Why Do I Get Heartburn, and When Is It GERD?

Dinner was good. The tomato sauce, the second glass of wine, the chocolate. Then you lie down and a hot, sour wave climbs up behind your breastbone, and you spend the next hour sitting upright against the headboard, negotiating with your stomach.

What it feels like

The NIDDK¹ lists two main symptoms: heartburn, and regurgitation, which is stomach contents coming back up through your esophagus into your throat or mouth. The NHS² adds an unpleasant sour taste in your mouth caused by stomach acid. Both agencies say reflux can also bring a chronic cough and hoarseness. The NIDDK adds chest pain, nausea and trouble swallowing, and the NHS adds bloating.

Why it happens

The NIDDK¹ says GERD develops when the lower esophageal sphincter, the valve at the top of your stomach, weakens. The contributors on its list:

• Being overweight or obese
• Pregnancy
• Smoking or secondhand smoke
• A hiatal hernia, which lets the upper part of the stomach move up into your chest
• Certain medicines: benzodiazepines, calcium channel blockers, NSAIDs and some antidepressants

The NHS² lists similar causes, plus stress, and names ibuprofen as one medicine that can contribute. If you take it for period cramps often, mention it to your clinician.

Foods and habits

The NIDDK³ says foods and drinks commonly linked to GERD symptoms include citrus and tomatoes, alcohol, chocolate, caffeine, high-fat foods, mint and spicy foods. The NHS² lists coffee, tomatoes, alcohol, chocolate and fatty or spicy foods. But triggers vary by person, the NIDDK says, so your own list may be shorter than the standard one.

Timing matters as much as menu. The NIDDK³ says eating meals at least 3 hours before you lie down or go to bed may improve symptoms. The NHS² says to avoid eating for 3 or 4 hours before bed. Smaller meals and loose clothing are on the NHS list, and so is weight loss if you’re overweight, and giving up smoking.

If bloating and fullness are the bigger problem, see why your stomach gets bigger through the day.

At night

Elevation helps. The NIDDK⁴ recommends raising your head off the bed 6 to 8 inches with a foam wedge, or extra pillows under your head and upper back, so your body is inclined. The NHS² says to raise the head of your bed by around 10 to 20cm.

Medicines

The NIDDK⁴ describes three kinds. Antacids provide temporary relief but shouldn’t be used daily without talking to a clinician, since they can cause diarrhea or constipation. H2 blockers reduce acid production but are weaker than the next group. Proton pump inhibitors, or PPIs, are better at treating GERD symptoms than H2 blockers, and can heal the lining of the esophagus in most people with GERD. The NIDDK also says PPIs may increase the chance of a C. diff infection, so it’s worth discussing the risks and benefits with your doctor. The NHS² says a pharmacist can recommend antacids or alginates, and that they give short-term relief.

The play

Try this: a two-week trigger and timing log

Each evening, write what you ate, what you drank, what time you finished eating and when you lay down, and if heartburn followed.

The NIDDK¹ says to work with your doctor on which foods seem to make symptoms worse.

After two weeks, move your last meal 3 hours earlier than bedtime for a few nights and see what changes.

When to get checked

Don’t wait if

1. Emergency

   And if chest pain comes with shortness of breath, sweating, or pain that spreads to your arm, back or jaw, call 911 instead of waiting to see if it’s heartburn.

2. Urgent

   Get care right away if you vomit blood or something that looks like coffee grounds. The NIDDK¹ lists that as a sign of a complication.

The NIDDK¹ says to get medical attention if symptoms don’t go away with over-the-counter medicines. The NHS² says to see a GP if lifestyle changes and pharmacy medicines don’t help, if symptoms happen most days, or if you have food getting stuck in your throat, are frequently sick or are losing weight.

Book an appointment if any of these fit:

• Heartburn happens most days
• Over-the-counter medicine isn’t controlling it
• It’s waking you at night
• You have trouble swallowing, or food feels stuck
• You’ve lost weight without trying
• You’re taking an antacid every day

Tomorrow’s dinner can still have tomatoes. It may need an earlier start time, and a pillow wedge.