When It’s More Than Just Heartburn

Did you ever wish you could turn back time and stop yourself from eating that bowl of spicy beef chili, then washing it down with a beer, and immediately kicking back for a nap? Most of us have had occasional heartburn that may result from a series of just such events. It isn’t uncommon. However, if you frequently have heartburn that feels severe or disruptive to your normal activity, it may be a sign that something more serious is going on.

Understanding Acid Reflux and GORD

Acid reflux is a condition that occurs in which stomach acid flows back into the tube connecting the mouth to the stomach – this tube is called the oesophagus. Gastroesophageal reflux disease (GORD) is a chronic condition in which there is a frequent pattern of troublesome acid reflux symptoms.

In both acid reflux and GORD, stomach acid washes over and irritates the lining of the oesophagus. In GORD, the lower sphincter of the oesophagus is often weakened or it relaxes at times when it should not relax: think of it acting as a door that doesn’t shut when it should. As a result, acid gets through and harms the oesophagus.

Common Symptoms

The most common symptoms of GORD include:

• Heartburn or a burning sensation in your throat
  
• A sour or bitter taste in your mouth
  
• The feeling of food, liquid, or stomach acid coming up into your throat (regurgitation)

Other symptoms associated with GORD are:

• Bloating, burping, nausea, vomiting, and other stomach discomfort
  
• Pain or difficulty in swallowing

Note that GORD symptoms are often mistaken for a heart attack. If you have heartburn and chest pain in addition to difficulty breathing and a pain in your arm, seek immediate medical attention.

More Serious Complications

There can be long-term effects of chronic, untreated acid reflux and GORD, which can lead to even more serious complications of the disease. As noted, the continual backwash of stomach acid can cause chronic injury and inflammation in the oesophagus. This can lead to the narrowing of the oesophagus, making it difficult to swallow or causing an ulcer to develop there. Acid reflux may also cause respiratory problems, such as asthma symptoms or chronic cough, and it can lead to dental problems, as acid tends to erode tooth enamel.

In very rare instances, acid reflux and GORD can lead to cancer of the oesophagus. Talk to your doctor about your risk for developing these complications.

When to See A Doctor

Though it may be more common in people who smoke, are overweight, take certain medications, or who are pregnant, heartburn can develop in just about anyone. So, when should you see your doctor? A good rule of thumb is to make an appointment when you experience frequent or severe heartburn that doesn’t go away with over-the-counter medication. Also, you should see a doctor if the heartburn you have causes pain or frequently disrupts your regular activities.

You should also seek medical attention when your symptoms:

• Continue even though you take medication, worsen or become more frequent
  
• Are associated with nausea, vomiting or bleeding
  
• Are accompanied with difficulty or pain with swallowing
  
• Occur with a persistent cough or worsening asthma

Getting a Diagnosis

Recognising a pattern of frequent or severe heartburn is the first step in addressing the problem. A second step is discussing it with your doctor so you can get an accurate diagnosis. Your doctor, or a specialist, called a gastroenterologist, who is an expert in the disorders of the gastrointestinal tract, will ask you to describe your symptoms. This means it is important to think about your symptoms before seeing your doctor.

Depending on the symptoms you have, how severe they are, and how long you’ve had them, your doctor may order a diagnostic test called an endoscopy. This is a procedure involving a thin flexible tube with a small camera that is fed down the throat. With it, your doctor will examine your oesophagus and may take a tissue sample from your oesophagus for biopsy testing.

Lifestyle Changes

After identifying how and when you experience heartburn, your healthcare provider may recommend lifestyle changes to help reduce the frequency or severity of your symptoms. These may include:

• Avoiding foods and drinks that commonly trigger heartburn, such as citrus fruits (like oranges, lemons, and limes), tomatoes in any form, chocolate, mint or peppermint, fatty, fried or spicy foods, onion, garlic, caffeine (coffee and tea), carbonated drinks, and alcohol
  
• Eating smaller meals and waiting at least 2-3 hours after a meal before lying down or going to bed
  
• Losing weight, if you are overweight
  
• Avoiding tight clothes that can increase heartburn discomfort
  
• Quitting tobacco and nicotine products by talking to your doctor for help to stop smoking

Keep in mind that lifestyle recommendations may be personalized. For example, if you experience acid reflux symptoms only at night, your doctor may recommend elevating the head of your bed.

Types of Treatments

You and your doctor can discuss a variety of treatment options and management strategies to help relieve symptoms. Your healthcare provider may recommend over-the-counter or prescription medicines. These can include:

• Antacids: which work by neutralizing stomach acid
  
• H2-receptor blockers: which work by reducing stomach acid production
  
• Proton pump inhibitors: which work by blocking stomach acid production

In some cases where lifestyle changes and medications are not controlling your symptoms, your doctor may recommend surgery.

How To Prepare

You don’t have to suffer with chronic heartburn. If you are uncomfortable, see your doctor, but be prepared to answer questions about your medical history, your eating habits, how your symptoms occur, and any medications you have tried for your heartburn symptoms. Some people find that keeping a food diary and jotting down when symptoms occur can help you and your doctor make important connections.

Chinyu Su, MD is a gastroenterologist and a Senior Director of Clinical Affairs at Pfizer.

Eric Mortensen, MD, PhD, is a gastroenterologist and the Vice President of Global Innovation at Pfizer.

Last reviewed: 28/09/2020