Heartburn and Acid Reflux: Symptoms, Triggers and When to Be Seen

What it involves

NIDDK explains that gastroesophageal reflux, or GER, happens when stomach contents come back up into the esophagus, and that many people have it once in a while. When it becomes a long-lasting problem it is called gastroesophageal reflux disease, or GERD. NIDDK names heartburn, a painful burning feeling in the middle of the chest behind the breastbone, and regurgitation as the common symptoms.

Who this is for

• Adults with burning in the chest or a sour taste in the mouth that returns more than once in a while
• Patients whose heartburn has not gone away with over-the-counter medicines or lifestyle changes
• Patients who cough, clear their throat, or sound hoarse for weeks without a cold
• Patients who want to know whether chest discomfort is reflux or something that needs a closer look

What to expect

• Questions about when symptoms happen, what you ate, and how often you use antacids or other medicines
• A review of every medicine you take, since some can cause or worsen reflux
• A physical exam and a check for warning signs such as trouble swallowing or weight loss
• A plan that may combine lifestyle changes, medicine, and follow-up visits

Symptoms that are not heartburn

NIDDK says not all adults with GERD have heartburn or regurgitation. Other symptoms can include chest pain, nausea, trouble swallowing or pain while swallowing, and signs in the mouth, throat, or lungs such as chronic cough or hoarseness. That is one reason reflux is sometimes found in a patient who came in about a cough, and why chest pain should never be assumed to be reflux without a proper check, as the chest pain guide explains. Upper abdominal pain that is not burning or tied to meals may have another source, and the gallstones guide describes the gallbladder pattern.

What weakens the valve

NIDDK says the lower esophageal sphincter and the diaphragm usually keep stomach contents down, and that GERD may develop when the sphincter becomes weak or relaxes when it should not. NIDDK names being overweight or having obesity, being pregnant, and smoking or inhaling secondhand smoke as factors. A hiatal hernia, where the upper stomach moves up through the diaphragm into the chest, can also raise the chance of GERD. The obesity and BMI guide covers the weight side.

Medicines that can make reflux worse

NIDDK says some medicines can cause GERD or make symptoms worse, and lists benzodiazepines, calcium channel blockers used for high blood pressure, certain asthma medicines, NSAIDs, and tricyclic antidepressants. Do not stop a prescribed medicine on your own. Bring the full list to your visit so your provider can weigh the benefit of each one against the reflux, including medicines taken for high blood pressure.

Foods, timing, and sleeping position

NIDDK says some people find certain foods and drinks trigger symptoms. It also says eating meals at least 3 hours before lying down may improve night symptoms, and that raising your head 6 to 8 inches with a foam wedge or extra pillows may help. Foods and drinks commonly linked to GERD symptoms include: Gas and a tight, full belly often come along with reflux, and the bloating and gas guide lists the foods and habits MedlinePlus says to watch.

• Acidic foods such as citrus fruits and tomatoes
• Alcoholic drinks
• Chocolate, coffee, and other sources of caffeine
• High-fat foods
• Mint and spicy foods

Over-the-counter and prescription medicines

NIDDK says antacids can relieve mild, occasional symptoms but should not be used every day or for severe symptoms without talking to a doctor. H2 blockers and proton pump inhibitors lower the amount of acid the stomach makes, and NIDDK says PPIs are better at treating GERD symptoms than H2 blockers. If over-the-counter medicines do not make symptoms go away, NIDDK says to talk with your doctor. Which medicine fits you is decided at a visit. Some antacids, especially those containing aluminum and calcium, can contribute to constipation, as the constipation guide explains.

Signs that should not wait

NIDDK says to see a doctor if symptoms do not get better with over-the-counter medicines or lifestyle changes, and also for chest pain, loss of appetite, persistent vomiting, trouble swallowing or pain with swallowing, vomit that contains blood or looks like coffee grounds, stool that contains blood or looks black and tarry, or unexplained weight loss. Chest pain can also be a heart problem, so call 911 for sudden or severe chest pain. Belly pain can come from many organs besides the esophagus, and the abdominal pain evaluation describes the pain patterns and warning signs that MedlinePlus lists.

Sources

• NIDDK — Symptoms & Causes of GER & GERD
• NIDDK — Treatment for GER & GERD
• NIDDK — Eating, Diet, & Nutrition for GER & GERD