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About Heartburn

Gastroesophagael Reflux Heartburn

Illustration of reflux with normal LES and relaxed LES

Causes of Heartburn

When you swallow, the Lower Esophageal Sphincter (LES) - a circular band of muscle around the bottom part of your esophagus - relaxes to allow food and liquid to flow into your stomach. Then it closes again.

However, if the LES relaxes abnormally or weakens, stomach contents, including acid, can flow back up into your esophagus. This may cause frequent heartburn and disrupt your daily life. The acid backup can become worse when you're bent over or lying down.

When the stomach contents back up into your throat, it is called Laryngopharyngeal Reflux or LPR. This can cause reflux laryngitis.

The constant backwash of acid can irritate the lining of your esophagus causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, producing bleeding, or narrow the esophagus (strictures), causing difficulty swallowing or even breathing problems. When there's evidence of esophageal irritation or inflammation, you have GERD.

Aggravating Factors

You have probably already figured out what causes your heartburn but some other factors that can make it worse are:

  • Eating foods such as fatty foods, spicy foods, chocolate caffeine, onions, tomato sauce, carbonated beverages and mint.
  • Drinking alcohol
  • Eating large meals
  • Lying down soon after eating
  • Cigarette smoking
  • Stress

Some medical conditions can increase the risk of having heartburn. If heartburn is already present these conditions may make it worse.

  • Obesity
  • Hiatal hernia
  • Pregnancy
  • Asthma Link out to explain
  • Diabetes
  • Peptic ulcer
  • Delayed stomach emptying
  • Connective tissue disorders

Symptoms of GERD (Gastroesophageal Reflux Disease)

The most common symptom of GERD is heartburn. You may experience a burning sensation in your chest, which sometimes spreads to the throat, along with a sour taste in your mouth. Some people refer to this as acid indigestion.

Other symptoms of GERD include:

  • Chest pain, especially at night while lying down
  • Difficulty swallowing (dysphagia)
  • Persistent dry cough, wheezing, asthma, hoarseness
  • Sour taste at the back of your throat
  • Constantly clearing the throat
  • Frequent burping or hiccups
  • Feeling food get stuck in the throat
  • Regurgitating food and/or liquids


Symptoms that may signify something more serious include:

  • Pain or difficulty swallowing
  • Persistent vomiting
  • Vomiting blood
  • Feeling full with less food
  • Abdominal pain
  • Black, tarry bowel movements
  • Unexplained weight loss
  • Persistent heartburn in spite of taking anti-reflux medication

If you are experiencing any of these symptoms please call the Rex Heartburn Center or complete the heartburn questionnaire.

If your chest pain is brought on by physical exertion or accompanied by shortness of breath, sweating, dizziness, nausea or pain radiating to your neck, shoulder or arm, you should seek emergency help. These symptoms could signify a problem with your heart rather than acid reflux. Get help at the Rex Chest Pain Center.

Diagnosis and Common Procedures

Usually a description of your symptoms will be all your doctor needs to establish a diagnosis and initiate treatment. However, if your symptoms are particularly severe or if you are already on medication and the medication isn't working, you may need to undergo some tests.

Tests that evaluate esophageal tissue and function include:

Esophagogastroduodenoscopy or upper endoscopy
A slender, flexible, lighted tube is placed gently through your mouth into your esophagus while you are sedated. The doctor can actually look at the condition of your esophagus and take biopsies of any suspicious tissue. These biopsies are sent to the lab for further study to determine the state of health of the tissue. This is the best test to identify esophagitis or Barrett's esophagus.

Ambulatory acid (pH)studies
The 24 hour pH is a very small catheter with acid monitors. This is placed gently through your nose and into your esophagus after numbing your nose with a topical anesthetic. The monitors are placed in the lower half of your esophagus to determine if there is acid reflux coming from your stomach. The catheter is connected to a data receiver you will carry with you. This test takes 24 hours to complete.

BRAVO Capsule
A BRAVO capsule is a tiny, rectangular box that is usually placed right after your upper endoscopy while you are still sedated. A long thin device is inserted through your mouth and into your lower esophagus. The device suctions the esophageal lining into an opening on the side of the BRAVO box, and your doctor deploys the box sticking it to the side of your esophagus. The placement device is removed and a data receiver is programmed to receive readings from the BRAVO box. This test takes 48 hours to complete The BRAVO unit will fall off after 48 hours and pass on out your GI tract.

Impedance study
Impedance testing tests for non acidic reflux. Some people suffer the same symptoms as acid reflux sufferers, but do not have acid reflux. This catheter is usually a combination catheter measuring both acid and non acid reflux. It is a very small catheter placed like the 24 hour pH catheter above. Using this combined acid and non acid monitoring catheter your doctor can see which reflux you have. This test takes 24 hours to complete.

Esophageal manometry
Esophageal Manometry is a test used to assess the motility in your esophagus and the performance of the lower esophageal sphincter. After numbing your nose, a small catheter is placed through your nose into your stomach and you are given 10-12 separate teaspoons of water. Then the catheter is pulled out.

Radiology tests that may be considered are Barium Swallow, Gastric Emptying study and Upper GI x-rays. These tests do not require hospitalization.

Rex Heartburn Center

Phone: (919) 784-BURN (2876)
FAX: (919) 784-7532