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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.
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.
What you eat can play a major role in episodes of heartburn. The following foods and beverages are common triggers:
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.
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:
When infants or children seem to be experiencing GERD, doctors sometimes order the following tests:
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:
In infants, common GERD symptoms can include:
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.
Making certain changes to your lifestyle and habits may help cut down on how often you suffer from heartburn and GERD. Some smart moves:
When infants have GERD, physicians often recommend making the following changes to feedings:
For older children, these changes may help reduce GERD:
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.
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.
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:
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:
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:
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:
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.
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.
If any of the following occur, get in touch with your healthcare provider:
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.
Some good questions to ask your doctor include:
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:
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