James A. Surrell, M.D.

Heartburn is very appropriately named. The personal symptoms of heartburn are a true “burning” painful sensation in the middle of the chest, usually located behind your breastbone, or sternum. It may occur anytime, but is also frequently experienced after one goes to bed, often with a full stomach from a late meal or snack an hour or two before bedtime. It may occur after one goes to sleep, but the severe burning pain will certainly wake you up! Then you head for the medicine cabinet looking for the chewable antacid tablets to try to get some relief. Let us now briefly review what causes heartburn, and how to deal with it.

The painful symptoms of heartburn come from the normal hydrochloric acid working on digestion in your stomach “refluxing,” or traveling up into your lower esophagus. Now, the lining of your stomach is designed to resist the effects of this potent stomach acid, and it generally does so very well. However, when this stomach acid goes up and makes contact with the lining of the lower esophagus, it inflames the esophagus tissue and causes this burning sensation behind your breastbone. Unlike the stomach, the lining of your esophagus is not designed to resist the effects of this potent stomach acid.

You likely have heard the term GERD. GERD stands for Gastro-Esophageal Reflux Disease, and GERD is now a commonly used medical term to describing this “reflux” of stomach acid up into the lower esophagus. Normally, the stomach acid is kept down in the stomach by a small muscle at the junction of the lower esophagus and the stomach. However, this junction of the esophagus and the stomach may “open up” over time, and this allows the acid to contact the lower esophagus causing these painful GERD symptoms.

The diaphragm is a very large flat muscle that separates the chest from the abdomen. The esophagus passes through an opening in the diaphragm to connect with the stomach. If this opening enlarges, it is called a “hiatal hernia”. Heartburn symptoms are very often seen with a “hiatal hernia”. With a hiatal hernia, the opening in the diaphragm enlarges, and this allows the stomach to partially slide up into the lower chest and this allows for stomach acid reflux to occur, causing heartburn.

GERD symptoms should always be treated. It is important not only to relieve the significant heartburn pain from the acid reflux, but long-term acid reflux into the lower esophagus can also cause cancer at this site. There are multiple ways to medically treat the symptoms of GERD. Heartburn symptoms are very commonly treated by antacid tablets or liquid, or by over-the-counter acid-reducing medications.

With any persistent heartburn, or GERD symptoms, it is very important to promptly discuss this with your health care provider. It may be recommended that you have an upper G.I. endoscopy procedure to directly look at the esophagus and stomach, not only to make a correct diagnosis, but to also check for any pre-cancerous changes. At this time, biopsies of the esophagus and stomach likely would be done, as determined at the time of the endoscopy procedure. Depending on findings, surgery may also be recommended to treat severe or advanced cases of GERD. Don’t ignore these heartburn symptoms! With any heartburn symptoms, see your health care provider, and take advantage of the many effective medications used to treat this very common painful medical condition.