Is it heartburn?

Picture this: You just ate a spicy meal and are now chilling on the couch watching Netflix. Suddenly, you have a burning feeling in your chest and a sour taste in your mouth. Is it heartburn? Acid reflux? GERD?

H. Scott Dinneen, DO, a gastroenterologist with Atlantic Health, explains the difference between the 3 conditions and offers insight into common causes and treatment options.

What is heartburn?

Heartburn is a burning feeling in your chest, just behind your breastbone. It happens when stomach acid moves up into your esophagus (the tube that connects your throat and stomach), typically after eating.

At the bottom of your esophagus is a band of muscles called the lower esophageal sphincter. The sphincter is like a gate. When you eat, it relaxes (opens) to allow food to move down into your stomach. It then tightens to close the tube.

“If the muscles are weak, the sphincter doesn’t close fully, allowing stomach acid to flow back into the esophagus, causing heartburn,” explains Dr. Dinneen.

How does heartburn differ from acid reflux and GERD?

Heartburn is actually a symptom of acid reflux and GERD.

Acid reflux (also called gastroesophageal reflux, or GER) is the term used to describe stomach acid moving back up into the esophagus. That burning pain you feel in your chest is heartburn and it’s the result of acid reflux.

GERD (gastroesophageal reflux disease) is a more severe form of frequent acid reflux. It’s a chronic (ongoing) condition that can damage your esophagus if left untreated.

What does heartburn feel like? Symptoms and warning signs

As the name implies, heartburn feels like a burning sensation in your chest, just behind your breastbone. For some, the burning reaches up to throat. For others, it’s felt near the bottom of the chest. It may be worse at night or when lying down or bending over.

Other symptoms reported less often may include:

• Nausea
• Mouth watering
• Bitter or acidic taste in mouth
• Dry cough
• Chest tightness (if you experience this, go directly to the ER to rule out a heart attack)

Heartburn can sometimes be mistaken for a heart attack.

“If your chest pain feels more like pressure than burning — or if you’re unsure — go to the nearest emergency department to be evaluated,” instructs Dr. Dinneen.

What causes heartburn?

Common causes of acid reflux and heartburn include:

• Smoking and vaping
• Being overweight
• Alcohol and coffee/caffeine
• Certain foods such as tomato sauce, spicy or fatty food, chocolate and citrus
• Certain medications such as GLP-1s and some high blood pressure medicines
• Certain anatomical conditions such as hiatal hernia
• Being pregnant

“Being overweight and smoking or vaping are the biggest contributors to heartburn,” says Dr. Dinneen. “Modifying those two things has the most significant impact.”

As for food triggers, Dr. Dinneen encourages people to be mindful.

“Everyone is different. Keep a food journal to track your symptoms and find your triggers,” he suggests.

Heartburn treatment options

Treatment options fall into 2 camps: lifestyle changes and medical interventions.

Lifestyle changes

• Maintain a healthy weight
• Quit smoking and vaping
• Avoid or limit your food triggers
• Try eating smaller, more frequent meals
• Avoid lying down after eating

Medical interventions

• Over-the-counter medications
  • Antacids such as Tums and Maalox (short-acting)
  • H2 blockers like Pepcid AC (stronger, longer lasting)
  • Proton pump inhibitors (PPIs) like Prilosec OTC^® and NEXIUM^® (long-lasting, intended for daily use)
• Prescription medications
  • Prescription-strength PPIs (40mg)
  • Potassium-competitive acid blockers (PCAB) such as Voquezna^®, a new FDA-approved class of antacids

In rare cases, surgery may be recommended to strengthen a weakened sphincter.

When to see a doctor

Heartburn can happen to anyone, even kids. If you get heartburn once in a while, it’s probably nothing to worry about. Occasional heartburn is common. But if your symptoms are frequent (a couple of times a week) or severe and interfere with your daily activities, it’s time to see a doctor.

You should also talk to a specialist if you experience trouble swallowing, nausea/vomiting, decreased appetite or unintentional weight loss. These could be a sign of something more serious.

“Heartburn is common, but very treatable,” says Dr. Dinneen. “There are many good options available to relieve your pain. You don’t have to suffer.”