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Heartburn or pyrosis is a painful and burning sensation in the esophagus, just below the breastbone usually associated with regurgitation of gastric acid.[1] The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn is also identified as one of the causes of chronic cough, and may even mimic asthma. Despite its name, heartburn actually has nothing to do with the heart. It is so called because of a burning sensation of the breastbone where the heart is located although some heart problems do have a similar sensation to heartburn. Compounding the confusion is the fact that hydrochloric acid from the stomach comes back up the esophagus because of a problem with the cardiac sphincter, a valve which misleadingly contains the word “cardiac,” referring to the cardia as part of the stomach and not, as might be thought, to the heart.
Relief is often found by raising the head of the bed, raising the upper body with pillows, or sleeping sitting up. Avoid pillows that raise the head only, as this does little for heartburn and places continuous strain on the neck. Eating a big meal causes excess stomach acid production, and attacks can be minimized by eating small frequent meals instead of large meals especially for dinner. To minimize attacks, a sufferer may benefit from avoiding certain foods that stimulate excess acid secretion and/or relax the opening between the stomach and esophagus. Acid fruit or juice, fatty foods, coffee, tea, onions, peppermint, chocolate, or highly spiced foods are to be avoided, especially shortly before bedtime.[2] While there are clearly other health-related benefits associated with dietary interventions a zealous recommendation for dietary restrictions is not evidence-based, and there is stronger support for reducing the symptoms of acid-reflux found in behavioral changes such as eating less and elevating your head while sleeping.[3] Tight clothing around the abdomen can also increase the risk for heartburn because it puts pressure on the stomach, which can cause the food and acids in the stomach to reflux to the LES.
Antacids, H2-receptor antagonists, alginates, proton pump inhibitors, and other alternative treatments are used to treat heartburn. Contrary to popular belief, milk is not a recommended antidote to heartburn. A glass of milk does provide immediate relief as it goes down, but milk contains calcium and protein, and these eventually stimulate even more acid production in the stomach. This can cause a more severe heartburn that can return in as little as a half an hour.[4]
Antacids work by neutralizing excess stomach acid. Therefore, although stomach acid will still splash into the esophagus, it will be neutralized, leading to decreased or absent heartburn symptoms. Antacids provide fast relief of symptoms, but relief typically lasts for only 20-60 minutes.
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