if the baby has another condition in addition to reflux, such as prematurity or congenital heart disease

Complementary and Alternative Treatment

Probiotics are moving from the realm of complementary medicine to frontline treatment for heartburn and GERD, along with other gastrointestinal conditions. Bacterial overgrowth is now understood to be a major factor in heartburn and GERD; restoring a healthy balance of intestinal bacteria is now understood to be key to overcoming these conditions. One can take probiotic supplements, and as well, eat probiotic-rich food like kefir, yogurt, sauerkraut, kimchi, kombucha, and other fermented foods.

Herbal remedies. It is not surprising that there are not many clinical studies evaluating the therapeutic potential of herbal rememdies for heartburn and GERD, though some do exist. In the USA, some naturopaths recommend chamomile, slippery elm, and licorice.

The following is a list of bitter herbs commonly used in Western and Chinese herbology:

  • Gentian root capsules
  • Barberry bark
  • Caraway
  • Dandelion
  • Fennel
  • Gentian root
  • Ginger
  • Globe artichoke
  • Goldenseal root
  • Hops
  • Milk thistle
  • Peppermint
  • Wormwood
  • Yellow dock

Guided imagery and progressive muscle relaxation have been shown to help manage the pain and discomfort of heartburn and GERD.

Acupuncture has been shown to help with the discomfort of heartburn and GERD.

 

 

 

Speak to your doctor about whether these alternative treatments might be right for you:

No alternative treatments are specifically recommended for children; speak to your physician before trying any.

 

 

 

 

Care Guide

Take all medications as prescribed by your doctor. In addition, follow smart general health practices, such as maintaining a healthy weight, refraining from smoking, and avoiding any foods known to trigger your heartburn. If your baby or child has GERD, follow all instructions from his doctor, and avoid exposing your child to secondhand smoke.

When To Contact A Doctor

If any of the following occur, get in touch with your healthcare provider:

  • Heartburn symptoms start happening more frequently or get worse
  • You or your child have trouble swallowing, or it hurts
  • You or your child have such bad heartburn that it makes you vomit
  • You find yourself (or your child, if he’s the one with GERD) losing weight
  • Over-the-counter antacids recommended by your physician haven’t helped
  • Heartburn symptoms persist even after taking any other medications your doctor has recommended
  • You or your child have become hoarse or are wheezing
  • Symptoms are interfering with daily activities

Questions For Your Doctor

Generally, you should first consult your primary-care physician if you or your child are experiencing chronic heartburn. She may be able to diagnose and treat it. Additionally, she may refer you to a gastroenterologist (who specializes in disorders of the digestive tract) for further testing and treatment.

 

To find a gastroenterologist associated with the American College of Gastroenterology (ACG), visit their website.

Questions For A Doctor

Some good questions to ask your doctor include:

  • Do you think GERD is causing this heartburn? Why? Could anything else be the reason for it?
  • Are there any tests that you think I/my child should have?
  • What is your recommended course of treatment, and why do you think it’s the best approach?
  • Will the treatment have any side effects, or cause reactions with other drugs? Will it make any other medical conditions I/my child have get worse?
  • What lifestyle changes do you think would be helpful?
  • What course do you expect the condition to take?
  • What symptoms could be a sign that the problem is getting worse? When should I contact you about them?

Resources

Thanksgiving week is GERD Awareness week, founded by the International Foundation for Functional Gastrointestinal Disorders (iffgd.org). Its website offers extensive information and research updates on heartburn and GERD. In addition:

  • The University of Maryland Medical Center’s website features a detailed overview of heartburn and GERD, including diagrams.
  • The National Library of Medicine’s MedlinePlus website gives an overview of heartburn and GERD, including an interactive multimedia tutorial
  • Boston Children’s Hospital features facts about GERD, as well as treatment options
  • NYU Langone Medical Center gives concise facts about pediatric GERD, as well as information specific to infants, adolescents, and children with disabilities