What is heartburn?

It's tough to watch TV these days without seeing commercials for Zantac, Prilosec, Tums, or some other heartburn medication. And many of you have likely needed these medications or experienced heartburn, but what causes heartburn?

First, heartburn = acid reflux = gastroesophageal reflux (GERD). You'll hear these words used interchangeably, and they all mean the same thing.

Heartburn actually has nothing to do with the heart. Our stomachs are normally acidic. Specific cells in the stomach called parietal cells secrete acid. The acid helps fight bacteria and activates certain enzymes such as pepsin, which helps digest proteins. This is a good thing, if the acid stays in the stomach. But that can be a big if...

After we chew up food, we swallow it via the esophagus. The esophagus connects to the stomach at the gastroesophageal junction (a.k.a. the GE junction). A muscle at this junction called the lower esophageal sphincter ideally is able to open to let food and liquid in but will close afterwards to keep things from going the wrong way. This junction, though, often does not close sufficiently. Some of the acidic contents can, therefore, come back up.

The stomach lining generally can handle acid, but the esophagus cannot. Heartburn describes the irritation of the esophagus caused by exposure to acidic contents from the stomach. Aside from being uncomfortable, long standing acid reflux can actually have very serious side effects. It increases the risk of esophageal cancer and esophageal dysfunction (via stricture/closure of the esophagus). In addition, if the acid makes its way up to the throat, it can cause cough, runny nose, and even lung problems like pneumonia.

A number of treatments can help reduce heartburn. The next post will be about how heartburn medication works, but other interventions can also help. 

Avoid laying down right after eating. The stomach contents have to work against gravity to enter the esophagus when sitting or standing. But when you lie down, it makes it easier for things to come up. Ideally, avoid laying down for 3 hours after a meal.

Raise the head of your bed. Kind of the same concept: gravity can be your friend. Just using extra pillows will not do the trick, though, as this can put additional pressure on the stomach. Use one of the two techniques below, with the block generally being the preferred method if possible:

Lose weight. Additional weight puts pressure on the stomach, which can push more of the acid into the esophagus.

For more tips on decreasing acid reflux: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000197.htm