Beyond the Burn: Understanding Heartburn and Reflux Disease

Millions of Americans experience the pain of heartburn – a condition that affects quality of life and keeps patients from sleeping and participating in daily activities. Richard Curtis, MD, Chief of Gastroenterology at Newton-Wellesley Hospital, treats many patients for the symptoms of heartburn.

“Heartburn is a very common condition. In fact, approximately one third of the U.S. population has heartburn and of that group, up to 10 percent may experience heartburn on a daily basis,” says Dr. Curtis. “This condition can be very problematic for patients and definitely affects their quality of life.”

Heartburn, characterized by a burning discomfort in the chest just behind the breastbone, usually occurs after eating and lasts a few minutes to several hours. This burning can also be accompanied by a hot, sour, acidic or salty-tasting fluid at the back of the throat and may feel like something is “stuck” in the middle of the chest or throat. Heartburn may cause a sore throat and chronic cough or hoarseness.

This condition generally occurs when the lower esophageal sphincter, the muscle at the base of the esophagus that contracts to prevent stomach contents from moving back into the esophagus, doesn’t tighten properly. Too much food in the stomach or too much pressure on the stomach can contribute to the functioning of the esophageal sphincter.

Gastroesophageal Reflux Disease (GERD)
While many experience occasional heartburn, regular heartburn can be a sign of gastroesophageal reflux disease (GERD).

“Occasional heartburn is common and does not necessarily mean that a patient has GERD,” says Dr. Curtis. “Patients who experience heartburn symptoms more than once a week are at risk of developing this condition.”

Reflux occurs when the liquid in the stomach backs up into the esophagus causing inflammation and damage. This liquid usually contains acid and pepsin (an enzyme that begins the digestion of proteins), both produced by the stomach, as well as bile from the small intestine. The acid is believed to be the most damaging; however, the pepsin and bile may also cause esophageal inflammation and damage.

While most people experience some degree of reflux, in patients with GERD the refluxed liquid often contains more acid, remains in the esophagus longer and has been found to reflux to a higher level.

Symptoms of GERD may include

Difficulty swallowing

Chronic chest pain

Voice changes

Chronic earache

Burning chest pains

Nausea

GERD can also be caused by a hiatal hernia. The hiatus is an opening in the muscular wall separating the chest cavity from the abdomen, called the diaphragm. The esophagus attaches to the stomach through the hiatus. A hiatal hernia occurs when the stomach bulges into the chest cavity through this opening. Hiatal hernias usually do not present any symptoms. Physicians will check patients for the presence of a hiatal hernia when they are experiencing chronic heartburn.

“Regular heartburn can have a significant impact on day-today living activities like eating and sleeping,” says Dr. Curtis, “It is important for patients to understand how to eliminate the factors promoting their heartburn. Many times we are able to help patients make lifestyle changes that significantly reduce their reflux. It is important for patients to treat this condition in order to prevent further damage to the esophagus.”

According to Dr. Curtis, several lifestyle modifications can help patients relieve the symptoms of GERD. Eliminating certain foods that have been proven to promote reflux can provide relief. Tomatoes, citrus fruits, garlic, onions, chocolate, coffee, alcohol, caffeinated products and peppermint have been shown to stimulate gastric acid secretion. Dishes high in fats and oils can also minimize the esophageal sphincter closing ability and delay stomach emptying.

Dr. Curtis recommends the following tips to help limit the symptoms of heartburn:

Quit smoking. Smoking relaxes the esophageal sphincter and stimulates stomach acid.

Avoid overeating or consuming large meals. Having smaller meals more often reduces heartburn risk, as there is less food in the stomach at any one time.

Avoid carbonated soft drinks with or without sugar.

Avoid eating within two to three hours of bedtime. (Especially milk and milk-based products containing calcium and fat).

Maintain a healthy weight. The added weight from obesity can cause pressure on the stomach, which affects the functioning of the esophageal sphincter.

Patients who experience reflux at night may also find relief by elevating the head of their bed. The head of the bed can be elevated by plastic or wooden bed risers that support the bedposts, a bed wedge pillow or an inflatable mattress lifter that fits between the mattress and box spring. The elevation must be at least six to eight inches to be effective to prevent the backflow of gastric liquids.

Dr. Curtis also suggests trying over-the-counter antacids to relieve the symptoms of heartburn.

“Antacids work to neutralize the acid in the stomach. Many patients find they quickly relieve their heartburn pain,” says Dr. Curtis. “However, lifestyle modifications and using over-thecounter medications are not always effective for every patient. We do have a variety of prescription medications that we use to improve their symptoms and ultimately, their quality of life.”

If patients are experiencing regular heartburn, Dr. Curtis says it is important to schedule an appointment to discuss treatment options with their physician.

Barrett's Esophagus
“Extensive reflux can cause Barrett’s esophagus, a condition that affects the tissue lining the esophagus because of the repeated exposure to stomach acid,” says Dr. Curtis. “While only a small percentage of patients with GERD develop Barrett’s esophagus, it is important to monitor because it can infrequently lead to cancer.”

Barrett’s esophagus is diagnosed using an upper gastrointestinal (GI) endoscopy to biopsy the esophagus. While the patient is sedated, the physician inserts a flexible tube, called an endoscope, with a light and a miniature camera into the esophagus. The physician is able to remove small pieces of tissue using a tool that is passed through the endoscope. The tissue is then sent for testing to determine the diagnosis. An upper GI endoscopy can also be used to determine the causes of heartburn or GERD.

“Patients experiencing the pain of heartburn need to know that this is a very treatable condition,” says Dr. Curtis. “Our gastroenterology specialists at Newton-Wellesley have many diagnostic resources to help determine the cause of these symptoms. We provide many treatment options and will work with patients to make the modifications necessary to relieve their pain and enhance their quality of life.”

For more information about physicians or services at Newton-Wellesley Hospital, contact CareFinder at 1-866-NWH-DOCS (694-3627) or visit our website at www.nwh.org.

Newton-Wellesley Hospital is proud to be a smoke-free campus.

Newton-Wellesley Hospital • 2014 Washington St. • Newton, MA 02462 • 617-243-6000