You've just eaten a big meal and leaned back in your favorite chair. Then it happens. Your chest starts to hurt so much it feels like it's on fire.
Every day, as many as 10 percent of adults have heartburn, which produces a burning sensation behind the breastbone. You may also experience a sour taste and the sensation of food re-entering your mouth (regurgitation). It results from gastroesophageal reflux, a condition in which stomach acid or bile salts back up into the food pipe (esophagus). When there's also evidence of esophageal irritation or inflammation, you have gastroesophageal reflux disease (GERD).
Most people can manage the discomfort of heartburn with diet changes, over-the-counter antacids and weight loss. But if heartburn is severe, these remedies may offer only temporary or partial relief. You may need newer, more potent medications to reduce symptoms.
When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. When it relaxes at the wrong time, stomach acid flows back up into your esophagus, even though you're in an upright position. The acid backup is worse when you're bent over or lying down. Some factors that can cause the sphincter to relax abnormally include:
Chocolate, caffeine, onions, spicy foods, mint and some medications
Lying down soon after eating
Tranquilizers, such as benzodiazepines including diazepam (Valium) and alprazolam (Xanax)
Asthma. it's possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your esophagus and pharynx, damaging lung airways.
Diabetes. One of the many complications of diabetes is gastroparesis, a rare disorder in which your stomach takes too long to empty. Left in your stomach too long, stomach contents can regurgitate into the esophagus and cause heartburn.
Peptic ulcer. An open sore near the valve (pylorus) that controls the flow of food from the stomach into the small intestine can keep this valve from working properly or can obstruct the release of food. Food doesn't empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus.
Most problems with heartburn are fleeting and mild. But if you have severe or frequent discomfort, don't ignore your symptoms. You may be developing complications that need more intensive medical treatment and prescription medications if you have any of these warning signs:
Heartburn several times a week
Heartburn that returns soon after your antacid wears off
Antacids. Antacids, can provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, typically diarrhea or constipation.
H2-receptor blockers. H-2-receptor blockers, Instead of neutralizing the acid, these medications reduce the production of acid. They don't act as quickly as antacids, but they provide longer relief. Take these medications before a meal you think may cause heartburn because it takes them about 30 minutes to work. They're also effective in reducing reflux at night if taken at bedtime. H-2-receptor blockers cause infrequent side effects, including bowel changes, dry mouth, dizziness or drowsiness.
If you have frequent and persistent heartburn, you may have GERD, leading to an inflamed esophagus (esophagitis). GERD usually requires prescription-strength medication. Prescription medications can help reduce and eliminate GERD symptoms, as well as help heal an inflamed esophagus - the result of continual exposure to stomach acid. The main types of prescription drugs are:
Prescription-strength H2-receptor blockers.
Proton pump inhibitors. These are long acting and are the most effective medications for suppressing acid production. They're safe and have few side effects for long-term treatment (at least 10 years). To prevent possible side effects, such as stomach or abdominal pain, diarrhea, loose stools or headaches.