Heartburn, acid reflux and GERD: causes, self-care and red flags

Many people get a burning feeling in the chest after a heavy meal. When it happens often, it may be a longer-lasting condition. This article explains heartburn, acid reflux and gastro-oesophageal reflux disease (GERD, also spelled GORD), the habits that help and when to see a doctor, using information from the NHS, the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and MedlinePlus.

1. Introduction

The NHS describes heartburn as a burning feeling in the chest caused by stomach acid travelling up towards the throat, which is called acid reflux. If it keeps happening, it may be called GERD ^[1].

NIDDK explains the difference. Gastro-oesophageal reflux (GER) happens when stomach contents move back up into the oesophagus, the tube that carries food from the mouth to the stomach. GERD is a more severe, long-lasting form in which reflux causes repeated symptoms or complications over time ^[2]. MedlinePlus says heartburn happening more than twice a week may point to GERD ^[3].

2. Signs and symptoms

The NHS lists these symptoms ^[1]:

• A burning feeling in the middle of the chest
• A sour taste in the mouth
• A recurring cough or hiccups
• A hoarse voice and bad breath
• Bloating and feeling sick

Symptoms often get worse after eating, lying down or bending over ^[1]. NIDDK says heartburn and regurgitation, which is stomach contents coming back up, are the most common symptoms ^[2].

3. Causes and risk factors

Often there is no obvious cause. The NHS says these things can trigger or worsen reflux ^[1]:

• Coffee, tomatoes, alcohol, chocolate, and fatty or spicy food
• Being overweight, smoking, and stress or anxiety
• Pregnancy and hormone changes
• Some anti-inflammatory pain relievers
• A hiatus hernia, where part of the stomach pushes up into the chest, or a stomach ulcer

NIDDK says GERD may develop when the muscle at the bottom of the oesophagus, called the lower oesophageal sphincter, becomes weak or relaxes at the wrong times ^[2].

4. Diagnosis and tests

NIDDK says a doctor often diagnoses GER and GERD from your symptoms and medical history. If symptoms do not improve with lifestyle changes and medicines, further tests may be needed ^[2]. MedlinePlus lists an oesophageal pH test, a test linked to acid in the oesophagus, among the tests for reflux ^[3]. The NHS says a specialist may carry out a gastroscopy, in which a thin camera tube is passed into the stomach, to look for the cause ^[1].

5. Treatment and self-care

The NHS suggests these self-care steps ^[1]:

• Eat smaller, more frequent meals
• Work towards a healthy weight if you are overweight
• Avoid your trigger foods and drinks
• Avoid eating within 3 to 4 hours of bedtime
• Avoid tight clothes around the waist
• Do not smoke, and avoid drinking too much alcohol
• Raise the head of the bed by about 10 to 20 centimetres. Extra pillows are not recommended, because they can increase pressure on the stomach.
• Find ways to relax

NIDDK gives a similar message, suggesting weight loss if needed and eating meals 2 to 3 hours before lying down ^[2].

A pharmacist can suggest antacids or alginates, which relieve symptoms for a short time. The NHS says they do not address the underlying problem and should not be used regularly for long periods ^[1]. MedlinePlus links to an FDA warning that antacids containing aspirin can cause bleeding ^[3]. If symptoms persist, a doctor may prescribe medicines that reduce stomach acid, usually for 4 or 8 weeks to begin with, and may refer you to a specialist if medicines fail. Surgery on the stomach or oesophagus is sometimes used ^{[1, 2]}. Do not stop a prescribed medicine without asking your doctor ^[1].

6. Complications and prevention

MedlinePlus says untreated reflux can damage the oesophagus over time, so treating it matters ^[3]. NIDDK says GERD can lead to complications over time, and has a related page on a condition called Barrett's oesophagus ^[2].

Prevention is mainly the same as self-care: avoid triggers, keep a healthy weight, do not smoke, limit alcohol, eat smaller meals and avoid late meals ^[1].

7. Special groups

Pregnancy and the hormone changes that come with it can cause heartburn. The NHS advises asking a pharmacist which medicines are safe during pregnancy ^[1]. Some anti-inflammatory pain relievers, such as ibuprofen, can also trigger reflux ^[1].

8. When to see a doctor

The NHS advises seeing a doctor if ^[1]:

• Lifestyle changes and pharmacy medicines are not helping
• Heartburn occurs most days
• Food sticks in your throat, you vomit often, or you lose weight without trying
• Symptoms are getting worse

MedlinePlus warns that crushing chest pain can be a sign of a heart attack rather than heartburn and needs immediate medical help ^[3]. The sources used here do not give a way to tell the two apart at home, so chest pain should be assessed by a doctor.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Heartburn is common and often settles with simple habit changes such as smaller meals, avoiding triggers, not eating late and keeping a healthy weight. Frequent heartburn may be GERD, which deserves medical review to avoid damage to the oesophagus. Crushing chest pain can be a heart attack and needs emergency help.