Why Do I Have Heartburn?

Feeling the burn is great when you’re running or lifting weights. Not so much when you’re trying to sleep. But that’s what heartburn feels like a fire pit in the middle of your chest.

“Heartburn is a symptom; it’s never normal,” says Alex Howard, MD, a gastroenterologist at Baptist Health Medical Group in Lexington.

Heartburn might not be normal, but it certainly is common. More than 60 million Americans experience heartburn at least monthly; 15 million people have it daily. If you’re one of those people, here’s what to know.

Prevent Heartburn from Happening

Bypassing trigger foods and adopting other lifestyle changes might be enough to help some avoid heartburn. Acidic foods and juices, citrus juices, for instance, may trigger it. “Caffeine, alcohol and cigarettes also increase the risk of acid reflux.”

Red wine, chocolate, and fatty foods are problematic too. If you’re prone to heartburn, try not to eat within three hours of bedtime, and raise your head six to eight inches when sleeping, either with pillows or with blocks under the head of the bed.

Losing a few pounds might also help. For his patients carrying extra weight, Dr. Howard recommends a 10 percent weight loss in a year.

How to Treat Heartburn

“If your heartburn is infrequent and a result of an occasional overindulgence, go with Tums or another antacid,” Dr. Howard says. “The calcium carbonate acts as a buffer.” Additionally, over-the-counter medications Pepcid and Zantac can be taken for immediate relief of symptoms,” Dr. Beebe says. (Products such as Tums and Rolaids neutralize stomach acid, while Pepcid and Zantac reduce acid production.)

But if you are reaching for medication a few times a week, it’s time to look for more proactive solutions.

“The first step is to make sure someone experiencing heartburn is truly suffering from gastric reflux, the most common cause,” Dr. Howard says. When a patient comes to him with new heartburn problems after about age 45, Dr. Howard often conducts an upper endoscopy test to help pinpoint the cause, and rule out other conditions, such as problems with your heart. Severe heartburn and heart attack can be hard to tell apart.

If lifestyle changes don’t work, relief might lie in potent prescription-strength acid suppressors called proton-pump inhibitors, or PPIs. (Think Nexium and Prilosec, among others, which are usually taken daily.) These PPI drugs are very effective at treating heartburn, but there are concerns about their long-term use. Some studies suggest the drugs might raise the risk of kidney disease, osteoporosis, and deficiencies of magnesium and B-12, among other problems.

Both doctors say patients should weigh the risks and benefits before taking these drugs. “I am not sure we have strong, reliable evidence of a problem that I would deprive somebody of a beneficial treatment (from PPI drugs) for a potential side effect,” Dr. Beebe says. “I don’t think everyone with gastric reflux needs a PPI, but there are those who definitely benefit from it.”

The doctors keep close tabs on patients taking PPIs, and watch for measurable changes that could indicate a problem. And for people whose heartburn doesn’t respond to medication, the doctors discuss surgical options.

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