Woman clutching chest

When you “feel the burn,” it’s not always the satisfying sensation you get from a great workout.

A burn at the center of your chest may be due to an indulgence from a large or late-day meal. But why do you feel “heartburn” in your chest and not in your stomach?

The answer lies in your esophagus, the passageway between your throat and stomach, says Dr. Jigar Patel, MD, gastroenterologist at Memorial Hermann Medical Group (MHMG) The Woodlands Gastroenterology.

A valve, or sphincter, at the bottom of your esophagus serves ideally as a one-way gate that allows food’s passage into your stomach, then shuts the door. Upon reaching the stomach, gastric juices break your meals down so your body can absorb nutrients.

But if you overeat or consume the wrong thing, the door can open both ways, with the stomach’s gastric juices rising into the esophagus, causing heartburn and indigestion.

Short-term, you may feel only some temporary discomfort from this condition, which is known as acid reflux.

However, when your stomach acid regularly rises into your esophagus, you could have a long-term problem known as gastroesophageal reflux disease, or GERD. That can cause lasting health issues, including an inflammation or thickening of the esophagus lining due to chronic stomach acid.

Dr. Patel shares what you need to know about easing the symptoms of heartburn and acid reflux.

What can you do to stop acid reflux?

A few lifestyle changes could make a big difference, and some choices are obvious: Eat smaller portions and avoid eating three to four hours before bedtime, Dr. Patel says.

“You also may benefit from sleeping with your head propped up.” This can be accomplished by using more pillows.

In addition, you should stop smoking and limit your alcohol intake, as both things relax the sphincter, allowing acids to come through.

“Also, avoid stress, which increases acid production in the stomach,” he says. “Find activities to help you decompress, like exercise.”

Heartburn is a matter of body chemistry, which you can balance by changing what you eat. “If you eat fewer acidic foods and add alkaline (non-acidic) foods to your diet, you should suffer less acid reflux,” Dr. Patel says.

Acidic foods which may trigger acid reflux include tomatoes, citrus, apples, spicy foods, alcohol, coffee, chocolate and peppermint. Greasy and fried foods also aggravate acid reflux.

Such foods have low numbers on the scale of acidity known as pH. Lemon juice has among the lowest pH—between 2-3—resulting in a more intense burn.

A pH of 7 is considered neutral, while anything with pH from 8 to 14 is far kinder to your esophagus. Such gentler foods include celery, watermelon and whole grains.

Besides making changes to your dietary habits, you also can fight heartburn by taking over-the-counter antacids (calcium bicarbonate) such as Tums®, Mylanta® and Pepto Bismol®. Or you may need to treat with medicines such as famotidine and esomeprazole.

However, you should check with your health care provider to ensure that over-the-counter medicines won’t interact poorly with your existing medications. Also, ask your physician if your current medicines themselves could contribute to acid regurgitation. 

If OTC products aren’t enough to soothe discomfort, your physician may prescribe a stronger dose of medicines to protect your esophagus. 

What are reflux risks?

Some popular weight loss and diabetes treatments can slow the emptying of the stomach and thus contribute to acid reflux, Dr. Patel says.

So can sleep apnea, especially if it’s severe enough to require the use of a CPAP (continuous positive airway pressure) machine. CPAPs open your airway so that you’re less likely to stop breathing due to apnea.

A gastric sleeve procedure—in which weight-loss surgeons remove 70% of the stomach–can spike acid reflux. The remaining stomach becomes a slender vertical shape that’s the size of a banana and cannot accommodate all that you eat.

If your reflux doesn’t respond to lifestyle changes or medication, then your doctor may need to run tests to determine if you have an ineffective valve.

Your physician also can determine if you have Barrett’s esophagus. This is a condition in which chronic stomach acid alters the lining of the esophagus.

Barrett’s esophagus is more prevalent in smokers, Caucasian men over 50 and those with a family history of the ailment or esophageal cancer, Dr. Patel says.

You may be screened for Barrett’s esophagus if you have those risks or reflux symptoms such as chronic cough, a deeper voice, an acidic taste in the mouth or a form of regurgitation for more than five to10 years. But not all people with Barrett’s have its common symptoms.

Similarly, be wary of an underlying condition known as laryngopharyngeal reflux, or silent reflux. That condition causes no symptoms at first but can create serious complications when stomach acids damage the esophagus or throat.

One common reason for such lack of awareness is the loss of sensation experienced by some diabetics, who may not complain about reflux pain until the damage becomes severe.

Barrett’s syndrome, too, can go undiagnosed at first, Dr. Patel says.

To reveal a problem, your doctor can perform an endoscopy, in which a long, skinny, flexible tube with a tiny camera is sent down your esophagus. There, it examines the esophageal lining, the amount of acid there and the valve’s function. The device also can take tissue samples to check for precancer or cancer. “Those changes over time could progress to esophageal cancer,” Dr. Patel says.

If you’re having trouble swallowing food, feel like something is stuck in your esophagus, have lost your appetite or are losing weight unintentionally, see your doctor. Those could be signs of esophageal cancer.

An endoscopy also may reveal a hiatal hernia, where the valve and part of the stomach have moved into the chest. “If a hernia is found of significant size, surgeons can repair the valve using an anti-reflux procedure,” Dr. Patel says. 

Barrett's esophagus can be eradicated with cryoablation, a procedure where liquid nitrogen is sprayed in the esophagus to destroy abnormal precancerous cells. 

Then again, you may just have a common case of heartburn. Visit your health care provider if you have questions or concerns.

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