Most people experience occasional heartburn, especially after eating big meals of spicy, fatty, or fried foods. Symptoms of chest pains and throat irritation are usually mild and go away within a few hours. Severe heartburn, also called chronic heartburn or gastrointestinal reflux disease, is a much more serious problem. People with severe heartburn experience long-lasting symptoms that are not necessarily triggered by foods. Episodes can be very frequent, and some individuals have heartburn that never really goes away. It is important to talk to a doctor if symptoms become bad enough to impact sleeping and daily activities to learn about different treatment options.
Heartburn is caused by stomach acids backing up in the esophagus. A muscle sphincter at the base of the esophagus usually relaxes as food passes through, then contracts to prevent acid backup. In a person with severe heartburn, the sphincter fails to contract properly. Acid accumulation irritates and inflames the lining of the esophagus, causing it to tighten, swell, and become tender. Severe sphincter dysfunction is usually caused by genetic abnormalities, but obesity, alcohol, fatty diets, and blood pressure medications can all make symptoms worse.
Severe heartburn can cause painful chest tightness and burning sensations that are usually the worst when lying down. Acids may be regurgitated into the back of the mouth, causing a very foul taste. A person may also have difficulty swallowing, wheezing, coughing, and throat hoarseness. The condition is considered severe when symptoms arise several times a week despite any changes in dietary habits.
A person who has severe heartburn can talk to his or her doctor about the condition and learn about treatment options. In most cases, a doctor first performs a series of diagnostic tests to make sure a more serious problem is not involved. A test called a barium esophagogram involves swallowing a small amount of barium and then undergoing x-rays. The physician can trace the path of the barium through the esophagus and stomach to see if it backs up through the sphincter. An endoscopic procedure may also be necessary to carefully inspect the lining of the esophagus to check for ulcers and tumors.
After confirming the diagnosis, the doctor can provide medications to help ease symptoms and reduce the frequency of episodes. Histamine blockers may be indicated to help calm the inflammatory response in the esophagus that causes swelling and burning. Drugs called prokinetics can encourage sphincter constriction to reduce stomach acid reflux. In addition, patients are often told to avoid alcohol and offending foods, exercise regularly, and waiting several hours after meals before they lie down. Surgery is usually not necessary, but a procedure may be considered if the sphincter or esophagus is seriously damaged.
