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Heartburn Center — Heartburn Relief That's Permanent

C. Steeve David, MD, FACS

Digestive enzymes that travel back up into the esophagus can cause symptoms such as a burning chest pain or pressure, cough, hoarseness, asthma, regurgitation or a constant lump-in-the-throat sensation. The Heartburn Center at Virginia Hospital Center offers two studies to assess gastroesophageal reflux disease (GERD) and optimal courses of treatment. One test measures swallowing and valve function in the esophagus, while the other records the frequency and nature of reflux episodes over a 24-hour period.

Most individuals with acid reflux can be, and are, treated successfully with medication and minor behavioral modifications. When these measures don't work, many individuals assume their reflux is caused by what they eat and the discomfort and pain is untreatable and just something they have to live with.

Your return to a normal life without food restrictions starts here with a better understanding of what causes heartburn and what can be done to provide relief that is permanent.

Frequent heartburn is worth looking into. Many people experienced heartburn, caused by rich foods, overeating and stress. But could your heartburn be symptomatic of a larger problem?

C. Steeve David, MD, FACS, provided answers to some frequently asked questions. Dr. David, who is Medical Director of the Heartburn Center, Virginia Hospital Center, and a member of VHC Physician Group–Surgical Specialists, offers both surgical and endoscopic anti-reflux treatments. For answers, please click on the links below to expand or collapse:

What is Heartburn?

Heartburn, or acid reflux, is a burning sensation in your chest. It is the backup of stomach contents and acid into the esophagus (food pipe). It’s often worse when lying down or bending over. Symptoms also can include stomach pain, difficult or painful swallowing, persistent cough, the sensation of something stuck in the throat and regurgitation.

What is the difference between Heartburn and GERD?

Occasional heartburn is very common and symptoms can often be managed with lifestyle changes and over-the-counter medications. When episodes of heartburn become more frequent and last longer and begin to interfere with daily life, it is usually considered to be Gastroesophageal Reflux Disease (GERD). If you have been taking antacids for more than two weeks, see your healthcare provider to find out if you might have GERD. Left untreated, GERD can lead to serious complications over time, including stomach ulcers and esophageal cancer.

What causes GERD?

The reason some people develop GERD is still unclear. In some people with GERD, the lower esophageal sphincter simply relaxes at an inappropriate time. More commonly, anatomical abnormalities such as a hiatal hernia contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the lower esophageal sphincter move above the diaphragm (a thin layer of muscle that separates the stomach cavity from the chest cavity). When the lower esophageal sphincter is in its normal position the diaphragm helps keep stomach contents and acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Like hernias in other parts of the body, it can be an acquired defect over time from straining, coughing or gaining weight. Fortunately, a hiatal hernia does not cause GERD or significant symptoms.

Other factors that may contribute to GERD include:

  • obesity
  • pregnancy
  • smoking

The food you eat does not cause reflux but foods that commonly worsen reflux symptoms include:

  • citrus fruits
  • chocolate
  • drinks with caffeine or alcohol
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods, like spaghetti sauce, salsa, chili, and pizza.

What are the symptoms of GERD?

The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breastbone, and in the mid-abdomen. Most children under 12 years with GERD and some adults have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.

What are the tests for GERD?

If your symptoms do not improve with lifestyle changes or medications, you may need additional tests.

Barium swallow radiograph

Barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then x-rays are taken. The test will not detect mild irritation, although strictures—narrowing of the esophagus—and ulcers can be observed.

Upper endoscopy

Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor's office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals the injury to the esophagus, usually no other tests are needed to confirm GERD. The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found.

pH monitoring examination

pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary—recording when, what, and amounts the person eats—which allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

The perfect diagnostic test for GERD does not exist. The tests mentioned above all have their strengths and weaknesses. It often takes a combination of tests and physician evaluations to accurately determine the cause of symptoms and to design and implement an appropriate therapy to control those symptoms and repair any damage from chronic reflux.

What are the medical treatments for GERD?

See your health care provider if you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than 2 weeks. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery.

Lifestyle Changes

  • If you smoke, stop.
  • Avoid foods and beverages that worsen symptoms.
  • Lose weight if needed.
  • Eat small, frequent meals.
  • Wear loose-fitting clothes.
  • Avoid lying down for 3 hours after a meal.
  • Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help.


Your physician may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription; however, see your physician before starting or adding a medication.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2 can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.

Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.

Prokinetics help strengthen the lower esophageal sphincter and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety and problems with physical movement.

Because drugs work in different ways, combinations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your physician is the best source of information about how to use medications for GERD.

It is important to note that medications do not "cure" reflux like antibiotics "cure" infections. Medical management of GERD is designed to control the symptoms and lessen the damage caused by stomach fluid splashing into the esophagus and airway. Medications and lifestyle adjustments do not repair the mechanical defects that allow reflux to occur. Most patients experience a rapid return of their previous symptoms when medications are discontinued.

Anti-Reflux Surgery

Millions of Americans suffer from chronic heartburn, which is usually a symptom of gastro-esophageal reflux disease or GERD. It is due to the acid from the stomach refluxing up into the esophagus. It is often frequent enough to have a significant impact on the individual’s quality of life by keeping him from enjoying certain foods or even keeping him up at night. It can also sometimes lead to serious conditions such as asthma, burning of the esophagus (esophagitis), and even cancer of the esophagus.

  • Nissen fundoplication
  • Stretta Procedure

To read more about anti-reflux surgery, click here.

What are the long-term complications of GERD?

Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures—narrowing of the esophagus—that make swallowing difficult. Some people develop Barrett's esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer, which is often fatal. Persons with GERD and its complications should be monitored closely by a physician.

Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis.

Points to Remember

Frequent heartburn, also called acid indigestion, is the most common symptom of GERD in adults. Anyone experiencing heartburn twice a week or more may have GERD. You can have GERD without having heartburn. Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing.
If you have been using antacids for more than 2 weeks, it is time to see your health care provider. Most doctors can treat GERD. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Health care providers usually recommend lifestyle and dietary changes to relieve symptoms of GERD. Many people with GERD also need medications. Surgery is a treatment option when medical management fails or is too burdensome for the patient over time. It can be performed by specially trained surgeons with a brief hospitalization and a short recovery when laparoscopic techniques are used.

What does the Heartburn Center do?

The Heartburn Center is at the forefront of diagnosis and treatment of heartburn and GERD, offering the latest in esophageal function testing and 24-hour reflux monitoring. A combination of these tests is usually required to determine the exact cause of reflux to identify the appropriate treatment. A physician referral is required for testing at the Heartburn Center.

Where can I go to get help for my Heartburn (GERD)?

1701 N. George Mason Drive | Arlington, VA 22205-3698 | tel 703.558.5000
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