Q: For several months I have been troubled with heartburn almost every day. What causes it and what can I do to get rid of it?
A: Your problem is a very common one. About a third of the population in this country suffers from heartburn at least once a month, and more than one in 20 has heartburn every day. Heartburn is a daily occurrence in about 25 percent of women during the early months of pregnancy.
Heartburn is caused by irritation of the esophagus resulting from the back flow (reflux) of stomach contents, especially gastric acid, into the esophagus. The discomfort is usually worse after eating and is often aggravated by stooping, bending over or lying down. Some people are troubled by excessive salivation or a sour taste in the mouth along with the heartburn. Continued reflux of gastric acid may cause chronic inflammation, ulceration and even narrowing of the esophagus. Symptoms associated with these complications include difficult or painful swallowing and even bleeding.
The likelihood of reflux is increased by cigarette smoking, alcohol, coffee (regular or decaffeinated), chocolate, peppermint and fatty foods. The first stop in an effort to control heartburn is to stop smoking and restrict alcohol and the above foods. Nocturnal reflux can be alleviated by elevating the head of the bed on 4- to 6-inch blocks.
If symptoms persist despite these lifestyle changes, antacids may help in relieving symptoms but do not help to heal the inflammation in the esophagus. The most effective medications for the treatment of heartburn are H2 receptor antagonists -- Axid, Pepcid, Tagamet and Zantac -- which produce a prolonged block in the secretion of gastric acid. These medications have a low incidence of side effects and are more effective than antacids in promoting healing of esophageal ulcers and inflammation. You would need to see your physician in order to obtain any of these prescription drugs.
Simeon Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.