Clutching his chest, your friend attempts to reassure his worried spouse, “Oh, it’s just a little heartburn.” What is heartburn? We hear the term every day, but you might be surprised to learn heartburn has little to do with the heart. That said, the symptoms of “heartburn” can overlap with and are often confused with the symptoms of a heart attack by both patients and physicians.
Heartburn and indigestion are layman’s terms for the discomfort felt in the upper chest and throat by stomach acid washing upwards out of the stomach into the esophagus, also called reflux. When we eat and drink, stomach contents including the acid that aids digestion, are supposed to do their work in the stomach and then move on down the gastrointestinal tract into the small intestine and below. There is even a valve between the lower end of the esophagus and the stomach that is designed to help keep stomach contents where they belong. In some people this valve malfunctions and allows stomach contents and/or acid to reflux up into the esophagus. In some people, the stomach acid can make it all the way up into the mouth causing “sourbrash.” The most common symptoms of heartburn are a burning sensation in the upper chest or throat. However, reflux can also cause chest pressure and other symptoms that can be confused with a heart attack.
Besides being confused with symptoms of a heart attack and often delaying life-saving care, chronic, untreated excess stomach acid and heartburn can result in peptic ulcer disease (ulcers of the stomach and small intestine), esophagitis, and even a premalignant condition known as Barrett’s esophagus. In Barrett’s esophagus, chronic washing of stomach acid into the lower esophagus causes a change in the types of cells that line the esophagus, and over time, these changes can progress to esophageal cancer. So there are many reasons to treat “just a little heartburn” — to relieve unpleasant symptoms, but also to prevent ulcers and even cancer. Ulcers are not only painful, but they can lead to life threatening low blood counts and even perforation of the stomach or small intestine.
Mild symptoms of reflux can be immediately alleviated by taking an antacid that neutralizes the stomach acid. These include baking soda, tablets like TUMS and Rolaids, or liquids like Mylanta. However, these treatments are only for the momentary relief of symptoms — they do nothing to relieve the cause of the reflux and thus little to prevent more serious consequences like ulcers and cancer.
Better options include the histamine-receptor blockers (H2 Blockers) like Tagamet, Pepcid, and Zantac. These were the first medications that actually reduced the amount of acid made in the stomach rather than just neutralizing it like the antacids. These can be very effective medications and were used for years to allow ulcers to heal. However, a more effective class of medications called proton pump inhibitors (PPIs) are now available that essentially cut off the production of stomach acid. These include Prilosec, Prevacid, Protonix, and Nexium. Due to the coloration of some of these capsules, people know the class as “the purple pill.” For many people, taking one daily tablet or capsule can completely prevent their heartburn symptoms. There is also data that suggests these treatments can prevent or lessen the chances of the development of esophageal cancer. Another class of medications called promotility agents can tighten the valve at the end of the esophagus. This helps keep stomach acid at bay and also stimulates the movement of stomach contents onward rather than upward. Sometimes these are used together with PPIs. Other simple things you can do to prevent heartburn — don’t overeat; don’t smoke; raise the head of your bed 2-3 inches to help prevent acid reflux.
Just a little heartburn? Better check it out with your primary care provider (PCP) — you do have one, right? While an antacid might be okay for occasional use, frequent heartburn can lead to very serious consequences. So listen to your family and don’t minimize your symptoms — make that call to your PCP and extinguish the fire!
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (which is closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com