You can often pinpoint a reason for the burn (that five-alarm chili, perhaps?), but if heartburn happens often — defined as a couple of times a week — it could be a symptom of a more serious condition called gastroesophageal reflux disease (GERD). While it may seem that GERD is just a fancy name for heartburn, they are more like close cousins than identical twins.
What Is Heartburn?
After you swallow food, it makes its way down the esophagus and into the stomach, where a ring of muscle, called the lower esophageal sphincter (LES), closes to keep the food in. But sometimes the LES is weak or doesn’t properly close, allowing stomach acid to back up, which irritates the lining of the esophagus. That’s acid reflux, or heartburn. According to the National Institutes of Health, more than 60 million Americans experience heartburn at least once a month. Symptoms include:
A burning sensation in the center of your chest that lasts from several minutes to an hour or twoA feeling of chest pressure or pain that is worse if you bend over or lie downA sour, bitter, or acidic taste in the back of your throatA feeling that food is “stuck” in your throat or the middle of your chest
You can generally avoid occasional bouts of heartburn with some lifestyle modifications. Your doctor will likely suggest that you try to treat heartburn by making the following lifestyle changes before medication comes into play:
Avoid foods that trigger reflux for you. Spicy, acidic, and fried or fatty foods are more likely to trigger reflux. So can caffeine and alcohol.Stay upright after eating a big meal, to allow for optimal digestion. “It’s best to not eat in the hours leading up to bedtime,” says Dr. Hagan.If you’re overweight or obese, losing some weight can help. (Obesity is a factor in the weakening of the lower esophageal sphincter.)If you smoke, do your best to quit.
When Acid Reflux Is Chronic: What Is GERD?
According to the American College of Gastroenterology, GERD is acid reflux that occurs two or more times per week. It is estimated that up to 20 percent of the U.S. population has GERD. That said, it’s not the case that a person who has occasional heartburn will necessarily progress toward having GERD, says Louis Cohen, MD, gastroenterologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Hospital in New York City. But the symptoms are the same as those of acid reflux, such as the burning feeling in your chest and the sensation that your stomach contents are in your throat. You may also have a dry cough or trouble swallowing. Diagnosing the condition can usually be done by a primary care doctor (or gastroenterologist) by simply evaluating symptom frequency and severity. “We may also put a probe into a patient’s esophagus for a day to measure how frequently reflux happens,” says Dr. Cohen. Knowing how often reflux occurs is another way to confirm a diagnosis, beyond evaluating the symptoms. Treatment for GERD starts with lifestyle modifications, adds Hagan: “We’ll ask patients to try these steps before we offer medication, although we understand that it can be hard to do some things, such as quitting smoking.” According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the most effective medication to treat GERD is a proton pump inhibitor (PPI), such as:
Prevacid (lansoprazole)Nexium (esomeprazole)Prilosec (omeprazole)
PPIs work by decreasing the amount of acid your stomach produces, which allows the esophageal lining to heal in the majority of people with GERD. They are available over the counter, or they may be prescribed by a doctor. PPIs are considered safe and effective, although they may lead to side effects such as headaches, upset stomach, or diarrhea. Some evidence suggests that PPIs are linked to an increased risk of infection from Clostridioides difficile, or C. diff, the NIDDK reports. Research is still looking into the effects of using PPIs long term or in high doses, so make sure to discuss the risks and benefits with a doctor. RELATED: Are Heartburn Drugs Safe? Other drugs called H2 blockers, such as Zantac (ranitidine) or Pepcid (famotidine), may also be effective, says Hagan. H2 blockers also lower stomach acid production, and they are available over the counter. “If we determine that GERD symptoms are caused by hypersensitivity in the esophagus or excessive relaxation of the lower esophagus, we might prescribe tricyclic antidepressants or selective serotonin reuptake inhibitors,” adds Cohen. Studies suggest that the pain-modulating effect of certain antidepressants can be beneficial in some gastrointestinal disorders, notes a review of research published in July 2020 in the Journal of Internal Medicine. For patients who do not respond well to medication or cannot tolerate it, surgery may be an option. A number of surgical procedures to treat GERD are available that strengthen the barrier between the stomach and the esophagus. Your gastroenterologist will walk you through the options and help you decide which procedure is best for you. RELATED: Surgical Options for GERD
Delaying Treatment for GERD May Lead to Complications
If GERD goes untreated, it can lead to more serious complications. One such issue is esophagitis, which is inflammation in the esophagus. Hagan says that if esophagitis is not treated, you may develop a stricture, which is a narrowing of the esophagus that can lead to esophageal pain and affect proper swallowing. Another complication of GERD is a condition called Barrett’s esophagus (BE). “Over time, the stomach acid causes cells in the lining of the esophagus to look more like the stomach lining,” says Hagan. These changes, which happen on a cellular level, may in rare cases lead to a form of esophageal cancer. According to the Mayo Clinic, BE is more common in:
White malesPeople older than age 50SmokersPeople who are overweight
Esophageal cancer is relatively rare, making up just 1 percent of all cancer diagnoses in the U.S., according to the American Cancer Society. However, over the past few decades, the incidence rate of esophageal adenocarcinoma (a form of esophageal cancer) has been on the rise in North America and Western Europe, according to a report published in 2019 in the Journal of Gastroenterology. Furthermore, a study published in January 2021 in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, found that this form of cancer is on the rise in younger adults: Between 1975 and 2015, the incidence rate of esophageal adenocarcinoma increased by an average of 2.9 percent per year. If you have BE, your doctor may recommend surveillance endoscopies, Hogan says. That means they’ll perform an endoscopy periodically to see how well your esophagus is healing, secondary to drug therapy. The bottom line: If you’re experiencing heartburn at an increased frequency, talk to your doctor about testing to uncover the underlying issue. If you learn to treat GERD with lifestyle changes or medication, you can avoid more serious complications. Additional reporting by Ashley Welch.
