Heartburn; Gerd
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By WebMD.com
What Is Heartburn? Despite its name, heartburn has nothing to do with the heart. Some of the symptoms, however, are similar to those of a heart attack or heart disease. Heartburn is an irritation of the esophagus that is caused by stomach acid. This can create a burning discomfort in the upper abdomen or below the breast bone. With gravity's help, a muscular valve called the lower esophageal sphincter, or LES, keeps stomach acid in the stomach. The LES is located where the esophagus meets the stomach -- below the rib cage and slightly left of center. Normally it opens to allow food into the stomach or to permit belching, then closes again. But if the LES opens too often or does not close tight enough, stomach acid can reflux, or seep, into the esophagus and cause the burning sensation. |
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Occasional heartburn isn't dangerous, but chronic heartburn or gastroesophageal reflux disease (GERD) can sometimes lead to serious problems.
Heartburn is a weekly occurrence for up to 20% of Americans and is very common in pregnant women.
What Causes Heartburn?
The basic cause of heartburn is a lower esophageal sphincter, or LES, that doesn't tighten as it should. Two excesses often contribute to this problem: too much food in the stomach (overeating) or too much pressure on the stomach (frequently from obesity, pregnancy, or constipation). Certain foods commonly relax the LES, including tomatoes, citrus fruits, garlic, onions, chocolate, coffee, alcohol, caffeinated products, and peppermint. Meals high in fats and oils(animal or vegetable) often lead to heartburn, as do certain medications. Stress and lack of sleep can increase acid production and can cause heartburn. And smoking, which relaxes the LES and stimulates stomach acid, is a major contributor.
Heartburn: Reducing Pressure on Your Stomach
Putting pressure on your stomach may push stomach juices into your esophagus, causing heartburn. You can make changes to help relieve your symptoms of heartburn. Here are some things to try:
Heartburn is a weekly occurrence for up to 20% of Americans and is very common in pregnant women.
What Causes Heartburn?
The basic cause of heartburn is a lower esophageal sphincter, or LES, that doesn't tighten as it should. Two excesses often contribute to this problem: too much food in the stomach (overeating) or too much pressure on the stomach (frequently from obesity, pregnancy, or constipation). Certain foods commonly relax the LES, including tomatoes, citrus fruits, garlic, onions, chocolate, coffee, alcohol, caffeinated products, and peppermint. Meals high in fats and oils(animal or vegetable) often lead to heartburn, as do certain medications. Stress and lack of sleep can increase acid production and can cause heartburn. And smoking, which relaxes the LES and stimulates stomach acid, is a major contributor.
Heartburn: Reducing Pressure on Your Stomach
Putting pressure on your stomach may push stomach juices into your esophagus, causing heartburn. You can make changes to help relieve your symptoms of heartburn. Here are some things to try:
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Top 10 Heartburn Foods
From coffee to grapefruit -- helpful tips for avoiding those enticing foods that may just trigger your heartburn.
By Denise Mann
WebMD Feature WebMD Feature Archive
Reviewed by Louise Chang, MD
You know it all too well. Heartburn. That fiery sensation that grabs hold of your lower chest after you eat something you know you shouldn't have. What often follows is that sour or bitter taste of acid reflux in your throat and mouth that can last minutes (if you are lucky) or hours (if you are not).
Yes, millions of us are familiar with the discomfort of heartburn, a condition in which stomach acids back up into the esophagus. The good news is that heartburn is largely avoidable if you steer clear of the top 10 heartburn foods. It also helps to avoid certain classic heartburn-inviting situations.
From coffee and liquor to tomatoes and grapefruit, experts tell WebMD that certain foods are known heartburn triggers.
Here's what you need to know about the top 10 heartburn foods.
From coffee to grapefruit -- helpful tips for avoiding those enticing foods that may just trigger your heartburn.
By Denise Mann
WebMD Feature WebMD Feature Archive
Reviewed by Louise Chang, MD
You know it all too well. Heartburn. That fiery sensation that grabs hold of your lower chest after you eat something you know you shouldn't have. What often follows is that sour or bitter taste of acid reflux in your throat and mouth that can last minutes (if you are lucky) or hours (if you are not).
Yes, millions of us are familiar with the discomfort of heartburn, a condition in which stomach acids back up into the esophagus. The good news is that heartburn is largely avoidable if you steer clear of the top 10 heartburn foods. It also helps to avoid certain classic heartburn-inviting situations.
From coffee and liquor to tomatoes and grapefruit, experts tell WebMD that certain foods are known heartburn triggers.
Here's what you need to know about the top 10 heartburn foods.
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Heartburn and Tangy Citrus Fruits
Oranges, grapefruits and orange juice are classic heartburn foods. "These are very acidic," says Robynne Chutkan, MD. Chutkan is the founder of the Digestive Center for Women in Chevy Chase, Md. and a gastroenterologist at Georgetown Hospital in Washington, D.C. "As a result of being so acidic," she says, "they are likely to cause heartburn, especially when consumed on an otherwise empty stomach." Heartburn and Tomatoes While they might be chockfull of healthy nutrients like lycopene, Chutkan tells WebMD that tomatoes are also highly acidic and likely to cause heartburn in those who are prone to it. |
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The acid antidote may be a sour ball, according to Daniel Mausner, MD. Mausner is the section head of gastroenterology at Mercy Medical Center in Rockville Center, N.Y. "Things that promote saliva -- like sour balls -- are good for acid reflux," he says, "because saliva neutralizes the acid that comes up from your stomach."
Heartburn and Garlic and Onion
Bonnie Taub-Dix, MA, RD, says, "Some people with heartburn do not do well with either garlic or onion." Taub-Dix, a spokeswoman for the American Dietetic Association, is a nutritionist in private practice in New York City and Woodmere, N.Y. "It's all very individual," she says. For avoiding heartburn, she offers the following suggestion: "Keep a food log to help you track the foods that are your heartburn offenders, and try to develop a list of safe foods." Foods like broiled chicken, baked sweet potatoes, toast, or cottage cheese, she says, are on the safe side of the heartburn food list.
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Heartburn and Spicy Foods Pepper, Mexican food, chili, and any other food that is loaded with pepper or other spices can trigger heartburn, says Deepa A. Vasudevan, MD. Vasudevan is an assistant professor of family medicine at The University of Texas Medical School at Houston. He tells WebMD that avoiding heartburn isn't necessarily a matter of all or nothing. "If spicy food triggers your heartburn, avoid it. Then slowly reintroduce milder versions of whatever you like." |
Heartburn and Cheese, Nuts, Avocadoes, and a Juicy Rib Eye
What do these foods have in common? They are all high in fat, according to Chutkan. "These foods may not get as much press as acidic foods when it comes to heartburn," she says, "but they can be major triggers." Here's why: Fat slows down the emptying of the stomach, so there is more opportunity for a big distended stomach -- which increases pressure on the esophageal sphincter -- to make heartburn more likely.
Chutkan says that doesn't mean you can never have those foods again. "Don't have a cheese plate at the end of a meal," she suggests. "Instead, eat it early in the day when you are not already full." Remember, a serving of cheese is roughly the size of two dice.
What do these foods have in common? They are all high in fat, according to Chutkan. "These foods may not get as much press as acidic foods when it comes to heartburn," she says, "but they can be major triggers." Here's why: Fat slows down the emptying of the stomach, so there is more opportunity for a big distended stomach -- which increases pressure on the esophageal sphincter -- to make heartburn more likely.
Chutkan says that doesn't mean you can never have those foods again. "Don't have a cheese plate at the end of a meal," she suggests. "Instead, eat it early in the day when you are not already full." Remember, a serving of cheese is roughly the size of two dice.
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Heartburn and Peppermint Chutkan says that while many people think peppermint is soothing for the tummy, it is actually a heartburn trigger food. Her advice? Skip the after-dinner mints -- especially after a rich meal. "They may be good for your breath on a date," she says, "but they are not so good if you are prone to heartburn." Peppermint may increase your chances of heartburn because it relaxes the sphincter muscle that lay between the stomach and esophagus. This allows stomach acids to flow back into the esophagus. |
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Heartburn and Alcohol
Wine, beer, or your favorite cocktail can all trigger heartburn, says Chutkan, especially when they are imbibed with a large meal. "If you have a meal of steak, creamed spinach, and lobster bisque and then alcohol on top of that," she says, "you may be in for it."
Taub-Dix agrees. "A glass of red wine may not be a big deal on its own," she points out. "But if you also have tomato sauce on your pasta and a glass of orange juice in the morning on an empty stomach, it could be a problem." Like peppermint, alcohol opens the sphincter, allowing the acid free range.
Wine, beer, or your favorite cocktail can all trigger heartburn, says Chutkan, especially when they are imbibed with a large meal. "If you have a meal of steak, creamed spinach, and lobster bisque and then alcohol on top of that," she says, "you may be in for it."
Taub-Dix agrees. "A glass of red wine may not be a big deal on its own," she points out. "But if you also have tomato sauce on your pasta and a glass of orange juice in the morning on an empty stomach, it could be a problem." Like peppermint, alcohol opens the sphincter, allowing the acid free range.
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Heartburn and Caffeine
Coffee, soda, tea, iced tea, and any other food or beverages that contain caffeine are big offenders. But java junkies don't have to give up their Joe forever, Chutkan tells WebMD. "It's not 'no coffee ever' if you have heartburn. It's about cutting down and paying attention toportion sizes. A Starbucks tall," she explains, "which is their version of a small, is like three cups of coffee. Some people tell me they drink two cups of coffee a day and that they get it at Starbucks. That's like six cups a day." If you have heartburn, you can likely consume a 3- or 4-ounce cup of coffee each morning with no problem. But if you guzzle coffee all day long, then, yes, heartburn is a consequence. |
Heartburn and Chocolate
Sure, it can be loaded with caffeine, but chocolate can also be a heartburn food in and of itself. "Pack up all of your chocolate and give it to your gastroenterologist for safekeeping if you have heartburn," Chutkan says. Chocolate relaxes the sphincter, allowing stomach acids to flow back into the esophagus, she says.
Heartburn and Carbonated Beverages
"Carbonated beverages cause gastric distension," Mausner says. And if your stomach is distended, this increases pressure on the esophageal sphincter, promoting reflux." He tells WebMD that people with heartburn may be wise to steer clear of pop and other carbonated beverages.
Sure, it can be loaded with caffeine, but chocolate can also be a heartburn food in and of itself. "Pack up all of your chocolate and give it to your gastroenterologist for safekeeping if you have heartburn," Chutkan says. Chocolate relaxes the sphincter, allowing stomach acids to flow back into the esophagus, she says.
Heartburn and Carbonated Beverages
"Carbonated beverages cause gastric distension," Mausner says. And if your stomach is distended, this increases pressure on the esophageal sphincter, promoting reflux." He tells WebMD that people with heartburn may be wise to steer clear of pop and other carbonated beverages.
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Heartburn Foods:
Find Your Triggers Taub-Dix's advice is to use the above list as a guide to help you figure out your heartburn foods and heartburn trigger situations. And remember, she cautions, even if your favorites are not on this list, you don't necessarily have a free pass. "Too much of any food can trigger heartburn," she says. It's not just what you eat; it's how much you eat and when you eat it. "Consuming a large meal right before you lie down," she says, "will likely cause heartburn even if it doesn't include any of these heartburn foods." |
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Medical Diagnostics and Tests
How do you know if it’s heartburn or something more serious?
See what steps doctors take and what heartburn and GERD tests may be used to find out.
Diagnosis
How Can You Tell When You Have Heartburn?
You think you have heartburn, but how do you know for sure? Here are the steps your doctor may take to find out. Your description of your symptoms may be all a doctor requires to diagnose heartburn, but sometimes additional testing may be necessary. The esophagus can be viewed through an endoscope, a long, thin, flexible tube inserted through the mouth, or by X-ray.Sometimes, your doctor may recommend a 24-hour esophageal pH probe study, especially if you have unusual symptoms, such as throat or chest or abdominal pain, coughing, or asthma-like symptoms. In this test, a long, narrow, flexible tube is inserted through the nose down into the esophagus and a probe is left there for 24 hours. This probe detects acid levels to determine if it correlates with your symptoms. A newer technique (called Bravo) measures 24-hour acid; it is done using wireless pH sensors, which eliminates the need for a tube insertion. To detect if your heart is the cause of your symptoms, an electrocardiogram (ECG), a recording of the heart's electrical activity, may be taken.
How do you know if it’s heartburn or something more serious?
See what steps doctors take and what heartburn and GERD tests may be used to find out.
Diagnosis
How Can You Tell When You Have Heartburn?
You think you have heartburn, but how do you know for sure? Here are the steps your doctor may take to find out. Your description of your symptoms may be all a doctor requires to diagnose heartburn, but sometimes additional testing may be necessary. The esophagus can be viewed through an endoscope, a long, thin, flexible tube inserted through the mouth, or by X-ray.Sometimes, your doctor may recommend a 24-hour esophageal pH probe study, especially if you have unusual symptoms, such as throat or chest or abdominal pain, coughing, or asthma-like symptoms. In this test, a long, narrow, flexible tube is inserted through the nose down into the esophagus and a probe is left there for 24 hours. This probe detects acid levels to determine if it correlates with your symptoms. A newer technique (called Bravo) measures 24-hour acid; it is done using wireless pH sensors, which eliminates the need for a tube insertion. To detect if your heart is the cause of your symptoms, an electrocardiogram (ECG), a recording of the heart's electrical activity, may be taken.
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Diagnosing Acid Reflux
Three out of every 10 people experience heartburn on occasion, so it can be somewhat arbitrary to decide when heartburn should be called acid reflux disease. .Also known as gastroesophageal reflux disease (GERD), acid reflux disease is a chronic irritation of the lining of a person's esophagus by stomach acid. Usually, it's just annoying. GERD can, however, have serious consequences, including esophagitis and Barrett's esophagus. Barrett's esophagus is a condition that increases the likelihood ofesophageal cancer. What Are the Symptoms of Acid Reflux Disease? People with acid reflux disease often have some or all of the following symptoms: |
- Pain when or difficulty swallowing
- Bad breath and/or bad taste in the mouth
- Burping
- Chest pain
- Heartburn
- Hoarseness
- Regurgitation
- Sore throat
- Cough
- Asthma
How Is Acid Reflux Diagnosed?
If you experience classic symptoms of acid reflux disease -- chronic heartburn and regurgitation -- without any troublesome complications, it may be relatively easy for your doctor to make an acid reflux diagnosis.
A few people have GERD that doesn't respond to treatment. Or they may have other concerning symptoms, such as weight loss, difficulty swallowing, anemia, or black stools. If you're one of them, you may need any of the following tests.
If you experience classic symptoms of acid reflux disease -- chronic heartburn and regurgitation -- without any troublesome complications, it may be relatively easy for your doctor to make an acid reflux diagnosis.
A few people have GERD that doesn't respond to treatment. Or they may have other concerning symptoms, such as weight loss, difficulty swallowing, anemia, or black stools. If you're one of them, you may need any of the following tests.
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Diagnosing Acid Reflux With a Barium Swallow Radiograph Your doctor may decide to use a special X-ray procedure -- the barium swallow radiograph -- to rule out any structural problems in your esophagus. In this painless acid reflux test, you will be asked to swallow a solution of barium. The barium enables doctors to take X-rays of your esophagus. Barium swallow isn't a surefire method of diagnosing GERD. Only one out of every three people with GERD has esophageal changes that are visible on X-rays. |
Diagnosing Acid Reflux With Endoscopy or EGD
During an endoscopy, the doctor inserts a small tube with a camera on the end through the mouthinto the esophagus. This enables the doctor to see the lining of the esophagus and stomach.
Before inserting the tube, your gastroenterologist may administer a mild sedative to help you relax. The doctor may also spray your throat with an analgesic spray to make the procedure more comfortable for you.
This acid reflux test typically lasts about 20 minutes. It is not painful and will not interfere with your ability to breathe.
While this test may detect some complications of GERD, including esophagitis and Barrett's esophagus, only about half the people with acid reflux disease have visible changes to the lining of their esophagus.
During an endoscopy, the doctor inserts a small tube with a camera on the end through the mouthinto the esophagus. This enables the doctor to see the lining of the esophagus and stomach.
Before inserting the tube, your gastroenterologist may administer a mild sedative to help you relax. The doctor may also spray your throat with an analgesic spray to make the procedure more comfortable for you.
This acid reflux test typically lasts about 20 minutes. It is not painful and will not interfere with your ability to breathe.
While this test may detect some complications of GERD, including esophagitis and Barrett's esophagus, only about half the people with acid reflux disease have visible changes to the lining of their esophagus.
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Diagnosing Acid Reflux With a Biopsy Depending on what the EGD shows, your doctor may decide to perform a biopsy during the procedure. If this is the case, your gastroenterologist will pass a tiny surgical instrument through the scope to remove a small piece of the lining in the esophagus. The tissue sample will then be sent to a pathology lab for analysis. There it will be assessed to see if there is an underlying disease such as esophageal cancer. |
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Diagnosing Acid Reflux With Esophageal Manometry
Your doctor may perform an esophageal manometry to diagnose acid reflux. This is a test to assess your esophageal function. It also checks to see if the esophageal sphincter -- a valve between the stomach and esophagus -- is working as well as it should.
After applying a numbing agent to the inside of your nose, the doctor will ask you to remain seated. Then a narrow, flexible tube will be passed through your nose, through your esophagus, and into your stomach.
When the tube is in the correct position, the doctor will have you lay on your left side. When you do, sensors on the tube will measure the pressure being exerted at various locations inside your esophagus and stomach. To assess your esophageal functioning even further, you may be asked to take a few sips of water. The sensors on the tube will record the muscle contractions in your esophagus as the water passes down into your stomach.
The test typically takes 20 to 30 minutes.
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Diagnosing Acid Reflux With Esophageal Impedance Monitoring
To obtain an even more detailed picture of how your esophagus functions, the gastroenterologist may recommend esophageal impedance monitoring. If so, this will be done in conjunction with manometry. This test uses a manometry tube with electrodes placed at various points along its length. It measures the rate at which liquids and gases pass through your esophagus. When these results are compared with your manometry findings, your doctor will be able to assess how effectively your esophageal contractions are moving substances through your esophagus into your stomach. |
Diagnosing Acid Reflux With pH Monitoring
This test uses a pH monitor to record the acidity in your esophagus over a 24-hour period.
In one version of this test, a small tube with a pH sensor on the end is passed through your nose into your lower esophagus. The tube is left in place for 24 hours with the portion exiting your nose affixed to the side of your face. It will be connected to a small recording device that you can wear or carry.
During the course of this acid reflux test, you will record in a diary when you are eating or drinking. You will also push a specific button on the recording device to indicate when you are experiencing acid reflux symptoms. This detailed information will allow the doctor to analyze and interpret your test results.
A newer, wireless version of this test is now being used. In this version a small pH sensor is affixed to your lower esophagus using suction. The small probe is able to communicate wirelessly with a recording device outside your body for 48 hours. The probe ultimately falls off and passes through the remainder of the digestive tract.
Many patients have found the wireless pH monitoring exam to be far more pleasant than the traditional version. Both techniques yield similarly information.
This test uses a pH monitor to record the acidity in your esophagus over a 24-hour period.
In one version of this test, a small tube with a pH sensor on the end is passed through your nose into your lower esophagus. The tube is left in place for 24 hours with the portion exiting your nose affixed to the side of your face. It will be connected to a small recording device that you can wear or carry.
During the course of this acid reflux test, you will record in a diary when you are eating or drinking. You will also push a specific button on the recording device to indicate when you are experiencing acid reflux symptoms. This detailed information will allow the doctor to analyze and interpret your test results.
A newer, wireless version of this test is now being used. In this version a small pH sensor is affixed to your lower esophagus using suction. The small probe is able to communicate wirelessly with a recording device outside your body for 48 hours. The probe ultimately falls off and passes through the remainder of the digestive tract.
Many patients have found the wireless pH monitoring exam to be far more pleasant than the traditional version. Both techniques yield similarly information.
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Tests
Gastroesophageal Reflux Disease (GERD) - Exams and Tests Learn about the tests used to diagnose GERD. To find out if you have gastroesophageal reflux disease (GERD), your doctor may first ask you questions about your symptoms, such as whether you have a frequent uncomfortable feeling of burning, warmth, heat, or pain just behind the breastbone (heartburn). If you have heartburn often, your doctor may prescribe medicines to treat GERD without doing any other tests. |
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If medicines don't help, you may have other tests. These may include:
- An upper gastrointestinal endoscopy. This allows your doctor to look at the inner lining of your esophagus, your stomach, and the first part of your small intestine (duodenum) through a thin, flexible viewing tool called an endoscope.
- Esophageal tests. These may be done to find out how well the muscles in the esophagus move food, or to monitor how often acid gets into the esophagus and how long it stays there.
- An upper gastrointestinal series. These X-ray pictures of the esophagus and stomach may help find other problems that may be causing GERD symptoms.
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Upper Endoscopy
This procedure, usually done on an outpatient basis, allows your doctor to take a look inside your esophagus and stomach. An upper endoscopy can be used to determine the cause of heartburn and is often performed as an outpatient procedure. Upper endoscopy uses a thin scope with a light and camera at its tip to look inside of the upper digestive system -- the esophagus, stomach, and the first part of the small intestine, called the duodenum. During endoscopy, certain procedures such as taking a small tissue sample (biopsy) for testing may be performed.Sometimes, the procedure is done in emergencies in the hospital or emergency room to both identify and treat upper digestive system bleeding such as from an ulcer. In addition to heartburn, the procedure may also be used to help evaluate: |
- Upper abdominal pain
- Nausea and vomiting
- Stomach bleeding
- Swallowing disorders