How to extinguish heartburn attacks
Q: I think I may have been suffering from heartburn. For several weeks, I have had a burning pain in my chest every day, which feels worse when I lie down in bed. Is there anything I can do that will help, other than take medication? – William. It does indeed sound as though you have been getting heartburn, William. It is in fact a very common condition, with about one in four adults being affected at some point in their lives.
Heartburn is the term used to describe a burning pain, rising from the upper abdomen into the chest and neck. It is caused when acid refluxes from the stomach into the lower oesophagus or gullet, causing inflammation and irritation of the lining.
The tight band or sphincter that lies between the stomach and the oesophagus usually prevents this happening, but sometimes the sphincter gets loosened, resulting in gastro-oesophageal reflux (GOR) and the pain known as heartburn.
Anyone can get GOR, but it is definitely more common as we age, and more common in men – with three times as many males being affected compared to females. Other risk factors include: Smoking. Pregnancy. Heavy drinking. Obesity. Diet – some foods make GOR worse, as they tend to relax the sphincter and allow more acid to reflux. Common culprits include spicy foods, tomatoes, peppermint, hot drinks and coffee. Certain medications, such as anti-inflammatory drugs (e.g. ibuprofen, voltaren or aspirin), calcium channel blockers, nitrates and diazepam. As well as causing heartburn, GOR can also present in less obvious ways. Symptoms that can be a result of GOR include burping, bloating, a feeling of fullness after eating, nausea, an acid taste in the mouth, persistent cough, hoarseness or a change in your voice quality.
Often these symptoms will fluctuate, tending to be worse after food, and when lying down as gravity then encourages the acid to travel up the oesophagus, causing the irritation.
If you feel you have been getting heartburn, or perhaps some of the other symptoms of GOR, it is important to discuss it with your doctor. If left untreated, not only will your symptoms likely persist or worsen, causing you a degree of distress and malaise, but in a small number of cases GOR can progress, resulting in more serious complications.
Over time, the persisting inflammation of untreated GOR can result in a narrowing or stricture at the base of the oesophagus, making swallowing difficult. In rarer cases, it can also lead to a problem known as Barret’s oesophagus – in this condition, the cells lining the oesophagus become altered, making them more prone to becoming cancerous; it is thought that about 1-2 per cent of people who develop Barret’s oesophagus will go on to get oesophageal cancer.
Often your doctor will make a diagnosis of GOR based on your symptoms alone, especially if you are younger and there are obvious lifestyle factors that might be triggering it. However, if your symptoms persist, worsen despite treatment, or are unusual in any way, it is important to discuss further testing to rule out something more serious.
Testing usually involves an endoscopy, where a camera is inserted through the mouth to look at the oesophagus and stomach area and take samples if required. Older investigations such as barium swallows or pH testing are much less commonly used now.
Treatment is usually pretty simple and effective. The first steps are to alter anything that is making your GOR worse – stopping smoking, improving your diet and cutting down alcohol and coffee can all make a huge difference.
I would also suggest you make sure you aren’t taking any regular medications that could be exacerbating things. Once you’ve made these changes, if you still have ongoing symptoms, a prescription for an acid-suppressing medication is a good next step. There are two common groups available in New Zealand: proton pump inhibitors (such as omeprazole and pantoprazole) and H2 blockers (such as ranitidine).
Initially, treatment for a month is recommended, as this time frame allows the inflamed oesophagus to heal. Once symptoms are better-controlled, you may be able to either stop the medication completely or take it intermittently if things flare up again.
In a small number of people, William, these medications won’t be effective – if you fall in to this category, talk to your doctor about a referral to a gastroenterologist to discuss other treatment options available.
Cathy Stephenson is a GP and medical forensic examiner.