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Heartburn - What is it?

Heartburn and esophageal reflux is one of the most common G.I. ailments. It is caused by the reflux, or movement, of stomach acid into the esophagus. The esophagus or "swallowing tube"

is not protected from the effects of stomach acid. The acid can cause a burning sensation behind the breastbone. This can range from a mild discomfort after eating to a severe "crushing" sensation that feels like a heart attack.

Why do people get Heartburn?

The esophagus is separated from the stomach by a valve or sphincter. The lower esophageal sphincter is normally closed 

except during swallowing. The sphincter keeps the stomach contents from refluxing or returning into the esophagus. Heartburn occurs when the pressure in the stomach overcomes this valve and forces the stomach acid into the esophagus. This can occur when the valve or sphincter is too weak to prevent the reflux or when the amount of stomach acid is too great to be kept in the stomach.

Is Heartburn "normal"?

Occasional heartburn is so frequent that it is almost considered normal. Almost everybody has had some episodes of heartburn. Exercising after a heavy meal, having extremely spicy or rich foods, alcohol and pregnancy can all cause heartburn. However, when it becomes a regular occurrence or it is uncontrollable, medical advice should be sought.

Hiatus Hernia and Heartburn

The esophagus enters the stomach at the diaphragm. When this junction is above the diaphragm, a hiatus hernia occurs. Hiatus hernias do not cause heartburn. Many people have hernias without any symptoms of heartburn.

Treatment of Heartburn

People can minimize the amount of heartburn by following several simple rules.

1. Avoid chocolate, caffeine, coffee of any form and alcohol. Caffeine is found in tea and many soft drinks.

2. Stop smoking. Nicotine weakens the esophageal valve and increases stomach acid.

3. If you are overweight, lose weight. Excessive weight increases the pressure on the stomach and forces acid into the esophagus.

4. Eat moderately. Don't gorge yourself. Large meals cause more acid and more stomach contents. Smaller meals will reduce heartburn.

5. Don't exercise immediately after eating. Exercise' using abdominal muscles causes increased abdominal pressure and therefore greater pressure on the lower esophageal valve.

6. Don't eat immediately before bedtime. Stop eating at least two hours before you go to bed. Don't lie down for an hour after eating. Gravity helps keep the acid in the stomach and prevents reflux.

7. For severe heartburn, elevate the head of your bed with blocks of 4-6" to prevent nighttime heartburn.

8. Use liquid antacids for relief of occasional heartburn

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