Most of us experience heartburn at times, but when heartburn persists or happens often, it should be treated by a doctor.

Symptoms can be alleviated temporarily, using over-the-counter remedies such as Tums, Maalox, Alamag, and others.

When heartburn becomes chronic, it is necessary to see a doctor, because if left untreated, the condition that causes heartburn can also cause other health problems.  Heartburn occurs when stomach acid escapes back into the esophagus, the tube that carries food from the mouth to the stomach.  It can also be caused when the muscles at the end of the esophagus do not close tightly enough.

Chronic heartburn can cause difficulty in swallowing, and such other symptoms as angina, hoarseness, continuous coughing or “whistles” when breathing.  Serious inflammation can cause hemorrhaging in the affected area.  Long term complications can include damage to the lining of the stomach, and cellular damage that can lead to cancer.  It is important to consult a doctor in cases of chronic or frequent heartburn.

The doctor will give a complete medical examination, and may recommend an extended test via endoscopy.  This test involves inserting a long, flexible device holding a small camera that allows the doctor to get an accurate picture of the esophagus, stomach and the duodenum, and to take a sample of the lining of the stomach to give to the pathologist.  The test is not painful, but sometimes causes a little discomfort.  It takes 5 to 10 minutes.

If this test finds extensive inflammation, the doctor will discuss the findings with the patient, and determine treatment.  Treatment usually involves prescription medication to suppress excess acid in the stomach.  Once the acid has been regulated, there is a need to determine a long range strategy to maintain stomach health, including changing eating habits, reducing weight if necessary, and stopping smoking.

Heartburn sufferers should avoid eating chocolate, fried food or, fatty food, and also avoid drinks containing alcohol or caffeine—all of these can make heartburn worse.  In addition, acidic foods such as citrus fruits and tomatoes can make inflammation worse.

Use of certain medications such as aspirin, steroids, some analgesics, oral contraceptives,  osteoporosis treatments, and others, can cause greater damage or make the heartburn itself worse.

Heartburn sufferers should eat small meals, wear looser clothing, and avoid lying down or strenuous exercise after a meal.  The last meal of the day should be eaten at least 3 hours before going to sleep.  Smoking can also aggravate heartburn symptoms, and this is a good opportunity to stop smoking.

In conclusion:  Heartburn that is only occasional can be treated with common antacids.  But if it becomes persistent, consult a gastroenterologist.

Professor Moshe Lygumski, the Department of Gastroenterology