Even the most pleasant meal can have unpleasant – and even painful – consequences with acid reflux. You may experience heartburn, a burning sensation in your chest, or feel the need to burp frequently or clear your throat. Heartburn is common for many people, but it may be a sign of a more serious condition known as gastroesophageal reflux disease.
Heartburn or GERD?
Heartburn is a burning pain behind the breastbone. It’s the most common gastrointestinal symptom, with more than 60 million Americans experiencing flare-ups at least once per month. Heartburn occurs as a result of eating certain foods and drinks, or due to overeating. It often goes away on its own after a few minutes, although it can last for hours and requires over-the-counter medications.
Occasional heartburn is not considered dangerous, but its symptoms can mimic gastroesophageal reflux disease or GERD.
These common digestive issues are often confused because they share many of the same features,” says Dr. Lawrence Friedman, MD, assistant chief of medicine at Massachusetts General Hospital and medical editor of the online Harvard Health Burning Handbook. “While they are connected, they are completely different.”
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What is GERD?
Severe and frequent heartburn is a symptom of frequent or persistent acid reflux, also known as gastroesophageal reflux disease. For people with GERD, stomach acid rises from the stomach into the esophagus, just like water that comes up into the pelvis from a blocked drain. When stomach acid reaches the esophagus, it can lead to heartburn.
Heartburn from GERD often extends from the bottom of the rib cage to the base of the neck and can last for hours. It may be accompanied by a stinging sensation in the throat and a sour taste in the mouth. “You should get a GERD test if you have heartburn more than twice a week,” says Friedman.
Left alone, GERD can cause complications such as esophagitis (inflammation of the esophagus) and sometimes precancerous changes in the lining of the esophagus (called Barrett’s esophagus).
While severe heartburn is the most common symptom of GERD, other symptoms include:
- Difficulty swallowing
- sore throat
- Regurgitation that may appear as a ‘wet burp’ or vomiting
- Coughing, wheezing, or a constant need to clear your throat
- Hoarseness, especially after waking up
The most common cause of GERD is a malfunction of the lower esophageal sphincter (LES), the ring of muscle that separates the esophagus from the stomach. Usually, it acts as a gateway. The muscle relaxes when swallowing, which opens the passage between the esophagus and the stomach and allows food to pass through.
When the sphincter tightens, it blocks the path, preventing food and acidic stomach juices from flowing back into the esophagus. However, with GERD, the LES relaxes when it shouldn’t, or weakens and remains partially open. This allows stomach acid to rise up into the esophagus.
For both heartburn and GERD, changes in diet and medications can help you stay ahead of the discomfort.
Limit foods and drinks that cause heartburn, such as mint, fatty and spicy foods, tomatoes, onions, garlic, chocolate, coffee, tea, soft drinks and alcohol. Also try to eat smaller meals, sit upright for at least an hour after eating, and avoid eating two hours before bed.
Over-the-counter antacids or antacids neutralize the digestive acids in the stomach and esophagus; These work well for mild and intermittent acidity. Your doctor may recommend acid reducers such as H2 blockers or proton pump inhibitors (PPIs) for persistent or severe symptoms. These medications are available in many over-the-counter products, with stronger prescription versions available.
Many self-help treatments for heartburn also help manage GERD. If these methods do not provide relief, you may need to consider surgery to tighten the lower esophageal sphincter.
GERD is also associated with a hiatal hernia, in which your stomach pierces a hole in the diaphragm and weakens the ligaments that hold the esophagus in place, making it difficult for the lower esophageal sphincter to function properly.
Almost everyone with a large hiatal hernia has GERD, and hiatal hernias are most commonly found in people with GERD who also have moderate or severe esophagitis.
Hiatal hernias usually do not require treatment. “However, you may need surgery to repair the hernia if you have persistent reflux symptoms, have esophagitis that doesn’t heal with medication, or the hiatal hernia is so large that part of the stomach is above the diaphragm,” says Friedman.
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