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Series on Symptoms (SOS): Heartburn
Episode 655th September 2023 • Your Doctor Friends • Dr. Jeremy Alland and Dr. Julie Bruene
00:00:00 00:12:21

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Have you FELT THE BURN?? Heartburn, that is. It's THE WORST.

“Heartburn” typically refers to an uncomfortable burning sensation in the stomach and chest, which can occur after eating. The medical terms for heartburn are “GERD (gastroesophageal reflux disease)”, “pyrosis” and “dyspepsia”. Heartburn is super common, can be terribly uncomfortable, and can sometimes be a sign of more serious issues. 

Thankfully in most cases, heartburn symptoms can be relatively easily addressed, and their root cause treated effectively.

We continue our "Series on Symptoms"- where we take a deep dive into common symptoms that we experience, why they exist, and what to do about them.

In this episode we cover:

What causes heartburn? What is acid reflux?

What is actually happening in our bodies when we experience these symptoms?

What are evidence-based treatments for heartburn?

What are risk factors for heartburn?

When should I seek urgent medical care (i.e. call my healthcare provider, go to the ER)?

Can chronic heartburn lead to other problems?

Our bodies are often trying to tell us things, but our symptoms are often spoken in code, so we may need a little “decoding” from time to time to understand them and respond to them effectively!

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But thankfully in most cases heartburn symptoms can be relatively easily addressed and their root cause treated very effectively. So Jeremy, are you ready to hop into where to turn when you feel the burn?


[00:00:58] Julie Bruene: I love it. so we like to break these series on symptoms down systematically, first starting with some background on the epidemiology and pathophysiology, so like, who gets it? Why does it happen? And what is the symptoms signaling in our bodies? And then we delve into the, what do I do section, meaning, how do I make these symptoms go away safely and sustainably?

And when should I be more concerned or seek out a higher level of care? So I like to think of it as what it is, and what to do. So, let's jump right in to what it is. Jeremy.


And so again, we've said this before in our series on symptoms to cover all of that would be too long, boring, and not get to the point of what you wanted this episode to be, but. Keep in mind that longstanding symptoms like this should see a medical professional. So for many people, this can involve burning discomfort and pain in the stomach and chest, a sour, bitter taste in the throat and mouth, churning stomach, burping, and sore throat.

Anybody who's ever had this knows how uncomfortable this can feel. It can taste like your food's coming back up in a weird way. I remember when I was, uh, uh, treating. Non sports related conditions. People go to the emergency room with chest pain, thinking they're having heart attacks sometimes and it's heartburn.

So it can create a lot of symptoms, but they all tend to be right in that stomach chest area and most commonly with that like sour, bitter, awful taste in your throat. So when you eat food, it goes from your mouth down to the esophagus and then into your stomach. It reminds me of that Jerry Seinfeld, standup that he did, where he was talking about the guy that they outlined with the pills, where it's just a head and then a.

Body. And it's just like, it's a tube in a circle and he's like, Oh shoot. That's not a tube or a circle. What do we do now? So, but in this case, we're talking about only the tube in the circle. Perfect for the heartburn episode to enter the stomach. The food must pass through an opening between this tube and your stomach.

Usually the opening closes as soon as food passes through. It's called a sphincter. Great word in medicine. If it doesn't close all the way, kind of like the doors open and bugs can get in, acid from your stomach can come back up through the opening into your esophagus. This is why it's called reflux.

Reflux is something where it was going back to where it came from. Stomach acid, which breaks down all our food and serves a really good purpose, is not meant to be in the esophagus. It does not feel good. It is. The esophagus is not happy, so it can irritate the esophagus and then cause heartburn. The cells that line the esophagus are not equipped to handle super low pH, which is very acidic contents from the stomach.

They are meant to be more like, you know, in the neutral type of world. So when those stomach juices reflux back up, this irritates and can damage the cells of the esophagus resulting in that burning discomfort you feel.


So other things like pregnancy or stress or certain specific foods can also make heartburn worse. Um, other factors that can trigger heartburn include cigarette smoking, drinking coffee and other caffeinated beverages or like fatty or spicy foods. Um, citrus fruits can do it, tomatoes, chocolate, onions, and then taking medications like non steroidal anti inflammatory medications like you know, ibuprofen or naproxen or aspirin.

Um, and then some studies suggest an association between being higher weight and GERD as well.


These are the things like Tums that everybody's kind of aware of. For most people, over the counter antacids can give them fast, short term relief. If you use N acids too much, they can cause diarrhea or constipation. Um, look for N acids that contain things like magnesium hydroxide and aluminum hydroxide.

Bold on the and there. One causes constipation and the other causes diarrhea, so they balance out. It is nice to actually have both in there. Some brands, as I already mentioned, include Tums, Maalox, Mylenta. You know, pick the one that tastes the best and doesn't leave that chalky taste in your mouth, I guess.

Medications that reduce the amount of acid in your stomach can help more long term. So again, if you're having heartburn and you want it to go away the minute you have it, you're probably not going to do some of the things that we have on this list next. Although some do work faster than others, the antacids that were referenced before are probably a better answer.

But if you're having this on a regular basis, you're going to look for something that's going to maybe either prevent or, or control these symptoms better. These include like antihistamines, but in this case it's the H two blocker, so not the ones that, uh, block our sinus, uh, and allergies like DRAs has told us before.

But this is actually more in our stomach. So these are the brand names of Pepcid and Zantac antagonist as well as, uh, uh, proton pump inhibitors, which are more commonly known as PPIs. And these have brand names like Prilosec and Prevacid. A lot of these have become over the counter. So one of the things that I would want to point out is that the H2 blockers, which are the pepsid xanthex, they tend to work a little bit faster and the PPIs take a little longer to start working. In fact, sometimes up to a week or two.

So just kind of thinking about when to take those medications and then also PPIs need to have acid in the stomach to work. So it's better to actually eat some food and take those about a half hour after that on a, when you take those on a regular basis, some common things that people forget to do now that those are over the counter.

So to prevent heartburn, you don't necessarily have to do medications. There are some modifications we can make. One of the things that I remember, Julie, is that, uh, nighttime cough. One of the most common causes of like, when I lay down, I start to cough is actually heartburn.

People usually think like they're getting a cold or whatnot, but you can elevate the head of your bed, not just like actually putting pillows down, but actually elevate the head of your bed, like six to nine inches using blocks underneath the posts. So it kind of looks like you're going down a ramp now while you're sleeping. I'm trying to actually not eat before you.

go to bed. This has actually a lot of health benefits. We shouldn't be eating before we go to bed more than just for heartburn. But, you know, restricting food, uh, no sooner than two to three hours before laying down, avoiding smoking again for a lot of health benefits, but also for this condition, alcohol would be a very similar thing.

Um, eat high protein, lower fat meals. Uh, again, that tends to lead to less heartburn. It's not reflecting on overall health, but that can help if you're having multiple heartburn issues. Avoid tight clothes and belts when eating. Again, we want the food to get into your stomach and then to go the right direction.

And the tighter the stuff you're wearing, it may kind of provide its own little sphincter and not let it go where it needs to. And then minimize your heartburn food triggers if you know what they are. I think all of us can kind of think about like, yeah, every time I have this, I tend to get heartburn.

And like, I don't know, maybe it's a good idea to avoid those or at least know if you're going to have them, you're going to deal with the consequences. So, Julie, when do we get concerned?


Um, and then diagnostic testing is usually used when the diagnosis is in doubt or complications are a concern. I was looking this up in the American Academy of Family Physicians page. And really the, the first line when there's not a lot of issues or concerns, which I'll get into is to start somebody on a PPI, like a Meprizol and see if their symptoms improve pretty rapidly within a couple of weeks.

Um, but then, you know. You should seek care from your healthcare provider. If so, like these are my red flag signs. Like if you have trouble swallowing or you're having a lot of pain when you're swallowing, uh, if you're vomiting blood. So big one there. I would hope that people, if that was happening to them, they would consider seeing their, their healthcare provider.

Um, if your stools are bloody or if they're like black and tarry. Um, if you're feeling really short of breath. If you're feeling dizzy or lightheaded frequently, uh, if you have pain kind of going into your neck and your shoulder that's coming from the chest area as well. Um, or if you're like breaking out in a sweat when you have the pain in your chest.

Those are all kind of signs that this may, may not be okay. And then the last one is if you're having heartburn more than three times a week for more than two weeks, it's probably time to talk to your healthcare professional, professional to talk about. more specific, um, treatment for this. Because chronic GERD can lead to a condition called Barrett's esophagus.

This is a pre malignant condition that can occur in folks with chronic GERD and when they also have other risk factors and if it goes unchecked that can turn into esophageal cancer. So, you know, these things if we just let them go for a very long time unchecked can have some more serious consequences.


And again, this is not meant to scare anybody. It just means that like regular heartburn that, you know, is coming on a regular basis. It's is not normal and should see a doctor just to make sure that it's nothing else.


So, thanks for listening. To your doctor friends.


the amazing music is credited to Skill Cell with Bay Licensure The podcast is meant for educational and entertainment purposes only The contents of this podcast should not be taken as medical advice to treat any medical condition in either yourself or others Please consult a medical professional for any medical issues that you may be having The contents of this podcast are the opinions of the host only and do not reflect the opinions of their employers or affiliations This entire disclaimer also applies to any guess or contributors to the podcast Under no circumstances shall Dr Julie Bruene or Dr.

Jeremy Alland or any guest to the podcast be responsible for damages arising from use of the podcast