Is It Heartburn or Something More?
While almost everyone has had to reach for the antacids after overindulging during a night of Tex-Mex and margaritas, maybe you’ve noticed that your occasional heartburn is becoming more regular.
If so, you’re not alone—it’s estimated that more than 60 million Americans experience heartburn at least once a month, and 15 million suffer from it daily.
But when should you start to worry about that heartburn? When do you know if it’s something more, like Gastroesophageal reflux disease (GERD)?
We asked Jay Yepuri, M.D., a gastroenterologist on the medical staff at Texas Health HEB, to explain what heartburn, reflux, and GERD are, and to dispel some common myths about GERD.
What do the terms heartburn, reflux, and GERD mean?
“We all normally reflux,” Yepuri says. “It is normal to have a little acid reflux—it’s a totally normal human function. Pressure builds up in your stomach, and just like a burp, sometimes a little acid will come up.”
We often see the three terms—especially heartburn and GERD—used interchangeably, something Yepuri says is not incorrect but can cause confusion.
“Heartburn and GERD are used interchangeably, but heartburn is only one part of GERD,” he explains.
“It’s when the reflux is happening more than two times a week, or more often and severely, and requiring meds on a semi-regular basis that we begin to worry about GERD,” he says, adding that difficulty swallowing or having a hoarse voice can also be indicators of GERD.
True or False: Heartburn and GERD are caused by spicy foods.
“False. Certainly, eating spicy food can burn,” Yepuri says,” but it’s the spices, which can burn your esophagus and stomach just like they do your mouth.
“There are definitely trigger foods,” he continues. “Spicy foods may burn the esophagus and give you heartburn. But it doesn’t increase the acid reflux or GERD.”
True or False: There is always regurgitation with reflux.
“The true definition of reflux is something coming up,” Yepuri explains. “But the real question is, ‘Is it acid or nonacid?’ If it’s not supposed to be in the esophagus, it can irritate and burn—and still not be stomach acid.
“I get patients that will tell me they’re taking their prescription acid-blocking medication as directed, and still have reflux,” he continues. “I have to explain that all those medicines are doing is reducing the production of acid—they’re not magically strengthening the muscles and the sphincter at the lower end of the esophagus that prevents reflux.”
True or False: You should begin to see improvement in your heartburn within 5 to 10 days of starting a medication.
“It varies, really,” Yepuri says. “If you picked up a 14-day supply of Prilosec at Costco and it says, ‘See a doctor if you are still experiencing symptoms after 14 days,’ it’s an arbitrary number.
“Really, the rule should be that if you’re having persistent symptoms, see a doctor,” he says. “If you have gotten to the point of needing medication consistently for heartburn and acid reflux, it’s worth seeing a doctor about.”
True or False: Medication is the only way to treat GERD.
“We generally try diet and behavioral changes first,” Yepuri explains. “We’ll also encourage lifestyle modifications like losing weight, which can help.
“But really, the one modification that has shown to help consistently is elevating the head of the bed,” he adds. “But if all of those things have been done and it’s still not improving, then we will go with medication.”
Yepuri says that H2 blockers like Zantac and Pepcid, or proton pump inhibitors like Nexium and Prilosec are generally prescribed, starting at the lowest dose possible.
“If medicine isn’t quite cutting it, or a patient is concerned about long-term use of these medications, there are procedures that are options,” he adds. “There are surgical and endoscopic procedures that can reduce the need for medications or eliminate it.”
True or false: If you don’t have heartburn, you don’t have reflux.
“False,” Yepuri says. “Some people don’t experience any symptoms with their reflux, and we don’t discover it until we’re running a test and see signs of it.”
True or false: Only unhealthy people get heartburn, GERD or reflux.
“I know the classic stereotype is the overweight, middle-aged guy,” Yepuri says, “but anyone can develop GERD. Genetic factors and anatomical factors can come into play as well.”
In fact, one group that commonly will suffer from GERD—albeit briefly—is pregnant women. “It’s very common to have it,” he explains. “Not only because a baby is rearranging things and making it physiologically likely, but also because pregnancy hormones can relax the muscles and sphincter at the bottom of the esophagus, making acid reflux more likely.”
Yepuri said some foods can also relax the sphincter, like chocolate, peppermint, caffeinated beverages, fatty foods and alcoholic beverages, so cutting out these items can cause some relief.
If you are looking for a primary care physician or specialist, it’s as easy as going to Texas Health Resources’ physician finder or calling 1-877-THR-WELL.