Dousing Heartburn's Flame

At one time or another, most of us have suffered from heartburn -- a burning feeling behind the breastbone or sometimes at the same level in the mid-back. We call it heartburn, but it has nothing to do with the heart; it's a digestive condition, and it can be controlled.
Heartburn, also called acid indigestion, occurs when the muscle that controls the valve (sphincter) at the lower end of the esophagus is not able to close the valve completely, according to the American Gastroenterological Association (AGA). Stomach juices back up into the esophagus, creating the burning sensation of heartburn. Another symptom of heartburn is regurgitation, or the sensation of food or liquid coming up into the throat or mouth, especially when bending over or lying down. When this occurs, you may have a bitter or acid taste in your mouth.
When heartburn occurs frequently, it may be the chronic condition called gastroesophageal reflux disease (GERD). Untreated, GERD can contribute to ulcers, asthma, Barrett's esophagus and cancer of the esophagus.
Scope of the problem
The stomach produces hydrochloric acid to help digest food, so it is normal in the stomach. When the esophagus is exposed to this acid, its very delicate lining can become inflamed and painful.
Heartburn affects 10 percent of Americans at least once a week, the AGA says.
Not all heartburn is equal, however, and not everyone suffers to the same degree. Episodic or occasional heartburn is a common type of heartburn that is infrequent and often predictable. Frequent heartburn occurs two or more days a week. According to a recent survey conducted by the National Heartburn Alliance:
Fifty percent of frequent heartburn sufferers believe it is impossible to live heartburn-free. This perception is gradually changing because of massive advertising campaigns touting highly effective heartburn medications.
More than 90 percent of frequent heartburn sufferers say that it affects their quality of life in some specific way.
Almost one-third of frequent heartburn sufferers feel as if they will never be able to enjoy the foods they love.
The good news is that heartburn symptoms can be controlled and complications generally avoided with proper treatment and monitoring.
Getting relief
Lifestyle modifications may help many people significantly reduce their risk for heartburn. The changes include avoiding the foods and behaviors that most aggravate their condition. These are the most common triggers: Tomato-based products, spicy foods, chocolate, garlic, fatty foods and coffee
A hectic lifestyle
Certain body positions, such as bending over or lying flat in bed, especially after eating a large meal or drinking alcohol
Medical reasons, such as pregnancy or taking certain medications
Other factors, such as smoking, drinking alcohol or being overweight
Exercise can help relieve heartburn symptoms by keeping the digestive system moving. Exercise also helps reduce stress from a hectic lifestyle. Taking a short, relaxed walk after dinner can help prevent heartburn. For a more vigorous or longer workout, you should wait at least two hours after a meal.
Sometimes lifestyle modifications are not enough to relieve heartburn, or people find that they don't want to give up the foods they like or their way of life. Medications are the next line of defense: over-the-counter (OTC) antacids and H2-receptor antagonists, OTC proton pump inhibitors (PPIs), and prescription versions of these.
Antacids neutralize stomach acid and provide relatively rapid but short-term relief of heartburn symptoms; they last for about one to two hours. It is often necessary to take an increasing amount of antacid to adequately control heartburn over a long period of time. Examples of antacids include Maalox, Mylanta, Rolaids and Tums. These medications typically contain calcium, aluminum or magnesium compounds that neutralize existing acid and act as a buffer.
H2-receptor antagonists (H2RAs), or H2 blockers, partially reduce the amount of acid produced in the stomach and last longer than antacids. H2RAs generally last six to 12 hours, so they need only be taken twice a day. Examples of H2RAs include Pepcid AC and Zantac 75. H2RAs are available OTC or by prescription.
PPIs completely inhibit stomach acid production by shutting down active acid pumps in the cells of the stomach for as long as 24 hours. Some are available OTC; and others by prescription. These include Prevacid, Nexium and Protonix.

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