I Can't Believe I Ate the Whole Thing

The day after Thanksgiving is not only the beginning of the shopping season, but it's also the beginning of the heartburn season.

Heartburn is the sensation of pain, burning, or pressure in your chest which usually occurs after a meal especially a large or rich meal. Other symptoms include a sour taste in the mouth, regurgitation of the food, hoarseness, difficulty swallowing, sore throat, coughing, or wheezing.

Heartburn is a symptom of gastroesophogeal reflux disease (GERD) which is caused by a back flow of stomach acid into the esophagus. This is due to a weakening of the valve, the lower esophageal sphincter, which normally holds the stomach content in place. Factors contributing to GERD or heartburn are the following:

• Alcohol use
• Overweight
• Smoking
• Pregnancy
• Certain foods such as chocolate, caffeine, garlic, onions, mint, citrus or spicy foods.
• Large meals, or lying down or bending down after a meal.

There are several over the counter medications available to treat heartburn. This gives an idea of how common the condition is.

• Antacids such as Maalox, Mylanta, or Tums are fast acting because they neutralize the acid, but their effect is short lived.
• H-2-receptor blockers such as Zantac (ranitidine), Tagamet (cimetidine), or Pepcid (famotidine) reduce the amount of acid production. They take a bit longer to work, but they provide a longer duration of relief of symptoms.
• Proton pump inhibitors such as Prilosec (omeprazole) stop acid production. Omeprazole is the only one that is currently available over the counter. This is usually used in more persistent cases and to allow healing of the esophagus.

Heartburn is common. It is considered benign if it occurs less than 3-4 times a month. In these cases simple lifestyle changes which avoid the triggers or taking antacids takes care of the problem.

However, if the symptoms are occurring on a regular basis, if they are not resolving with the usual over the counter medications, or if they are waking you up at night then you should contact your doctor. Heartburn symptoms could also signal more serious conditions such as an ulcer or esophagitis (irritation of the lining of the esophagus).

If untreated, the prolonged exposure to the acid can damage the lining of the esophagus and lead to a condition called Barrett's esophagus. This condition is associated with an increased risk of esophageal cancer. It is uncommon and the risk of developing cancer is about 1% per year, but regular follow up with a physician is necessary if this condition is diagnosed. It may only be diagnosed by an upper endoscopy.

Finally it should be noted that the pain of a heart attack may present like heartburn. If you have other risk factors for heart disease such as obesity, smoking, high blood pressure or high cholesterol, of if this is your first episode of heartburn type symptom then contact your doctor for advice.

References: please see links.
Photo: courtesy of overeating.