Heartburn

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Heartburn

Gastroesophageal reflux disease (GERD) occurs when material from your stomach or small intestine repeatedly enters your esophagus. Some individuals have GERD for many years. Complications, such as serious damage to the esophagus, respiratory diseases, and ear, nose, and throat conditions can occur, but are more likely with older people.

Signs and Symptoms

Heartburn—a burning sensation in the chest, throat, neck, or back—is the primary symptom of GERD. Other symptoms include:

	Regurgitation
	Difficulty or pain with swallowing
	A full sensation in the neck
	Belching
	Chest pain (similar to angina)
	Laryngitis
	Chronic cough
	Wheezing
	Hoarseness
	Sore throat
	Bad breath

What Causes It?

GERD has many possible causes.

	Spicy foods, tomato-based foods, citrus fruits, fatty foods, chocolate, coffee, alcohol, and certain medications
	Overeating, burping intentionally, wearing tight-fitting clothes, bending over frequently, lying down soon after eating, and smoking
	Physical condition (particularly being overweight)
	The effectiveness of the valve at the bottom of your esophagus in preventing material from your stomach from entering the esophagus
	Medical conditions

What to Expect at Your Provider's Office

Your health care provider can generally diagnose GERD by discussing your symptoms, what you eat and drink, medications you are taking, and your lifestyle. Your provider also may order diagnostic tests.

Treatment Options

Treatment Plan

Treatment begins with avoiding food, drink, and medications that may be causing your GERD. Modifying your lifestyle (for example, stop overeating or smoking) may help cure GERD. Raising the head of your bed about 6 inches also can be helpful. Drug treatment varies with the severity of the GERD. If the esophagus is inflamed (esophagitis), you will be treated with drugs to prevent or treat damage as well as drugs to relieve symptoms.

Drug Therapies

Prescription

	Antacids and alginic acid—for symptom relief with mild GERD; does not work for esophagitis
	Prokinetics—relieve heartburn; may not work for esophagitis; various side effects, especially in the young and old
	H2 antagonists—relieve symptoms, can heal mild-to-moderate esophagitis; prevents relapse of mild GERD; various side effects
	Proton-pump inhibitors—very effective and long-lasting drugs to stop the secretion of gastric acid; relieve severe symptoms and heal esophagitis; few short-term side effects, long-term side effects are unknown

Over the Counter

Antacids are also available over the counter.

Complementary and Alternative Therapies

Changes in your diet can help decrease the irritation of GERD. Herbs may be very effective at healing esophagitis (inflammation of the esophagus).

Nutrition

	Digestive enzymes may help if you have heartburn.
	Avoid sweets, oils, fats, and caffeine.

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Some herbs typically used to help digestive problems actually make GERD worse. The following herbs can be used to treat GERD.

	Licorice (Glycyrrhiza glabra) is an anti-inflammatory and antispasmodic, and relieves pain in the gastrointestinal tract. Chewable lozenges may be the best form for treating GERD. Take 380 to 1,140 mg a day. Do not take licorice if you have high blood pressure or use it for a prolonged period of time.
	Slippery elm (Ulmus fulva) protects irritated tissues and promotes their healing. Take 60 to 320 mg a day. You may mix 1 tsp. powder with water three to four times a day.

In addition, a combination of four of the following herbs may be used as either a tea (1 cup three times a day) or tincture (30 to 60 drops three times a day).

	Valerian (Valeriana officinalis)—bitter, sedative, especially for anxiety or depression or poor digestion
	Wild yam (Dioscorea villosa)—antispasmodic, anti-inflammatory, especially for fatigue from long-term stress and poor digestion
	St. John's wort (Hypericum perforatum)—pain reliever, antidepressant
	Skullcap (Scutellaria laterifolia)—antispasmodic, sedative, calming, especially for disturbed sleep
	Linden flowers (Tilia cordata)—antispasmodic, mild diuretic, gentle bitter, especially for dyspepsia (gas)

Homeopathy

Some of the most common remedies used for GERD are listed below. Usually, the dose is 12X to 30C every one to four hours until your symptoms get better.

	Arsenicum album for burning pain that feels better with warmth
	Carbo vegatabilis for bloating and indigestion that is worse when lying down, especially with flatulence and fatigue
	Lycopodium for heartburn that feels worse with eating
	Nux vomica for heartburn with cramping and constipation

Acupuncture

May be helpful to normalize digestion and relieve stress

Following Up

Contact your health care provider if the medication does not help or if you experience side effects, such as cramping or diarrhea.

Special Considerations

GERD is quite common during pregnancy, particularly in the third trimester. Chewable papaya tablets may provide relief and are safe to use.

Supporting Research

Andreoli TE, Bennett JC, Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 1993:285–287.

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:443–446.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:217.

Dambro MR. Griffith's 5 Minute Clinical Consult–1999. Baltimore, Md: Lippincott Williams & Wilkins; 1999:422–423.

Kelley WN, ed. Essentials of Internal Medicine. Philadelphia, Pa: J.B. Lippincott Company; 1994:104–106.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:39–43, 102–103, 229–231, 272–275.

Stoller JK, Ahmad M, Longworth DL, eds. The Cleveland Clinic Intensive Review of Internal Medicine. Baltimore, Md: Williams & Wilkins; 1998:595–599.

Werbach MR. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing Inc; 1987:210.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein