Heartburn and Indigestion

In the United States, almost 50% of the population has heartburn at least once a month; 7% have it daily. Heartburn is even more common during pregnancy, with about 1 in 4 women reporting it daily at some point during their pregnancy. Statistics on acid indigestion are difficult to find because the definition is vague, but it's probably almost as common as heartburn.

Heartburn, Acid Indigestion

Heartburn is a burning feeling in the middle of your chest caused by acid leaking upwards from the stomach into the esophagus, or swallowing tube. Doctors call this reflux esophagitis. Normally, the muscular esophagus acts like a one-way valve allowing food to enter your stomach after swallowing, but not letting anything go back up. When your esophagus is too loose where it connects to the stomach, strong stomach acid seeps back through the opening and causes heartburn. Because your esophagus doesn't have a protective lining like the stomach, it can be burned by the acid causing pain and sometimes damage. Heartburn can also cause night time cough, wheezing, and in some cases difficulty swallowing food due to scarring of the esophagus.

Acid indigestion is a similar burning discomfort, but in the pit of your stomach. It can be caused by acid irritating the stomach lining or duodenum. Acid indigestion is believed to happen not just because of too much acid, but also because of too little protection from the mucus lining the stomach. Acid indigestion can burn so deeply into your stomach or duodenum that a canker sore-like crater forms (peptic ulcer disease).

Of course, these more severe conditions need to be treated by a physician. Fortunately, you can prevent ulcers by following a few simple steps and using newly available OTC medicine to stop problems in their early stages.

Heartburn

To prevent stomach acid from splashing back up, you must tighten the loose esophagus where it meets the stomach. Avoiding certain foods and activities can stop the problem in many cases, (see chart), but those with hiatal hernia (a bulging of the stomach partly into the chest cavity), overweight people, and pregnant women may not be able to improve the leakiness of the esophagus/stomach junction. In those cases, gravity can help. Just staying upright long enough to let food and acid empty out of your stomach can stop the problem. To prevent heartburn:

  • Never lay down after a meal
  • Allow 2-3 hours between eating and bed time
  • Try propping up the head of your bed 2 or 3 inches with books or blocks under the legs of the frame. It's hard for stomach acid to go uphill into your esophagus.

The foods and activities listed below loosen the esophagus or promote heartburn in other ways.

Foods to avoid
  • Alcohol
  • Peppermint/Spearmint
  • Chocolate
  • All caffeinated drinks (coffee, tea, many soft drinks)
  • Fatty foods
Activities to avoid
  • Smoking
  • Eating before bed
  • Laying down after a meal
  • Tight-waisted clothing

Many prescription drugs cause heartburn - check with your doctor if you take:

  • Certain high blood pressure medicine
  • Some tranquilizers and anti-depressants
  • Female hormones

Acid Indigestion

To prevent acid indigestion, you need to protect the stomach lining and avoid activities that increase stomach acid. To help maintain the protective layer:

  • Don't take aspirin, ibuprofen, or other anti-inflammatory drugs. They can directly damage your protective stomach lining (acetaminophen products will not cause such damage).
  • Don't smoke or use any tobacco products. Nicotine and other substances found in tobacco both weaken the stomach's protective layer and increase acid production.

To stop your stomach from producing extra acid, avoid:

  • Coffee (regular or decaf)
  • All caffeinated products (even chocolate)
  • Carbonated drinks (such as soda pop)
  • Citrus fruits and juices
  • Milk (Surprise! This actually may aggravate your acid indigestion, not soothe it.)

There are two types of OTC medicines proven to work against heartburn and indigestion: antacids and H2 blockers. They both reduce the acidity of stomach juices, which reduces irritation of the stomach, duodenum, and esophagus. But remember, neither medicine stops stomach juices from getting back into the esophagus. So it's still important to take all the preventive measures discussed in the last section.

Antacids have the advantage of working very quickly --- you can get relief within minutes. They are also inexpensive. But beware: the dozens of antacids available vary greatly in potency. You have to drink ten times the amount of the weakest antacid to get the same acid-eliminating effect as the strongest antacid! Only high-potency antacids are recommended in our Recommended Products section.

H2 blockers were prescription-only anti-ulcer drugs until recently. Instead of neutralizing acid after it is already formed (like antacids), H2 blockers reduce your stomach's acid production. Since they work much longer than antacids (6-12 hours compared to 1-3 hours), they are only dosed once or twice daily.

Tagamet (200 mg/tablet) The first H
2 blocker approved for OTC use, Tagamet reduces stomach acid production for 8-12 hours.

Tums EX This high-potency antacid has the additional benefit of 600 mg of elemental calcium per dose --- That's half the recommended amount for prevention and treatment of osteoporosis.

It's important to know when your condition has gone beyond the self-treatment stage. What may seem like simple acid indigestion or heartburn can actually lead to serious and even life-threatening conditions such as peptic ulcer disease or cancer of the esophagus. These serious conditions require diagnosis and more intensive treatment by a physician.

Heartburn and acid indigestion should cause fairly mild pain. If the discomfort is severe enough to prevent normal functioning at work, home, or school, or is not completely and consistently relieved by the medications and other measures discussed in this Advisory, you should seek prompt evaluation by a physician. The chart below gives you examples of other warning signs and their causes. You may be surprised; they are not as obvious as the usual stomach pain and heartburn.

Warning Signs Cause
Black stools or stools with a tar-like consistency. Blood from an ulcer mixes with stomach acid, turning the stools black.
Frequent nighttime cough, or awakening at night with a choking sensation or foul taste in the back of the throat. Stomach acid leaking into the esophagus is a common cause of chronic cough and even asthma. It can awaken people at night, and chronic daytime fatigue may result.
Difficulty swallowing or sensation that food becomes "stuck" part way down. Scarring or swelling of the esophagus from acid causes narrowing and blockage; the esophagus may have to be stretched for relief.

Self-treatment of heartburn and acid indigestion is easier and more effective than ever before, thanks to super-potency antacids and the new H2 blockers. But remember, this is one of the few health conditions in the Self-Care Advisory that can actually progress to potentially life-threatening problems. So don't take any chances --- see your doctor if any of the above warning signs occur, or if these medicines stop working.




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