The best way to treat heartburn or acid reflux is through your stomach

A friend of mine, expecting her first baby, recently asked what I had enjoyed least about being pregnant.

Without hesitation I said, “Having heartburn.” I’d never had it before, but from just a few weeks into the pregnancy I suffered almost non-stop from that horrible burning sensation. Thankfully it disappeared once my daughter was born, but it made me feel for several people I know who’ve had ongoing problems with heartburn, or acid reflux. One suffered so badly she needed several operations.

If heartburn is the bane of your life, or just an occasional problem, here’s some information that may shed light on why you get it and what you can do about it.

How do I know if I have heartburn?
The most obvious symptom is a burning pain in your chest, under your breastbone. Some people describe this pain as feeling like you’ve drunk acid, or like your chest is on fire. It may feel worse when you bend over, lie down or eat. It may also be more frequent or become worse at night.

What causes it?
The burning pain is due to acid from your stomach flowing up into your oesophagus (gullet). A valve at the bottom of your oesophagus – which opens to let food and liquid pass through to your stomach and then closes again – is supposed to prevent this from happening. But if the valve (properly known as the lower oesophageal sphincter) relaxes too much, or has been weakened for some reason, the acid gets through and wreaks havoc on your oesophagus.

Frequent heartburn is usually a symptom of a condition called gastroesophageal reflux disease (GERD). It can also be caused by a hiatus hernia, which is when part of your stomach sticks into your lower chest.

Who is likely to get heartburn?
The following all increase your risk of suffering from it:

• Being obese. Excess weight puts added pressure on your stomach and diaphragm (the muscle that separates your chest from you abdomen), forcing the oesophageal valve open and causing acid to travel back into your oesophagus.
• Having a hiatus hernia. This condition weakens the valve.
• Being pregnant. Carrying around a baby puts greater pressure on your stomach. Plus, when you’re pregnant, your body produces more of the hormone progesterone, which relaxes many of your muscles, including the ones that control the oesophageal valve.
• Having asthma. It’s not known exactly why being asthmatic makes you more prone to heartburn, but it’s thought that it may be the result of breathing problems that put extra pressure on your chest.
• Being diabetic. One of the complications of diabetes can be a disorder that means it takes a long time for your stomach to empty after you’ve eaten. If food sits in your stomach, being digested for a long time, it may be regurgitated into your oesophagus and cause reflux.
• An obstruction in your stomach. If an ulcer, a growth or scarring develop in the wrong place, they can lead to a blockage, which may prevent the oesophageal valve working properly.

When should I go to the doctor?
Heartburn is common and getting it every now and again is usually nothing to worry about.

You should see your doctor if:

• You get it several times a week.
• It wakes you up in the night.
• You take an over-the-counter (OTC) antacid but the pain returns as soon as the medication wears off.

Get help straight away if you have:

• Difficulty swallowing.
• Unexplained weight loss.
• Regurgitated blood or black gunk.

What is the treatment for heartburn?
It depends on how badly you suffer. If your acid reflux is mild and infrequent then an over-the-counter medication may be all you need. These are available either as antacids, which neutralise the stomach acid or H-2 receptor blockers, which reduce the production of acid. They can have side effects however, so read the label carefully.

If your heartburn is persistent, you may have GERD and will need stronger medication, and possibly surgery. You’ll need to see a doctor.

What can I do to reduce heartburn?
You may be able to ease it or reduce how often you get it by making lifestyle changes such as:

• Maintaining a healthy weight.
• Not wearing tight clothes or belts that can put pressure on your abdomen.
• Eating smaller meals so there is less pressure on your oesophageal valve.
• Eating slowly and chewing your food more thoroughly.
• Working out the foods that may trigger an attack – common ones include fatty, fried or spicy foods, chocolate, alcohol, garlic, onion and tomatoes – and cutting them out of your diet.
• Cutting down your caffeine consumption – or cutting it out completely.
• Avoiding activities where you are likely to need to bend over for long periods of time (ie gardening). And instead of slumping on the sofa – sit up straight.
• Waiting at least two or three hours after eating before you lie down – never go straight to bed after a meal.
• Raising the head of your bed. Gravity can help counter the flow of acid. You’ll need to actually put objects like bricks under the feet of your bed – simply raising your pillows won’t work.
• Stopping smoking. It may increase the amount of acid in your stomach.

The milk myth

Milk is often suggested as a remedy for heartburn as its alkaline content was thought to neutralise the acid that causes burning in the oesophagus.

However, researchers say that while it may help to ease that burning sensation when you drink it, the relief is only temporary. It can actually have a rebound action that may encourage your stomach to produce extra acid.

If you drink it before bed, it could end up causing acid reflux while you’re asleep.

Did you know ...?
It’s not only the food you choose that can increase your chances of getting heartburn. Excess pressure on your abdomen is another major factor. It forces the oesophogeal valve open, which allows acid to travel back into your oesophagus. For this reason, heartburn is closely linked to pregnancy or wearing clothes or belts that are too tight.