by Kimberly Allen, RN
Many of us have experienced that uncomfortable burning sensation in our chest known as heartburn at least once. In fact, 1 out 10 Americans complain of having heartburn at least once a week. And as if pregnant women don’t have enough to deal with, approximately 45% will suffer from heartburn throughout their pregnancy. Even children can experience heartburn. Some experts estimate that of children ages 3-9 years old 2% are affected by heartburn and that increases to 5% in children 10-17 years of age.
Heartburn occurs when the circular band of muscle around the entrance to the stomach separating the stomach and the esophagus becomes weakened or does not close properly. Normally when you swallow your food and/or drink, the muscle will relax allowing it to enter the stomach and then it closes. Once in the stomach, the stomach acids begin to go to work breaking down the food/drink you swallowed. These acids are very strong and corrosive. The stomach has a special mucous lining to protect it from the acids, however, the esophagus does not, so if the band of muscle at the stomachs entrance is weak or doesn’t close properly the the acid in the stomach pushes back through the muscle into the esophagus causing the burning sensation.
There are a variety of “triggers” that can lead to heartburn. The three most common triggers of heartburn are large meals, fatty foods and late-night meals. Most people experience heartburn after a large meal like Thanksgiving or Christmas dinner. When you eat a large meal you fill your stomach with too much food. This stretches the stomach weakening the band of muscle that allows food into the stomach so that it doesn’t close properly and the stomach acids to push back up into the esophagus. Fatty foods not only stay in your stomach longer they require more acid for digestion. Someone that eats a lot of fatty foods produces more acid to digest them and that increase in acid production can cause the band of muscle to become weakened or lazy which can lead to GERD, a complication of heartburn.
Most people notice the symptoms of heartburn 30-60 minutes after eating. They will complain of a burning sensation behind their breastbone that worsens when lying down or bending forward. Most people find the burning sensation improves when they sit or stand. However, if the burning sensation becomes severe and is accompanied by other symptoms like pain in your left arm or jaw or if you have difficulty breathing seek medical attention immediately, it could be a heart attack not heartburn.
Many people can treat their heartburn by simply making a few small changes. One of the most important is to maintain a healthy weight. Excess weight puts pressure on your stomach causing acid to back up into your esophagus. Avoid wearing clothes that fit tight putting pressure on your waist. Figure out what foods trigger your heartburn and try to avoid them. Eat smaller meals so you don’t stretch out your stomach putting pressure on the band of muscle at the stomach opening. And wait at least 2-3 hours after eating before lying down. Some people also find they get relief with antacids as well.
Persistant heartburn left untreated can lead to other health problems including damage to your esophagus and GERD. If you are experiencing heartburn frequently and it is causing you to have difficulty swallowing you may have GERD. If you suspect you have GERD contact your Dr for treatment before your esophagus becomes damaged.
What is GERD?
GERD also known as gastroesophageal reflux disease is a digestive disorder affecting the circular band of muscle tissue around the entrance to the stomach known as the lower esophageal sphincter or LES and the esophagus. Anyone can develop GERD from infants to adults. Experts estimate that at least 20% of Americans or approximately 6 out of every 1000 in the US suffer from GERD. GERD has also been associated with increased age and is most commonly diagnosed in people 60-70 years of age. And because our population is aging the prevalence of GERD is expected to increase. There are numerous health conditions that can increase your risk of developing GERD including obesity, Hiatal hernia, diabetes, asthma and pregnancy as well as connective tissue disorders like scleroderma to name a few.
GERD develops when there are changes to the area between the stomach and esophagus, especially the muscle known as the LES. If the LES becomes weakened and unable to close properly there is a constant reflux, or back wash of stomach acid into the esophagus. This constant reflux of acid into the esophagus can cause damage to the lining of the esophagus and lead to other complications including esophagitis, esophageal strictures, Barrettes esophagus and even cancer.
The most common symptom of GERD in adults are heartburn, difficulty swallowing and regurgitation. However, you can also experience a dry cough, sore throat, hoarseness and some people complain of feeling like there’s a lump in their throat all the time. In infants and children the symptoms differ from those of adults. They may have repeated episodes of vomiting and spitting up as well as coughing and other respiratory symptoms like wheezing. Infants may refuse food or they may cry for food but then pull away from the bottle or breast and start crying again. They tend to burp or belch frequently and have bad breath as well as fail to gain sufficient weight. Drs estimate that approximately 35% of the babies born in the US have reflux problems in their first few months of life. However , most will grow out of their reflux problems before their first birthday.
When treating GERD your Dr will usually start with over the counter medications like Maalox, Rolaids, Tums or Mylanta. There are also medications that reduce acid production known as H-2 receptor blockers like Tagamet HB, Pepcid AC, Zantac, and Axid which can be purchased over the counter. These medications provide relief for a longer period of time but they don’t act as quickly as antacids. However, these medications will not heal the esophagus if it has been damaged and is inflamed. Medications that will heal the esophagus as well as block acid production are known as proton inhibitors. These medications can also be purchased over the counter like Prevacid 24HR and Prilosec OTC. There are also prescription strength forms of both the H-2 receptor blockers as well as the proton pump inhibitors that your Dr may prescribe if you are not getting relief with the over the counter medications. There are also medications available that will strengthen the LES known as prokinetic agents. These medications promote quicker emptying of the stomach as well as tightening the valve between the esophagus and the stomach. Should your GERD not improve with medications your Dr may discuss surgical options with you, however most people obtain relief without surgery.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.