Stomach/GI: Heartburn

Overview and Heartburn Facts
Heartburn, also known as acid reflux and gastroesophageal reflux disease, is characterized by a burning sensation in the chest. One 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.

Heartburn 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 bedtime
• 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 heartburn triggers and behaviors that contribute to acid reflux flare-ups.

Day-to-Day Management
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

Treatment and Care
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 OTC medications, patients should inform their physician and discuss next steps in the treatment plan.

Lifestyle Modifications and Alternative Medicine
Patients can find symptom relief by making changes such as avoiding restrictive or tight clothing and elevating the head of the bed 4 to 6 inches. Patients whose heartburn is caused by stress and anxiety may want to consider the following:

• Light-to-moderate exercise
• Relaxation techniques
• Massage

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

• Antacids
• Histamine-2 blockers and histamine-2 blockers with antacids
• Proton pump inhibitors and proton pump inhibitors with 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