Heartburn? Reflux? Or Something Else? Helping Patients Understand that Burning Pain in Their Esophagus

We’ve all been there - a delicious plate of barbecue and shared laughs with friends, and an hour later you’ve got that tell-tale burn in your throat and are searching for the antacids. What we may not realize, though, is that sometimes the problem is more than that extra sauce on the barbecue dish.

You’re not alone: just about everyone has or will experience an episode of heartburn at some point in their lives. It might have been that plate of nachos at the football game, or maybe it occurred after a spicy meal on vacation. Heartburn is also very common during pregnancy.

That uncomfortable feeling is commonly caused by acid reflux, a condition that occurs when stomach acid backs up into the esophagus, causing symptoms of heartburn or a sour taste at the back of the mouth. But it may be more than that. A chronic case of uncomfortable, even painful acid reflux could be gastroesophageal reflux disease, or GERD. Left untreated, GERD can cause inflammation and bleeding in the esophagus, respiratory problems, trouble swallowing—and in some cases, a higher risk of developing esophageal cancer.

To make a GERD diagnosis, your doctor will typically use a diagnostic test such as the following:

• Upper gastrointestinal X-ray series
• Upper gastrointestinal endoscopy and biopsy
• Esophageal manometry or esophageal pH test (to measure the acid that backs up in the esophagus).

Lifestyle Changes Can Make a Difference

If you're just starting to experience more frequent heartburn or acid reflux, lifestyle changes can help address the problem.

Watch out for medications that are known triggers  for heartburn, like certain pain relievers and antibiotics.

Avoid medications that can worsen acid reflux , like some sedatives, calcium channel blockers, and tricyclic antidepressants. Switch to a different medication where needed.

• Stop smoking
• Avoid eating high-fat or fried foods
• Avoid eating large meals, especially late at night
• Watch out for foods like tomatoes and citrus fruits known to contribute to acid reflux
• Don't lie down right after you eat
• Avoid or reduce your consumption of caffeine and alcohol
• If you snore, you are more likely to have both GERD and sleep apnea

*Be sure to discuss this with your physician as well.

Some people suffering from acid reflux may need to take antacids, proton pump inhibitors, or other medications to dull that discomfort in their chest. And since obesity is a big risk factor, losing some weight can also have benefits.

When You're Suffering From GERD

If you've been diagnosed as suffering from GERD, lifestyle changes are likely not enough, though all the advice for patients with regular old heartburn and acid reflux still applies.

Because GERD is a chronic disease, long-term management is the goal , according to the American College of Gastroenterology.

Why is it so important to treat GERD? Left untreated (or treated inadequately), GERD can lead to a narrowing of the esophagus and esophageal bleeding. It can even cause gradual changes to occur in the lining of the esophagus that experts believe can eventually lead to cancer, a condition known as Barrett's esophagus.

It may take some trial and error to find the right medications that can help control your GERD symptoms. For example, for some people, an H2 blocker can help heal their esophagus and relieve some of the pain, too. But others may find better relief with different meds.

And a subset of people may even find that lifestyle changes and medications just are not effective enough. For those people, surgery may be an option.

Keep an Open Dialogue With Your Doctor

The differences between heartburn, acid reflux, and GERD can be confusing. Because the best treatment for each patient is rarely the same, it's helpful if you keep your doctor posted about your reactions to medications and lifestyle changes.

Finally, a critically important note: Chest pain and shortness of breath, especially if you feel like you're being squeezed, warrant an immediate call for emergency care. It could still be acid reflux or GERD, but those might also be warning signs of a heart attack.