Stomach/GI: Heartburn

June 10th 2014



Overview

Heartburn, which is often a result ofacid refluxorgastroesophageal reflux disease, is characterized by a burning sensation in the chest. Approximately 2 in 10 individuals in the United States experiences heartburn at least once a week. Although occasional heartburn is common and can be managed by incorporating lifestyle changes and taking OTC medications, more frequent heartburn that interferes with a patient’s daily routine may be a symptom of something more serious.

Signs and Symptoms

Patients with heartburn can experience a variety of symptoms, including:

  • Burning pain in the lower part of the mid-chest and in the abdomen that usually occurs after eating
  • Pain that becomes worse when bending over or lying down
  • Bitter taste in the mouth
  • Indigestion
  • Belching

Causes/Common Triggers

Although the specific triggers of heartburn vary in each individual, factors that can contribute to heartburn include:

  • Obesity
  • Pregnancy
  • Smoking
  • Stress
  • Drinking caffeinated or carbonated beverages
  • Consuming large meals
  • Eating fatty, fried, or spicy foods
  • Eating less than 2 hours before
  • Drinking alcoholic beverages, especially before bedtime
  • Taking certain medications (eg, antidepressants, beta-blockers, antibiotics, hormone replacement therapy)

Tests and Diagnosis

For patients whose heartburn is not relieved by lifestyle modifications and OTC products, a gastroenterologist may recommend a more comprehensive diagnostic evaluation. Patients may undergo an endoscopy, a biopsy, and ambulatory pH monitoring. Surgery may be an option for patients with severe reflux or for those who respond poorly to medical treatment plans.

Prevention

Heartburn symptoms can be avoided by maintaining a healthy weight, eating small meals, quitting smoking, and avoiding triggers and behaviors that contribute to acid reflux flareups.

Treatment and Care

Heartburn can be manageable if patients:

  • Avoid common heartburn triggers
  • Take OTC heartburn products as directed by their physician and/or pharmacist
  • Keep a diary to better help manage symptoms

Patients should consult with a physician or pharmacist about the best course of treatment to relieve heartburn symptoms. If symptoms do not abate with lifestyle changes and use of OTC medications, patients should inform their physician and discuss the next steps in the treatment plan.

Homeopathic and Alternative Remedies

Patients can find symptom relief by making changes such as avoiding restrictive or tight clothing and elevating the head off the bed 4 to . Patients whose heartburn is caused by stress and anxiety may want to consider the following:

  • Light to moderate exercise
  • Relaxation techniques
  • Massage

Self-Care

A number of OTC medications are available to relieve heartburn symptoms, including some products that previously were only available by prescription. OTC medications for heartburn include:

  • Antacids
  • Histamine2 blockers with or without antacids
  • Proton pump inhibitors with or without antacids

Pharmacists can counsel heartburn patients on the proper use of these products. It is important that patients inform the pharmacist of all medications they are taking, to help prevent serious drug interactions or contraindications.

Resources for Patients

In addition to consulting with their physician and/or pharmacist, patients can find information at the following sites:

  • American Gastroenterological Association
  • American College of Gastroenterology
  • National Digestive Diseases Information Clearinghouse

Resources for Pharmacists

  • MUSC Health Digestive Disease Center
  • American Gastroenterological Association

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