Question:

Please explain heartburn to me. It got so bad during the holidays, but is better now. What can I do to prevent it from coming back?

Answer:

Heartburn is often an unwelcome guest at the holiday table. Binging on sumptuous feasts provokes heartburn symptoms, including burning behind the breastbone, difficulty swallowing, sore throat, chest pain and nausea. In fact heartburn is very common; nearly 40 percent of Americans experience it at least once a month. Some people are particularly prone to heartburn. For example, nearly half of pregnant women complain of heartburn in the later stages of pregnancy, according to the American College of Gastroenterology.

Also called acid indigestion or reflux, heartburn is the most common symptom of gastroesophageal reflux disease (GERD) and occurs when the contents of the stomach back up into the esophagus. A valve - the lower esophageal sphincter located between the esophagus and the stomach - will normally open after swallowing to allow food into the stomach. This valve will then close quickly to prevent the reflux of food and stomach juices back into the esophagus. If the valve relaxes or weakens, the stomach's contents can back up into the esophagus causing a burning pain.

Heartburn is described as a sour, burning sensation in the upper abdomen or chest. It may go up into the neck and mouth and be associated with acid regurgitation or food "sticking" in the throat. The burning, pressure, or pain can last as long as two hours and is generally worse after meals, while laying down at night, or while bending over.

To reduce heartburn symptoms, doctors recommend lifestyle and dietary changes for most people. Treatment aims at decreasing the amount of reflux or reducing damage to the lining of the esophagus from refluxed materials. Follow these tips to help combat heartburn:

• Avoid overeating.
• Avoid fried and fatty foods, as well as alcohol, chocolate, caffeinated soda and coffee (caffeine relaxes the muscle between the esophagus and the stomach), peppermint, spicy foods, citrus fruit and juices, and tomato products.
• Avoid lying down for two to three hours after eating; the muscle that connects the stomach and the esophagus may relax, causing acids to travel up the esophagus.
• Avoid strenuous activity to allow the stomach's contents to digest without disruption.
• Lose weight if overweight.
• Stop smoking.
• Elevate the head of the bed six inches, which reduces heartburn by allowing gravity to minimize reflux of stomach contents into the esophagus while sleeping.
• Wear loose clothing that does not constrict the stomach muscles.
• If you experience heartburn on a regular basis, take an over-the-counter, acid-reducing agent before the meal to avoid symptoms; or take an antacid after the meal to reduce or relieve heartburn symptoms.

In people with mild heartburn, simple lifestyle changes may improve symptoms. However, people with recurring symptoms or more severe symptoms or esophageal damage usually need either long-term medications or surgery to cure their heartburn. Work with your doctor. With an understanding of the causes of heartburn and GERD and proper treatment, most people find relief.