The burning sensation of heartburn

Unfortunately, some people know it all too well: “A burning pain in your chest, just behind your breastbone,” as the Mayo Clinic describes the feeling.¹

Is it heartburn? Or acid reflux? Or GERD (gastroesophageal reflux disease, also known as GORD in Great Britain)? But wait, are those all the same thing or different? Or, worse, is that chest pain something scarier, like a heart attack?

First, a general explanation from the Mayo Clinic:²

• Acid reflux is the physical effect of stomach acid backing up into the esophagus.

• Heartburn is the uncomfortable or painful chest symptom acid reflux sometimes causes.

• GERD is the condition when acid reflux symptoms occur often and regularly.

Acid reflux

Acid reflux, or gastroesophageal reflux, is caused by stomach acid flowing backward up the esophagus from the stomach to the throat. This can be due to the relaxing or weakening of the lower esophageal sphincter, a band of muscle that normally relaxes to allow food down the esophagus.

Stomach acid is usually safely handled by the stomach’s lining, but if the band of esophagus muscle relaxes at the wrong time, it can allow that acid back up the wrong way, toward your throat and mouth. Because the esophagus is not equipped to tolerate the acid, that can cause a sour or regurgitated taste at the back of your mouth or sometimes a burning feeling behind your sternum or breastbone.³

Heartburn

That burning feeling is called “heartburn” because of its location in the center of the chest, but it doesn’t have anything to do with your actual heart. However, people sometimes mistake severe heartburn for a heart attack.

Occasional heartburn is typically nothing to worry about. It can be caused by eating or drinking certain types of food, being overweight or pregnant, or bending over or laying down too soon after a big meal.¹

GERD

However, when acid reflux symptoms like heartburn occur more regularly—for example mild symptoms several times a week or severe symptoms at least once a week—that could be a sign of GERD. Other ongoing symptoms of GERD could include a chronic cough or laryngitis.³

Is my chest pain heartburn or heart attack?

Chest pain can be scary, and it’s not always easy to tell if you’re just experiencing heartburn—or something more serious.

Below are some general guidelines from Harvard Health Publishing for telling the difference between heartburn and a heart attack.⁴ If you’re still not sure what your symptoms mean, see a doctor or go to the emergency room—and call 911 if you have trouble breathing.

Heartburn

• Burning sensation behind breastbone that may move toward throat

• Feeling like there’s food in the back of your mouth or a bitter or acidic taste in your throat

• Gets worse when you lie down or bend over

• Symptoms may be felt after large or spicy meal

Heart attack or angina

• Lightheaded, weak, dizzy, shortness of breath

• Tightness or stabbing pain that can spread into shoulders, neck and arms

• Irregular or rapid heartbeat or a cold sweat and clammy skin

• Symptoms may be felt during or after physical exertion or stress

Dealing with acid reflux and GERD

If you experience acid reflex or heartburn, there are things you can do to help manage it.

Change your habits¹ ⁵

Cut down on or avoid foods and drinks that you’ve found aggravate your acid reflux. Those might include things like:

• Spicy foods, fatty foods, fried or greasy foods

• Mint, tomatoes, onions, garlic, chocolate, citrus (oranges, lemons)

• Fizzy (carbonated) drinks, caffeine (coffee, tea, energy drinks), alcohol

Second, you can change how and when you eat and what you do after eating, such as:

• Eat smaller meals more often and eat more slowly.

• Wait 3 hours after eating before laying down or sleeping (that includes after-lunch naps).

• When sleeping, elevate your head about half a foot by raising the head of the bed or using an upper-body foam wedge—don’t add more pillows because that may just put extra pressure on your stomach.

• Avoid vigorous exercise for an hour or 2 after eating.

Other things you can do include:

• Losing weight as advised by your doctor

• Stopping smoking

• Loosening tight clothing, especially around the waist (including belts)

Over-the-counter (OTC) medicines

There are 3 main types of OTC medicines that can help manage stomach acid and reduce acid reflux’s effects:

• Antacids neutralize stomach acid for quick relief but won’t heal a damaged esophagus. (Alka-Seltzer®, Maalox®, Mylanta® Rolaids®, TUMS®, Pepto Bismol®)

• Histamine 2 (H2) receptor antagonists or blockers (H2RAs) reduce stomach acid more slowly but for a longer period (up to 12 hours). (Tagamet HB®, Pepcid-AC®, Zantac®)

• Proton pump inhibitors provide stronger and longer acid blocking, which can allow the esophagus to heal. (Prevacid®, Nexium®, Prilosec®)

Surgery

If lifestyle changes and medicines aren’t effective or viable options, your doctor may suggest a minimally invasive surgery such as:

• Fundoplication—tightening the lower esophageal sphincter by wrapping the top of the stomach around it.

• Placing a LINX® device—a ring of small magnetic beads around where the stomach meets the esophagus keeps the opening closed to acid but allows food to pass through.

Talk to your doctor about the best treatment for you. If he or she recommends an OTC medicine, some Humana Medicare plans offer an OTC allowance to help pay for your medicine. To see if your plan offers such savings, sign in to MyHumana and go to “Coverage and Benefits.”

Learn more about the OTC allowance

Sources:

1. “Heartburn,” Mayo Clinic, last accessed July 30, 2019, https://www.mayoclinic.org/diseases-conditions/heartburn/symptoms-causes/syc-20373223.
2. “Acid Reflux and GERD: The Same Thing?” Mayo Clinic, last accessed July 30, 2019, https://www.mayoclinic.org/diseases-conditions/heartburn/expert-answers/heartburn-gerd/faq-20057894. 
3. “Gastroesophageal Reflux Disease (GERD),” Mayo Clinic, last accessed July 30, 2019, https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940. 
4. “Heartburn vs. Heart Attack,” Harvard Health Publishing, last accessed July 30, 2019, https://www.health.harvard.edu/heart-health/heartburn-vs-heart-attack. 
5. “9 Ways to Relieve Acid Reflux without Medication,” Harvard Health Publishing, last accessed July 30, 2019, https://www.health.harvard.edu/digestive-health/9-ways-to-relieve-acid-reflux-without-medication.