Heartburn, also known as acid reflux, is a common digestive condition characterized by a burning sensation in the chest, often rising to the throat. This discomfort occurs when stomach acid flows back into the esophagus, the tube connecting the mouth to the stomach. While frequently experienced, with up to 30.9% of U.S. adults reporting weekly symptoms, understanding its potential complications and when to seek medical attention is important for managing symptoms and maintaining overall health.
Understanding the Immediate Danger
Heartburn itself does not typically cause immediate death, but its symptoms can be alarming and easily confused with more severe conditions, such as a heart attack. Both heartburn and a heart attack can manifest as chest pain or pressure, leading to diagnostic challenges. The esophagus and heart are in close proximity, and the nerves in this region do not always clearly signal the precise origin of pain to the brain.
While heartburn pain is often described as a burning sensation that may worsen after eating or when lying down, heart attack symptoms typically involve intense pressure, squeezing, or pain that can radiate to the arms, jaw, or back. Heart attack symptoms may also include shortness of breath, sweating, or dizziness. If chest pain is persistent or accompanied by these additional symptoms, immediate medical evaluation is necessary to rule out a cardiac event.
Serious Complications of Chronic Heartburn
While immediate danger from heartburn is rare, chronic, untreated acid reflux, also known as gastroesophageal reflux disease (GERD), can lead to serious complications over time. GERD occurs when acid reflux is frequent or severe enough to cause symptoms or damage to the esophagus. This ongoing exposure to stomach acid can progressively damage the esophageal lining.
One common complication is esophagitis, which is inflammation of the esophageal tissues. Chronic esophagitis can lead to the formation of open sores called ulcers, which may cause bleeding and make swallowing difficult. Persistent inflammation can also result in esophageal strictures, where scar tissue forms and narrows the esophagus. These strictures can impede the passage of food and liquids, leading to difficulty swallowing, known as dysphagia, and nutritional deficiencies. Approximately 70% of esophageal strictures are caused by chronic acid reflux.
A long-term complication is Barrett’s esophagus, a condition where the normal cells lining the lower esophagus are replaced by cells similar to those found in the stomach or intestine. This cellular change is considered precancerous and increases the risk of developing esophageal cancer, specifically esophageal adenocarcinoma. While a small percentage of Barrett’s esophagus cases progress to cancer, it represents a significant risk factor for this form of cancer. Long-term GERD, especially for more than five years, increases the risk of developing esophageal adenocarcinoma.
Recognizing Warning Signs
Recognizing warning signs, often called “alarm symptoms,” is important for identifying when heartburn may indicate a more serious condition or complication requiring medical attention. Difficulty or pain when swallowing, known as dysphagia or odynophagia, are red flags that suggest esophageal damage or narrowing. Unexplained weight loss, persistent nausea, or vomiting also warrant prompt medical evaluation.
Signs of gastrointestinal bleeding, such as vomiting blood (hematemesis) or having black, tarry stools (melena), are alarm symptoms that require immediate medical care. Chronic hoarseness or a persistent sore throat not associated with a cold can be extra-esophageal manifestations of GERD that signal ongoing acid exposure. Any chest pain accompanied by symptoms like shortness of breath, sweating, or radiating pain to the arm or jaw should be treated as a medical emergency, as these could indicate a heart attack.
Managing Heartburn and Reducing Risks
Managing heartburn and reducing the risk of serious complications often involves a combination of lifestyle modifications and, if needed, medication. Dietary changes are a common first step, including avoiding trigger foods like fatty or spicy meals, chocolate, caffeine, and alcohol. Eating smaller, more frequent meals instead of large ones and avoiding lying down immediately after eating can also help. Elevating the head of the bed by six to eight inches during sleep can reduce nighttime reflux.
Maintaining a healthy weight, quitting smoking, and avoiding tight clothing are additional lifestyle adjustments that can alleviate symptoms and reduce pressure on the digestive system. For occasional heartburn, over-the-counter antacids can neutralize stomach acid, providing quick relief. Histamine-2 receptor blockers (H2 blockers) and proton pump inhibitors (PPIs) are also available over-the-counter and by prescription, working to reduce stomach acid production. If heartburn symptoms are frequent, severe, or do not improve with over-the-counter remedies, consulting a healthcare professional is important for proper diagnosis and management.