Doesn't everyone get heartburn?
Heartburn is very common. Nearly 40% of Americans experience it at least once a month. Some people are particularly prone to heartburn. For example, nearly 50% of pregnant women will complain of heartburn in the later stages of pregnancy. Heartburn may be a troubling nuisance symptom, or it may represent a more serious disease known as gastroesophageal reflux disease (GERD). Clues that it may be something serious include: heartburn at least twice a week; heartburn not getting better with antacids or over-the-counter medicine; or heartburn associated with food sticking, weight loss, or low blood count.

What are the symptoms of heartburn?
Heartburn is described as a sour, burning sensation in the upper abdomen or chest. It may go up into the neck and mouth and be associated with acid regurgitation or food sticking. Heartburn is generally worse after meals, while laying down at night, or during exercise associated with bending over.

Can heartburn lead to something more serious?
For many people, heartburn is just a minor nuisance. However, some people with frequent heartburn or "warning signs" such as associated symptoms of food sticking, weight loss, or low blood count may have a disease known as gastroesophageal reflux disease. This represents a severe form of heartburn which may be associated with esophageal ulcers, esophageal bleeding, narrowing of the esophagus known as peptic stricture, and even a premalignant condition known as Barrett's esophagus. Unfortunately, the severity of symptoms does not distinguish between heartburn or GERD. Therefore, patients with frequent symptoms or associated "warning signs" need to see their physician or gastroenterologist for a more thorough evaluation.

What are the causes of heartburn?
Heartburn is not a result of bad lifestyle, but has a physical cause. The major cause is the too frequent relaxation of a muscular valve in the lower esophagus known as the lower esophageal sphincter. This allows stomach acid to move upwards into the esophagus causing symptoms of heartburn and damage to the esophageal lining. Other factors potentially making heartburn worse include a weak esophagus muscle, lack of saliva, slow emptying of the stomach, or large hiatal hernias.

How does heartburn differ from GERD?
Heartburn and gastroesophageal reflux disease represent a spectrum. Everyone will experience occasional heartburn sometime in life. However, the progression from occasional heartburn to heartburn more than twice a week, or heartburn associated with warning signs such as food sticking, weight loss, or low blood count, suggest that you may have gastroesophageal reflux disease. You need to see a doctor who can better diagnose the severity of your condition.

Can other complaints mimic or masquerade as heartburn or GERD?
GERD can masquerade as many complaints. For example, chest pain resembling a heart attack, asthma, sore throat, hoarseness, bronchitis, or wheezing can all be signs of acid refluxing into the esophagus and on to the vocal cords or into the lungs.

Isn't heartburn just the result of poor habits or does it have a physical cause?
In otherwise healthy people, heartburn may be made worse by poor eating habits. For example, overeating meals high in fat or alcohol intake, or certain food products such as citrus juices, spicy tomato products, or chocolates may cause heartburn even in healthy individuals. However, those people having heartburn more than twice a week or associated with other "warning signs" have a physical cause of their heartburn which often can occur completely independently of these lifestyle or behavioral factors.

How do I know when my antacids or over-the-counter H2 blockers aren't enough?
Over-the-counter antacids and H2 blockers are excellent and safe products for occasional heartburn. Antacids are particularly useful for rapidly relieving heartburn symptoms. Over-the-counter H2 blockers do not relieve symptoms as fast as antacids but are more long acting. Furthermore, these products may be taken prior to meals or activities that may cause reflux symptoms to occur. However, these over-the-counter products should not be used daily as they may be hiding a more severe disease and when used in excess may have significant side effects and be expensive. If you have heartburn more than twice a week or heartburn associated with food sticking, weight loss, or low blood count you need to see your doctor.

Does my doctor have other more powerful medicines for my severe heartburn?
Physicians have a number of prescription medicines that may be helpful for patients with gastroesophageal reflux disease. These include promotility drugs which help strengthen the lower esophageal sphincter and improve the emptying of acid from the esophagus and stomach. Other drugs can decrease the acidity of the stomach contents. In this latter group are the H2 blockers and proton pump inhibitors.

Can anything cure my troubling heartburn?
In patients with mild heartburn, simple lifestyle changes may improve symptoms. However, patients with more severe symptoms or esophageal damage usually need either long-term medications or surgery to cure their heartburn. Similar to the treatment of high blood pressure, medications for GERD control the disease, but only are effective when taken regularly. For those who cannot achieve adequate symptom relief and healing through medical therapy, antireflux surgery offers the only potential for cure by strengthening the lower esophageal sphincter.

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