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My Heart Burns

The holiday season is upon us. That means it is time for family gatherings and celebrations. These celebrations always involve food, lots of food. After indulging maybe a little too much, many people experience some abdominal/chest pain. Although it is called heartburn, the sensation does not have anything to do with the heart. It is a feeling of pain and misery that starts in the stomach and can continue for hours. What can be done to prevent it? Are your symptoms truly due to heartburn or is something more ominous going on?

What causes heartburn?
Heartburn is caused by a leakage of acid from the stomach up into the esophagus, the tube leading from your throat to your stomach. Normally, a circular muscle, called a sphincter, keeps the stomach contents in the stomach. Sometimes, this muscle malfunctions or the acid forcefully goes through it into the esophagus. The acid causes irritation leading to pain and often a burning sensation. This is what is commonly called heartburn.

Sometimes heartburn is caused by having a hiatal hernia. This is when part or all of the stomach has pushed up through the diaphragm and is in the lung cavity. This needs to be diagnosed by your doctor and is most often discovered on a chest x-ray. If you have this condition, your doctor needs to be involved in your care. In pregnancy, heartburn is frequently experienced due to the pressure on the stomach from the uterus and fetus. There are medications that can be taken for this during pregnancy but you must check with your obstetrician to see what medication he or she would like you to take. Do not take over the counter medications during pregnancy without first checking with your OB provider.

How is heartburn treated?
There are different ways to treat heartburn. Conservatively, one can try lifestyle modifications such as avoiding offending foods and eating frequent, small meals. Also, you can elevate the head of the bed approximately 4 inches to ensure you are sleeping on an incline. Avoid eating within 2 hours of lying down so the acid has to work against gravity.

If these conservative measures don't work, there are several medications that can be helpful. First, over the counter antacids such as TUMS or Rolaids can be tried for immediate symptom relief. If you only get heartburn occasionally, this may be the most effective treatment for you. If you experience heartburn on a regular basis, daily preventive medicine such as Prilosec or Zantac may be recommended. There are many prescription strength options available as well. If you are experiencing problems with heartburn, check with your medical provider today to see what type of treatment may benefit you.

What if I don't get better?
Based on your history and physical exam, your medical provider may determine that you have symptoms consistent with heartburn. Your provider likely will have you try lifestyle modifications and medications before proceeding with testing. If your symptoms continue, further testing may be warranted. There is a bacteria that can cause these symptoms called Helicobactor pylori. This bacteria can be detected by testing the blood or stool or by doing an endoscopy. Endoscopy is a procedure in which a camera is inserted in the throat and goes down the esophagus to take a direct look at the stomach. It can detect ulcers and biopsies can be taken to assess for H. pylori or other pathogens. Endoscopy is the main procedure done to diagnose persistent reflux. Other tests may include testing the stool for microscopic blood, x-rays or ultrasound. All tests must be ordered and interpreted by your primary care provider.

If you have questions or concerns about reflux that is not improving with conservative treatment, see your primary care provider today.

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