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Comprehensive Guide to Managing Heartburn and GERD

Heartburn is a burning sensation in the chest, specifically in the heart area. The source of the burning is located in the esophagus (the tube that carries food from your mouth to your stomach). This symptom is caused by acid reflux from the stomach.

Key Facts

  • The main cause of heartburn is gastroesophageal reflux disease (GERD). It causes stomach contents to be thrown into the esophagus more often and stay there longer.
  • It is not always possible to determine why heartburn occurs in a particular person. Factors such as being overweight, pregnancy, hormonal changes, and some other factors predispose one to the disease.
  • In addition to GERD, heartburn can occur for functional reasons or due to hypersensitivity of the organ’s receptors. The other causes of heartburn are very rare.
  • Prolonged heartburn can lead to precancerous changes in the esophagus. This does not mean cancer will definitely develop, but it increases the risk. Lifelong treatment and regular checkups are then necessary.
  • Medications that reduce stomach acidity are taken for heartburn. Proton pump inhibitors are used for long-term relief, while antacids serve as an emergency remedy.
  • Tums can help with the symptoms of heartburn, but they do not treat the cause. If you need Tums for more than two weeks, talk to your doctor. It is best not to take this medicine if you have kidney or heart disease.
  • During the periods when a person is off the medicine, you need to watch your lifestyle so that heartburn does not reappear. For example, do not lie down immediately after eating, do not eat at night, do not wear tight clothes.
  • Some supplements can increase or decrease heartburn symptoms. Pay attention to this if you take vitamins.

Why is Recurrent Heartburn Called Gastroesophageal Reflux Disease?

Heartburn is a typical symptom of gastroesophageal reflux disease (GERD). It is a chronic recurrent disease in which stomach contents are regularly thrown into the esophagus. Such reflux is called reflux.

More than 15 million adults in the United States experience heartburn every day. Sometimes, people call heartburn something that is not heartburn. For example, an unpleasant burning sensation in the stomach. However, heartburn is not a sensation in the stomach but behind the sternum. The burning sensation extends from the solar plexus area upward to the throat.

Interesting fact. Acid reflux is a normal phenomenon. It occurs throughout the day in all of us (up to 50 times a day). It is called physiologic reflux. We do not feel it, and it does not harm us. It usually occurs after a meal and does not last long. If the stomach contents linger longer in the esophagus, this is pathologic reflux (GERD).

How Often Can Heartburn Occur?

When the burning sensation behind the sternum occurs a few times a year, it is not yet a disease. But when heartburn is regular, occurring at least several times a week, it is considered a disease.

Check if You Have Acid Reflux

The Main Signs of Acid Reflux Include the Following Symptoms

  • Recurrent heartburn after eating, exercising, or at night (more than once a week).
  • Unpleasant sour taste in the mouth caused by stomach acid.

Additional Symptoms of Acid Reflux

  • Prolonged coughing or frequent hiccups
  • A hoarse voice
  • Bad breath
  • Abdominal bloating, flatulence, and nausea

Symptoms often get worse after eating, lying down, or bending over. There are also other diseases that can cause sensations in the esophagus behind the sternum, but they are less common.

Why Does Heartburn Come on Suddenly?

Heartburn can come on suddenly, even if you have not changed your lifestyle or had GERD before.

Possible Causes of Sudden Heartburn

  • Aging.

Heartburn can occur with age due to weakening of the lower esophageal sphincter muscles.

  • Weight gain.

Most people gain weight gradually, but symptoms of weight gain (such as heartburn) may not appear right away.

  • Medications and supplements.

Some medications (such as ibuprofen) can cause acid reflux. Talk to your doctor about changing the medication if it’s the cause.

  • Pregnancy.

Such a symptom is observed in almost 80% of cases during the period of carrying the fetus. Most often heartburn in pregnancy appears in the 20th week. The increase in the size of the uterus causes compression of the stomach, which contributes to the release of acid into the esophagus.

  • Hormonal issues.

Increases in progesterone and estrogen can trigger recurrent heartburn.

  • Helicobacter pylori.

This is a highly resistant bacteria that can survive on the stomach mucosa for decades with little or no effect on the immune system. These bacteria cause the stomach to produce more stomach acid. In addition, the bacteria produce toxins that damage the stomach mucosa, which provokes heartburn and more serious illnesses.

Does Heartburn Increase the Risk of Esophageal Cancer?

Heartburn can cause precancerous change in the cells of the esophagus, known as Barrett’s esophagus. Normally, the esophagus has flat epithelium, but with Barrett’s esophagus, it becomes cylindrical. This is a protective reaction of the organ to constant inflammation.

A final diagnosis can only be made after a biopsy. Additionally, the visible area of the esophagus must be at least 1 cm (centimeter) in height to be considered Barrett’s esophagus. If it is smaller, it is not classified as Barrett’s esophagus.

Precancerous esophageal changes are not a verdict. According to one large study, the annual risk of Barrett’s esophagus becoming cancer was 0.4%. Other reports put the risk of developing esophageal adenocarcinoma at 0.5 to 2.1% per year. The risk also depends on how timely the problem is detected and treatment is started.

In Barrett’s esophagus, a lifelong regimen of proton pump inhibitors is prescribed. In this case, the benefits of taking the medication continuously will outweigh the risks of long-term use.

Drug Therapy for Heartburn

Several groups of drugs are used for heartburn. If you have a deficiency, consult with your doctor about taking supplements.

Antacid drugs

Antacids neutralize excessive acid in the stomach and reduce the acidity of gastric juice. Reducing the amount of acid in the stomach helps alleviate or prevent the painful burning sensation that occurs with heartburn.

Most Common Antacids

  • Tums
  • Rolaids

Why Shouldn’t Tums and Similar Antacids Be Taken All the Time?

Calcium carbonate supplements such as Tums can prevent and relieve heartburn attacks. They can also be used as a supplement in situations, such as kidney disease, where you have low blood calcium levels.

Tums are part of a group of medications called antacids. They work by neutralizing stomach acid.

Tums are sold over-the-counter, so for most people it is the first remedy for heartburn. Tums products contain 750 to 1,200 mg of calcium carbonate. Other calcium carbonate supplements are also available over-the-counter.

Important: Antacid medications do not treat the cause of heartburn. After you stop using Tums, your heartburn symptoms may become more severe. After you stop using Tums, your stomach may produce more acid.

The most common side effect of calcium carbonate is constipation. Tums contain a very high amount of calcium. More than 2000 mg of calcium a day increases the risk of heart problems (arrhythmias).

High doses of calcium are a trigger for kidney stone formation and hypercalcemia (elevated blood calcium levels). Do not take Tums for more than two weeks if you have kidney disease, heart failure, or swelling. This is not a harmless candy, although it looks that way.

In addition to the above problems, an altered stomach environment can prevent the medication from being absorbed properly. Oral medications are designed with the stomach’s natural acidity in mind. When we disrupt this with antacids, the effectiveness of the medication can change.

Proton Pump Inhibitors (PPIs)

Proton pump is an enzyme that is found in large quantities in the gastric mucosa and is involved in the synthesis of hydrochloric acid. Proton pump inhibitors inhibit the activity of this enzyme. As a result, the production of hydrochloric acid is reduced, and its irritating effect on the GI tract is reduced

These drugs are prescribed by the doctor for courses of one month to six months. The dose and regimen for each drug depends on the clinical situation.

Common PPIs

  • Omeprazole
  • Pantoprazole
  • Lansoprazole

What are the Dangers of Taking PPIs for a Long Time?

  • If you take PPIs for a long period of time, digestion may be impaired due to decreased acidity and pathogenic bacteria may start to multiply in the gastrointestinal tract.
  • When taking PPIs for long periods of time, bone density deteriorates and magnesium, calcium, and vitamin B12 levels decrease in the body. Patients who are constantly taking PPIs are recommended to regularly check the level of vitamins and minerals in the blood.

Rules to Help Reduce the Likelihood of Heartburn

For people who often experience heartburn, there are “anti-reflux rules”. These rules are important to follow even if you are taking heartburn pills.

Don’t Go to Sleep Immediately After Eating

After a meal, the stomach volume increases, the esophageal sphincter opens even more, and in a horizontal position, acid enters the esophagus. For the same reasons, a full dinner should be at least three hours before bedtime.

Use a GERD Pillow

A special pillow can help from sudden nocturnal reflux. It helps a person to organize sleep in the right position, without bending in the lower back.

A 6-inch (15-cm) raised bed headboard has the same effect.

Be Careful with Sports

Heartburn is usually caused by movements involving abdominal straining, bending over, or lifting weights. Limit these exercises if you notice a real connection between them and reflux. For example, heartburn occurs while lifting weights, running, or bicycling. If the exercise does not cause unpleasant sensations, then you can do it. It is necessary to focus on how you feel.

Tip. Prolonged lack of motor activity (for example, in office work) can provoke heartburn. Be sure to add sports and walking to your daily routine.

Choose Loose-fitting Clothing

Corsets, belts, and tight clothing can put pressure on your stomach and trigger heartburn. This is especially common right after a meal.

Tip! When a person takes medication to treat GERD, heartburn will not bother him, no matter what he does. As soon as the therapy ends, unpleasant symptoms can return. In order not to provoke heartburn it is important to adjust lifestyle and some habits.

Dietary Patterns Can Influence the Course of Reflux Disease

Water

Drinking plain water can temporarily reduce the symptoms of acid reflux. A small study in healthy people showed that drinking 200 ml (about 7 fluid ounces) of water quickly reduces stomach acidity. This effect lasts only a few minutes.

Note that drinking too much water is not necessary. Orient yourself to your needs.

Diet

Overeating can trigger reflux. Excess food will put pressure on the sphincter and provoke the throwing of acid into the esophagus. Seek help from your doctor if you have difficulty controlling the amount of food you eat. You may have vitamin and mineral deficiencies or more serious medical conditions.

Foods

  • Cocoa can cause heartburn and gastritis in some people because of its caffeine and theobromine content. Coffee and tea , can also trigger acid reflux, although research does not support this fact (Wei, Tzu Chi Med J 2019; Feldman, Gastroenterology 1995; Gudjonsson, Laeknabladid 1995).
  • Heartburn triggers are often carbonated drinks , spicy foods (including raw onions), acidic foods and citrus juices, and fatty foods.
  • Use apple cider vinegar with caution if you have heartburn. Some people find it helps with heartburn, while in others it worsens symptoms.
  • High-fat foods and fried foods increase the risk of reflux. They lower the pressure in the lower esophageal sphincter (LES) and delay gastric emptying. Choose lean meats, grilled, boiled or baked.
  • Alcoholic beverages can trigger reflux if they are stronger than 5% (whiskey, scotch, rum, etc.). If you drink alcohol, choose light drinks. For example, beer, light wine (Moscato), ale.

The topic of acid reflux is being actively researched. It is not yet possible to say that there are foods that definitely do or definitely do not cause heartburn. Small studies on specific foods have not yet shown a clear link. For example, there is no evidence that if a person with GERD drinks coffee, they will get heartburn 100% of the time. It’s the same with other foods. Citrus, tomatoes, chocolate, mint, fried and fatty foods are often said to provoke reflux, but there is no clear link in studies.

For this reason, eating right for heartburn does not always mean giving up all your favorite foods. Often, it’s enough to make just a few simple changes to your diet. For example, one small study found that adults who followed a Mediterranean diet were less likely to suffer from GERD. In contrast, the Western diet is low in fruits and vegetables and high in fat and sodium. In addition, the Western diet is higher in calories and higher in fat and sugar.

Supplements to Help with Heartburn

Magnesium

Magnesium is a common ingredient in antacid medications. It reduces acid reflux symptoms and neutralizes stomach acid.

The most effective forms of magnesium for heartburn are Magnesium carbonate and Magnesium Trisilicate.

Important: Many people experience diarrhea and nausea when taking high doses of magnesium. For this reason, there are no general dosage recommendations for this supplement. You can calculate the correct dosage of magnesium with your doctor. Remember that constant reduction of stomach acidity with antacids is inevitably harmful to health. Our body needs stomach acid to assimilate magnesium.

Sodium Alginate

Sodium alginate is a salt of alginic acid, belongs to antacids, and looks like a powder. It is obtained from brown or red algae that grow near the Philippines and Indonesia.

Alginate supplements are highly effective in treating heartburn symptoms. In the stomach, alginate turns into a gel. This gel floats on top of the stomach acids. This physical barrier keeps the acids from entering the esophagus.

Currently, alginate preparations are safe for children, pregnant and lactating people.

Manuka Honey

Manuka honey reduces the symptoms of acid reflux. It coats the esophagus and gastric mucosa, which helps reduce the upward flow of gastric juice. Better studies are needed to prove the benefits.

A number of studies prove the effectiveness of manuka honey in treating stomach ulcers caused by the bacterium Helicobacter pylori. Helicobacter causes recurrent heartburn in some people.

Melatonin

Preliminary studies have shown that melatonin reduces the pain of acid reflux. Keep in mind that heartburn treatment will be a long-term treatment, and melatonin is not recommended to be used for more than two months without a break.

DGL

DGL (deglycyrrhizinated licorice) works much like manuka honey. It coats the walls of the esophagus, which reduces the symptoms of acid reflux.

Important: Doctors do not recommend taking licorice for pregnant women, people with hypertension and kidney disease.

D-limonene

D-limonene in moderate dosage improves symptoms of heartburn and GERD. Too much can cause nausea and diarrhea.

Supplements That Don’t Affect Heartburn Symptoms

  • Zinc-carnosine.

The drug helps reduce inflammation in the stomach from H. pylori infection and is advertised to treat acid reflux. There is still too little data available to claim a pronounced effect against heartburn.

  • Probiotics.

Probiotics help against bloating and flatulence, but may have no effect on heartburn.

  • Curcuma.

Curcuma and curcumin may not significantly affect heartburn symptoms, according to the study.

  • Herbs.

Parsley, chamomile, fennel, cumin and milk thistle are sometimes suggested as natural remedies for heartburn. We found no reliable scientific evidence for this.

Supplements That Can Cause Heartburn

  • High doses of vitamin B-6 may irritate the stomach or cause heartburn in some people.
  • L-arginine, an amino acid, can potentially make stomach contents more acidic and also cause heartburn.
  • Alpha lipoic acid may also contribute to acid reflux due to its acidic content.
  • CoQ10 can sometimes cause heartburn and nausea. However, this can be minimized by splitting the dose and taking it throughout the day. Do not take this supplement too late in the evening.
  • Menthol can cause heartburn in people with GERD. Menthol can be found in many mint-flavored products, including toothpaste, mouthwash, and chewing gum.
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