Heartburn: Signs and Symptoms and When It’s an Emergency

Heartburn, well, does just that… it burns. That burning sensation is caused by a backward flow, or reflux, of stomach acid into your esophagus. Your lower esophageal sphincter, the part where your esophagus connects to your stomach, prevents the contents of your stomach from escaping. But sometimes it relaxes or weakens and allows acid to flow backward into the esophagus. Since your esophagus isn’t resistant to acid the same way your stomach is, it can cause a painful, burning feeling in your chest.

Common heartburn symptoms include:

• Burning chest pain usually after eating or at night.
• Worsening pain when lying down or bending over.
• Bitter or sour taste in the mouth.
• Difficulty swallowing.
• Chronic cough or sore throat from acid irritation.
• Hoarseness or voice changes.

When you start to feel that tell-tale burning sensation in your chest, you may wonder how long your heartburn will last. Symptoms can last as little as a few minutes, or as long as several hours. Generally, however, the symptoms should begin to ease once you’ve properly digested your most recent meal. Healthy digestion typically takes around two hours, though it can take up to five hours for the small intestine to fully digest your foods.

Foods and Drinks that Trigger Heartburn

Here are some items you may want to avoid:

1. Coffee has both caffeine and acids, two things that cause heartburn. Try decaf or a low-acid roast.
2. Citrus fruits and juices are very acidic, which can trigger heartburn, especially if consumed on an empty stomach.
3. Tomatoes are highly acidic and should be eaten occasionally if they give you symptoms.
4. Garlic and onion can cause pain in some people, but researchers aren't sure why. Raw onions do activate acid but cooking them helps.
5. Peppermint is thought to also relax the LES. But we need more research to fully understand this.
6. High-fat foods such as french fries and pizza stimulate your stomach to produce more acid, irritating your esophagus. Greasy foods can also make heartburn more likely.
7. Alcohol drinks, such as wine and beer, relax the lower esophagus, allowing acids to escape from the stomach.
8. Chocolate not only has caffeine, but it also reduces lower esophagus pressure, research shows. But scientists still don't know if not eating chocolate can improve your heartburn.
9. Caffeine in coffee, soda, and tea calms the lower esophagus, which can give you symptoms.
10. Carbonated beverages cause gastric distension. Don’t drink them at night, as they're known to cause nocturnal heartburn.

Heartburn vs. Heart Attack

Chest pain caused by heartburn can be like what you would feel if having a heart attack, which can be alarming. However, while you do feel a burning sensation in your chest in both cases, there are some key differences.

With heartburn you may:

• Feel a burning sensation in your chest.
• Experience it after eating or while laying down.
• Find you mouth tastes sour – as heartburn typically accompanies acid reflux.
• Get relief from antacids.

With a heart attack you may:

• Feel pain, tightness or aching in your chest or arms.
• Find it hard to catch your breath.
• Feel tired, dizzy and lightheaded.
• Want to vomit.

If you are experiencing chest pain but aren’t sure whether it’s heartburn, you should call 911 or go to your nearest emergency room.

Other Serious Conditions Related to Heartburn

Occasional heartburn is normal, but frequent or severe symptoms may indicate other conditions, such as:

• Gastroesophageal reflux disease (GERD)
  • Heartburn more than twice a week.
  • Regurgitation of food or acid.
  • Persistent cough, sore throat, or wheezing.

• Esophagitis (inflammation of the esophagus)
  • Painful swallowing.
  • Chest pain unrelated to heartburn.
  • Bleeding or black stools (signs of damage).
• Barrett’s Esophagus (a pre-cancerous condition)
  • Chronic GERD symptoms.
  • Increased risk of esophageal cancer.

When To Go to the Emergency Room

If you experience any of the following symptoms, it’s time to head to the ER:

• Frequent heartburn (two or more times a week).
• Symptoms persist despite over-the-counter medication.
• Difficulty swallowing or persistent sore throat.
• Unintentional weight loss.
• Vomiting blood or black stools.
• Chest pain that persists.

A doctor will determine if heartburn is a serious problem by evaluating symptoms, medical history, and diagnostic tests. Here’s how they assess the condition:

1. Medical History and Symptom Assessment

The provider will examine the frequency of the symptoms. Heartburn more than twice a week suggests GERD. They will also examine the severity. Intense, persistent, or worsening symptoms raise concerns. Lastly, they will identify triggers. Certain foods, lying down or exertion may indicate different conditions.

2. Diagnostic Tests

If symptoms indicate a bigger issue, a doctor may order the following diagnostic tests:

• Endoscopy: A flexible camera examines the esophagus and stomach for inflammation, ulcers or Barrett’s esophagus.
• pH monitoring: A sensor measures acid reflux over 24 hours.
• Esophageal manometry: Tests how well the esophagus moves food to the stomach.
• Barium swallow X-ray: A special liquid highlights the esophagus on an X-ray to check for narrowing or damage.

Inform your health care provider if you had an episode of unexplained chest pain that went away within a few hours, and you did not seek medical attention. Both heartburn and a developing heart attack can cause symptoms that subside after a while. The pain doesn't have to last a long time to be a warning sign.

If you have persistent chest pain and you aren't sure it's heartburn, call 911 or go to the emergency room.

Common Remedies for Heartburn

Keeping tabs on your lifestyle and diet will have a positive impact on your overall health. Making these simple changes can help reduce or prevent heartburn.

• Eat smaller meals: Large meals put pressure on the stomach.
• Avoid trigger foods: Spicy, fatty, acidic and caffeinated foods can worsen symptoms.
• Don't lie down after eating: Wait at least two to three hours before lying down or going to bed.

• Wear loose fitting clothing: Wearing tight fitting pants, jeans or skirts can apply pressure to the part of your esophagus that connects to your stomach.
• Elevate your head while sleeping: Raise the head of your bed by six to eight inches to prevent acid reflux.
• Maintain a healthy weight: Excess weight puts pressure on the stomach.
• Quit smoking and limit alcohol: Both weaken the esophageal sphincter, leading to reflux.

Find the Right Care for You at ProMedica Toledo Hospital Emergency and Urgent Care

ProMedica Toledo Hospital Emergency and Urgent Care provides patients with quality care and services. Staff are ER-trained to determine patient conditions, and patients only pay for the level of service they receive - either ER or urgent care. The emergency department is open 24/7 and the urgent care clinic is open from 7 a.m. to 9 p.m. daily. You don't need an appointment. All walk-ins are welcome.

ProMedica Toledo Hospital Emergency and Urgent Care is located at 1075 Medical Center Parkway, Maumee, Ohio 43537.