Heartburn

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Digestive system

Gastroesophageal reflux disease

Hiatal hernia

Hiatal hernia - X-ray

• Antacids, like Maalox or Mylanta, work by neutralizing stomach acid.
• H2 blockers, like Pepcid AC, Tagamet, and Zantac, reduce stomach acid production.
• Proton pump inhibitors, like Prilosec OTC, stop nearly all stomach acid production.

Call 911 if:

• You vomit material that is bloody or black like coffee grounds.
• Your stools are black (like tar) or maroon.
• The burning sensation is accompanied by chest squeezing, crushing, or pressure. Sometimes a heart attack is mistaken for heartburn.

Call your doctor if:

• The problem becomes frequent or doesn't go away with a few weeks of self-care.
• You start losing weight unintentionally.
• You have difficulty swallowing (food feels stuck as it goes down).
• You have a persistent, unexplained cough or wheezing.
• Your symptoms get worse with antacids or H2 blockers.
• You think that one of your medications may be causing heartburn. DO NOT change or stop your medication on your own, without discussing with your doctor.

Heartburn is usually easy to diagnose from the symptoms you describe to your doctor. Sometimes, heartburn can be confused with another stomach problem called dyspepsia. If the diagnosis is unclear, then you may be sent to a gastroenterologist for further testing.

First, your doctor will perform a physical examination and ask questions about your heartburn, such as:

• When did it begin?
• How long does each episode last?
• Is this the first time you have had heartburn?
• What do you usually eat at each meal? Before you feel heartburn, have you eaten a spicy or fatty meal?
• Do you drink a lot of coffee, other caffeinated beverages, or alcohol? Do you smoke?
• Do you wear clothing that is tight in the chest or abdomen?
• Does the pain also appear in the chest, jaw, arm, or elsewhere?
• What medications are you taking?
• Are you vomiting blood or black material?
• Do you have blood in your stools?
• Do you have black, tarry stools?
• Are there other symptoms accompanying your heartburn?

The following tests may be performed:

• Upper GI series
• Esophageal motility to measure the pressure of your LES
• Upper endoscopy to look at the inside lining of your esophagus and stomach

If self care has not been successful, your doctor may consider prescribing you medications to reduce acid secretion. These are stronger than the medications available over the counter. Any sign of bleeding will require a more complicated treatment plan.

Review Date: 04/28/2005
Reviewed By: Christian Stone, M.D., Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.