Heartburn is a disease that occurs when gastric contents flow backward from the stomach into the esophagus. It is also termed reflux and gastroesophageal reflux disease (GERD) or pyrosis. Heartburn may or may not be associated with mucosal injury; that disease, termed esophagitis, is addressed in a separate article. Surveys suggest that as many as 25% to 40% of adults have experience heartburn once a month, while about 7% to 10% have daily heartburn. Heartburn occurs more often in males and in people over the age of 40 years.
Symptoms of heartburn usually consist of a sensation of burning or discomfort after eating, located in the middle of the lower chest underneath the sternum (breastbone). The discomfort may increase when bending over or lying flat on the back. Some people experience dysphagia (difficulty swallowing) or feeling like food is stuck in the lower esophagus while others may have a cough or respiratory discomfort, although these symptoms occur less frequently.
When to Call the Doctor
In most people, heartburn lasts for a short period of time and stops quickly, especially with the use of certain medications. People should seek medical care if heartburn is increasing in frequency, occurring daily, not responsive to over-the-counter (OTC) medications, or if additional symptoms such as difficulty in swallowing, and frequent nausea and vomiting occur. Other symptoms, such as shortness of breath and/or chest pain, can be mistaken for heartburn; these symptoms should be evaluated emergently.
Generally, most people with heartburn are presumptively diagnosed on the basis of the patient’s clinical history and the person’s response to OTC medications. However, more severe symptoms may be due to an underlying cause. The doctor then will schedule additional tests that may include an upper GI endoscopy, pH probe study (acid measurement), esophageal manometry (pressure test), upper GI series or other tests, depending on the suspected underlying cause.
Surgery for heartburn is rare; however if heartburn is uncontrollable or complications like Barrett’s esophagus develop, surgery may be considered by your doctors. The surgery may reduce the hiatal hernia, may narrow the esophageal hiatus, involve implantation of a device to augment the sphincter above the stomach or other specialized procedures.
The prognoses for the large majority of people with heartburn is very good. Many people require no treatment or only treatment with OTC’s. A small number of people will develop complications and their prognosis will vary from good to a more guarded.
As stated above, heartburn can be reduced or prevented by a stepwise treatment program that includes lifestyle changes, avoiding certain foods, OTC medications, prescription medications, and infrequently, surgical intervention.