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WIN 2017

Spirit of Women magazine is a national publication presented to women by hospitals and their physicians. The magazine provides up-to-date, evidence-based healthcare information and promotes our hospitals as leaders in women's health excellence.

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19 What causes heartburn Despite its name, heartburn has nothing to do with your heart. The burning sensation in your stomach and/or throat can happen when acid from your stomach backs up into your esophagus because the band of muscle at the bottom of your esophagus isn't working correctly to keep out the acid—acid reflux. The result is a burning chest pain, usually after eating or at night, that gets worse when you lie down or bend over. You might also get a bad taste in your mouth from the acid. A more serious form of acid reflux with severe symptoms that go on for a long time is known as GERD (gastroesophageal reflux disease). If you have GERD, you may develop other associated symptoms too, such as a cough or hoarseness. Serious symptoms So how do you know you've hit the point where you need a complete medical exam? "Treating at home is OK if you don't have risk factors for cardiac disease, you're otherwise healthy, and [heartburn] is occasional, depending on what you ate," says Dr. Ann Ouyang, a professor in the gastroenterology and hepatology division at the Penn State Department of Medicine. However, "any kind of heartburn that's persistent for more than a few weeks, and something that's new for you," is reason for a call to the doctor, says Dr. Paula Dionisio, a gastroenterologist affiliated with Parkview Medical Center in Pueblo, Colo. "It's important to be seen by a doctor at least once because [heartburn] can be associated with damage to the esophagus or precancerous changes [in the body]." If your heartburn is persistent and you also are losing weight or having difficulty swallowing, or you find yourself reaching for more and more medications to keep your heartburn under control, it's important to schedule an appointment with your physician, Dr. Dionisio adds. Easing the pain Your doctor may recommend an X-ray, endoscopy or other medical tests to determine the exact cause of your symptoms. Beyond GERD, your heartburn could be caused by pancreatitis, gallbladder disease, ulcers or other conditions that could affect the treatments recommended. For GERD, you'll likely start with medication—either over the counter or prescription—along with lifestyle changes such as cutting back on fatty foods and big meals, not eating more than three hours before bedtime, maintaining a healthy weight and not smoking. Antacids, H2R As and proton pump inhibitors (PPIs) are the most common medications, although recent research suggesting health risks with extended use of PPIs may result in physicians prescribing lower doses for shorter amounts of time, says Dr. Dionisio. "It's a conversation I have with people every time I prescribe [a PPI]," she says. "There's more of a goal now of using it in the short term, and potentially transitioning to something a little more like [H2R As]." "Most physicians now say you should be on the lowest [PPI] dose needed to control the symptoms, and maybe [put] a little more attention on dietary control and lifestyle modifications," says Dr. Ouyang. Surgery or endoscopic treatments are options for GERD that doesn't respond well to medication and lifestyle changes, but they aren't as commonly used, says Dr. Dionisio. "If you can manage it with diet, lifestyle and habits, that's probably the best way to go for anybody," she says. "A lot of people can improve their symptoms with those measures." HEARTBURN TRIGGERS Some foods and drinks can act as triggers for heartburn, so you may want to try avoiding them: • Chocolate • Peppermint • Alcohol • Carbonated beverages • Coffee and other caffeinated drinks • Spicy foods • Onions • Citrus fruits • Tomato products • Fatty/fried foods • Large meals A GLOSSARY OF HEARTBURN MEDICATIONS Antacid: neutralizes (weakens) the acid in the stomach, works quickly to treat mild symptoms Examples: calcium carbonate (Tums), calcium carbonate/magnesium hydroxide (Rolaids) H2RA (H-2 receptor antagonist): causes the stomach to produce less acid by blocking the action of histamine; available over the counter or by prescription Examples: famotidine (Pepcid AC), ranitidine (Zantac), cimetidine (Tagamet) Proton pump inhibitor (PPI): causes the stomach to produce less acid by blocking the enzyme system that produces it; available over the counter or by prescription Examples: lansoprazole (Prevacid), omeprazole (Prilosec)

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