hard to swallow

Don't let a burning, churning stomach keep you up at night

You know the feeling: You're so full that you feel as if your stomach is going to explode. Perhaps there were cheese fries involved, or spicy tomato sauce and half a bottle of red wine. Maybe the culprit was the greasy fried dough you couldn't resist at some outdoor feast. Chances are, you're paying for this splurge with a late-night bout of heartburn.

All, heartburn, that painful, burning and, for some, all-too-familiar sensation that lurks just behind the breastbone. It's often accompanied by a bloated, nauseated feeling that leaves you vowing never to eat two orders of nachos again. Sufferers sometimes experience a bitter taste in their mouths or have the sense that food is "coming back up on them." Discomfort can last as long as two hours and is often exacerbated when a person lies down.

Heartburn occurs when stomach contents (semidigested food and digestive acids) back up into the esophagus. Under normal circumstances, the lower esophageal sphincter (LES) muscle, located at the bottom of the esophagus, acts as a "gatekeeper." It opens briefly to let food pass into the stomach and then closes tight to keep it down. But if the LES is compromised--by stress, foods that relax the muscle or physical pressures like too much food in the stomach--the valve won't form a tight enough seal, allowing acid to sneak back into the esophagus. And because the esophagus doesn't secrete protective mucus (like the stomach and intestines do), it is easily irritated by the acid.

More than 60 million Americans experience heartburn at least once a month, and about 25 million suffer from it daily, according to the National Institutes of Health. Occasional heartburn isn't cause for alarm; it's just the aftermath of a particularly spicy, rushed or heavy meal. But if you experience symptoms of heartburn two or more times a week, you should be concerned because you might be suffering from gastroesophageal reflux disease, or GERD. You may have heard this called acid reflux, dyspepsia, chronic heartburn or acid indigestion, but GERD is the most contemporary moniker.

An equal-opportunity offender, GERD affects men and women of all ages. Being pregnant or overweight or wearing tight garments makes one especially prone because the stomach has increased pressure on it. Nutrition also plays an important role: GERD is less common in countries where people eat lower-fat, higher-fiber diets--unlike in the United States. Fortunately, GERD is usually controllable with diet and lifestyle modifications and, failing that, medication. In the worst cases, patients may need to undergo surgery to tighten a too-loose lower esophageal sphincter.

If you're suffering from frequent heartburn, your doctor will look for signs of acid damage in the esophagus and at how your LES muscle is functioning. According to Ray Clouse, M.D., a professor of gastroenterology at the Washington University School of Medicine in St. Louis, Mo., there are several diagnostic tools used to detect GERD. They include an upper GI series (in which a special X-ray is used to examine the esophagus and stomach); tests to measure the amount of acid that reaches the esophagus in a 24-hour period; and visual examination of the esophagus with a scope. "Be aware, however, that the presence of heartburn on any kind of regular basis often suggests GERD," says Clouse, which explains why many patients are given the diagnosis based on symptoms alone.

Treatment is necessary because not only is constant heartburn unpleasant, but it can also lead to serious complications. Stomach acid may irritate the lining of the esophagus (esophagitis) to the point of scarring and narrowing, making it difficult to swallow or causing esophageal ulcers that bleed. GERD can also affect the cells lining the throat by replacing them with cells designed for the small intestine, leading to a condition called Barrett's esophagus, which is believed to increase the risk of esophageal cancer from 1 in 100,000 to 1 in 100. Further, if stomach contents travel high enough through the esophagus to reach the top of the throat, they can affect the vocal cords (causing hoarseness) and the lungs, resulting in a chronic dry cough or asthma.

How to Spell Relief?

Most heartburn sufferers immediately reach for an over-the-counter antacid like Rolaids, Tums or Maalox to reduce stomach acidity. Antacids are mild alkalines that neutralize stomach acid for a short time. There are also drugs designed to work longer by reducing the amount of: acid your stomach secretes; these include Axid AR, Pepcide AC, Tagamet HB and Prevacid. Yet another type of drug, such as Propulsid or Reglan, speeds up digestion, making it less likely for food to creep up into the esophagus.

Interestingly, GERD is not caused by an overly acidic stomach, but rather by an esophagus that has been exposed to acid it wasn't designed to come into contact with. "In fact, there is typically nothing wrong with acidity in patients with GERD and/or heartburn," says Clouse. He explains that people may feel better after popping an antacid because this lowers the overall amount of time the esophagus is exposed to acid, giving it a chance to recover.