Heartburn/GERD

Despite its name, heartburn has nothing to do with the heart. (Some of the symptoms, however, are similar to those of a heart attack or heart disease.) Heartburn is an irritation of the esophagus that is caused by stomach acid.

With gravity's help, a muscular valve called the lower esophageal sphincter, or LES, keeps stomach acid in the stomach. The LES is located where the esophagus meets the stomach -- below the rib cage and slightly left of center. Normally it opens to allow food into the stomach or to permit belching; then it closes again. But if the LES opens too often or does not close tight enough, stomach acid can reflux, or seep, into the esophagus and cause a burning sensation.

Occasional heartburn isn't dangerous, but chronic heartburn can indicate serious problems and can develop into gastroesophageal reflux disease (GERD). Heartburn is a daily occurrence for about 10% of Americans and up to 50% of pregnant women. It's an occasional nuisance for 30% of the population.

The basic cause of heartburn is an underactive lower esophageal sphincter, or LES, that doesn't tighten as it should. Two excesses often contribute to this problem: too much food in the stomach (overeating) or too much pressure on the stomach (frequently from obesity or pregnancy). Certain foods commonly relax the LES, including tomatoes, citrus fruits, garlic, onions, chocolate, coffee, alcohol, caffeinated products, and peppermint. Dishes high in fats and oils (animal or vegetable) often lead to heartburn, as do certain medications. Stress increases acid production and can cause heartburn. And smoking, which relaxes the LES and stimulates stomach acid, is a major contributor.

Many people have different heartburn triggers, but most people have similar heartburn symptoms:

• A burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few minutes to several hours.
• Chest pain, especially after bending over, lying down or eating.
• Burning in the throat -- or hot, sour, acidic or salty-tasting fluid at the back of the throat.
• Difficulty swallowing.
• Feeling of food "sticking" in the middle of the chest or throat.
• Heartburn may cause chronic cough, sore throat, or chronic hoarseness.

Often, the pain caused by a heart attack and during a severe heartburn episode is so difficult to distinguish that sophisticated medical testing is needed to determine whether or not you are having a heart attack. To complicate matters even more, the two problems have many of the same symptoms and occur in similar types of people (For example, older age and overweight people.)

Possible signs of heartburn that could be mistaken for a heart attack include:

• A sharp, burning sensation just below the breastbone or ribs.
• Pain generally does not radiate to the shoulders, neck, or arms, but it can.
• Pain usually comes after meals, when lying on the back, when exercising or when experiencing anxiety.
• Symptoms usually respond quickly to antacids.
• Rarely accompanied by a cold sweat.

Possible signs of angina (severe pain in chest area) or heart attack:

• A feeling of fullness, tightness, or dull pressure or pain generally in the center of the chest.
• The feeling of a belt being tightened around your chest.
• Sudden chest pain or pressure that worsens.
• Dizziness.
• Pain may spread to the shoulders, neck, jaw or arms.
• Pain often responds quickly to nitroglycerin.
• Shortness of breath.
• Often accompanied by a cold sweat.
• Possible lightheadedness.

If you have any pain that lasts for more than a few minutes or any warning signs of a heart attack, seek immediate medical attention.

The symptoms of Heartburn/GERD may be caused by other medical conditions and disorders. Prescription and non- prescription medications, alcohol, caffeine, citrus juices, high fat or spicy foods and tomato based products may also cause these symptoms.

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