A night of rich food, wine, coffee and dessert may sound great—but not if it results in heartburn. The condition, which more than 60 percent of Canadians will experience at some point in their lives, occurs when gastric acid in the stomach backs up into the esophagus. “[The result] is a burning pain behind the breastbone that can rise to the back of the throat, along with sour-tasting acid in the mouth,” says Dr. Richard Fedorak, a professor in the department of gastroenterology at the University of Alberta. “More rarely, the esophagus can spasm and cause a choking sensation that is sometimes misinterpreted as a heart attack. If you are concerned, go to the hospital immediately.”
Under normal circumstances, a valve between the stomach and the esophagus called the lower esophageal sphincter (LES) prevents acid from entering the esophagus when the stomach is using it to digest food and beverages. But when the valve becomes weakened, the acid can come up the LES and into the esophagus, causing irritation and discomfort. Symptoms are usually the worst in the evening (when the concentration of acid in the stomach is at its peak), and lying down or bending over from the waist after a meal can exacerbate them (since that allows the acid to pool in the esophagus instead of staying in the stomach). Because we produce less saliva—which neutralizes acid—during sleep, heartburn can also interfere with a good night’s rest.
This problem affects roughly the same number of women as men. People who smoke, are obese or have a family history of heartburn are the most likely to suffer from it, says Fedorak. Pregnant women often experience the condition in their third trimester (when the uterus puts pressure on the stomach ), and certain medications, such as beta-blockers, sedatives and tricyclic antidepressants, are also triggers.
What you consume matters, too, since certain food and drinks weaken the LES. If you experience heartburn, avoid chocolate, peppermint, alcohol, caffeine, soft drinks, citrus fruit and juices, tomatoes and tomato sauces, and fried, spicy and fatty foods. You can also prevent heartburn by eating smaller meals and not eating within three to four hours before bedtime; also, avoid bending over, lying down or exercising just after eating. Quitting smoking and losing weight (even 10 to 15 pounds, if you are overweight) may improve, if not completely eradicate, symptoms, adds Fedorak.
Although occasional heartburn is common, if it occurs regularly, the lining of the esophagus can be damaged over time. Complications include erosive esophagitis (an uncomfortable, chronic inflammation of the esophagus); painful or bleeding esophageal ulcerations; asthma; and Barrett’s esophagus (an advanced stage of erosive esophagitis that is a precursor to esophageal cancer). “If you are getting heartburn more than three times a week or waking up in the night with coughing, wheezing, choking or asthma (which can be symptoms of inflammation), you should see a doctor,” advises Fedorak.
If symptoms are infrequent, consider one of these over-the-counter remedies.