Q. I think I have heartburn, but I hear that what feels like heartburn is sometimes a more serious condition. How do I know if I have heartburn?
A. You’ve asked an important question. “Heartburn” describes symptoms caused by the reflux of stomach acid up into the esophagus (the tube that carries food from the mouth down to the stomach). It is a burning sensation. You can feel it high in the abdomen, just below the bottom of the breastbone, or underneath the middle of the breastbone in the chest. In other words, despite the word “heart” in the word “heartburn,” real heartburn comes not from the heart, but from the stomach and esophagus.
Heartburn often starts following a meal (when there’s lots of acid in the stomach) or when you’re bending over or lying down (allowing gravity to pull acid from the stomach into the esophagus). It can awaken you from sleep. The burning sensation can last minutes or longer and usually is relieved by swallowing antacids.
Heartburn often is accompanied by other symptoms. Acid-tasting stuff (sometimes containing small particles of chewed, partially digested food) can regurgitate up to and irritate your throat, producing a sour or salty taste, or causing you to make so much saliva that it sometimes drips out of your mouth. People who have had heartburn for a long time sometimes have trouble swallowing food because stomach acid has irritated and narrowed the esophagus, so that food sticks going down or swallowing becomes painful. Reflux of stomach acid up to the vocal cords in the throat can cause hoarseness, a chronic cough, or wheezing.
When you have what seems like “just” heartburn, what serious conditions should you worry about? If you’ve had heartburn for a long time, acid can irritate the bottom part of your esophagus and raise the risk of cancer forming there. Heartburn may be caused by an ulcer in the stomach or small intestine, which can cause serious bleeding or an abdominal infection. If you’ve had heartburn for many years and done little or nothing about it, your doctor should check it out.
Finally, what seems like “just” heartburn can actually be a condition called angina—a symptom caused by the buildup of fatty deposits in the arteries of the heart, which can cause a heart attack and even sudden death. If, along with your heartburn pain, you feel lightheaded or faint; if you break out in a sweat; or if the pain goes into your jaw, your shoulders, your back, or down your arms, contact your doctor. While it still might really be just heartburn, the chance that it’s heart trouble is great enough that you need to get it checked out.
— by Anthony L. Komaroff, M.D.
Editor in Chief, Harvard Health Letter
Image: © LaylaBird/Getty Images
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