Affecting one in three UK adults, heartburn is common.
Thankfully, most of the time, that horrid burning sensation under the breastbone – sometimes accompanied by a nasty taste, stinging in the throat and pain in the stomach or chest – caused by acid rising into the oesophagus, is very temporary.
For one in six (some 8.2 million Britons) however, it’s a frequent problem, occurring twice a week or more.
“It can have a big impact,” says GP Dr Sarah Jarvis, pictured below. “As a GP, that’s something that almost everybody experiencing frequent heartburn says – it really does affect them and can really bring them down.”
A BURNING WORRY
Aside from the discomfort, there’s often anxiety too. “Frequent heartburn can leave people feeling like they have no control over the condition,” notes Helen Boardman, a pharmacist and lecturer in Pharmacy Practice.
Knowing what’s safe to eat can become a worry, and this – along with the symptoms – can affect people’s social lives and stop them participating in hobbies and sports.
One of the biggest anxieties is that there’s something more sinister going on – it’s not uncommon for people to fear that they are suffering heart problems or cancer.
These things combined are part of the reason why lots of people present to their GPs with heartburn.
The majority of the time, heartburn is something that can be self-managed and doesn’t really require a trip to the doctor. While some people with particularly troublesome, frequent heartburn may need a prescription, for most, symptoms can be avoided with few simple lifestyle tweaks and soothed with over-the-counter (OTC) treatments.
Until relatively recently, these were mainly antacids and alginates – which work by neutralising stomach acid or forming a protective barrier over it – and can offer speedy relief for mild symptoms, lasting a few hours.
For more intense and long-lasting symptoms, however, a proton pump inhibitor (PPI), which blocks acid production, may be more suitable.
Nexium Control(R) (esomeprazole) (available from pharmacies and supermarkets, RRP £6.99 for pack of 7), previously a prescription-only drug, recently launched as an OTC; one daily tablet provides 24-hour protection. Your pharmacist will be able to discuss which treatments may be suitable for you.
However, if you’re still popping those PPIs after 14 days, or symptoms are getting worse or not going, make an appointment to see your GP.
WHEN HEARTBURN GETS SERIOUS
Though heartburn generally isn’t serious, there are always exceptions, and if in doubt, get things checked – sooner rather than later.
The NHS recently launched a campaign highlighting the importance of seeing your doctor if you’ve had heartburn most days for three weeks or more in a row, as it could be a sign of oesophageal or stomach cancer (find out more here: www.nhs.uk/be-clear-on-cancer/oesophagogastric-cancer/home).
That’s also why you should make an appointment if your symptoms are worse, or lingering, after two straight weeks of taking OTC treatments. It’s extremely rare for these cancers to occur where heartburn is the only symptom – usually there are other warning signs too, such as sudden weight-loss, difficulty swallowing, vomiting, pain or swelling–but it’s always wise to check.
Tips to stop heartburn
Keep a food diary
One of the best ways to avoid heartburn is to avoid the triggers. “Triggers vary from person to person, but common ones include citrus drinks, high-fat foods, onions and chocolate. Cutting down on alcohol, coffee and fizzy drinks can also help,” says Boardman. The only way to know your triggers for certain is by monitoring symptoms and trying to spot patterns – do certain foods always result in a flare-up? Jotting down everything you eat and drink can be an extremely useful tool.
Prop yourself up to sleep
Heartburn is often much worse at night, because when we’re lying down, it’s easier for acid to travel into the oesophagus. Let gravity give you a helping hand and avoid sleeping in a completely flat position. Stacking up some pillows, or buying a wedge pillow, may help. Or, Dr Jarvis has this top tip: “Try placing a couple of sturdy bricks under the head of your bed to prop it up. You don’t want it to tilt so much that you slide out, of course, but just enough that you’re slightly tilted when you’re lying down - it could really help.”
Don’t go to bed on a full stomach
In addition to the above, it’s also a good idea not to eat your dinner too close to bedtime. If symptoms are particularly troublesome at night-time, you may even find it helpful to have your bigger meal at lunchtime and a lighter evening meal. “Wait for two to three hours after you eat before going to bed,” suggests Boardman. “This gives your stomach a chance to process your meal and move it through your digestive system. Your stomach will then be empty and less likely to reflux when you lie down.”
Smoking is bad news for health all round – and that includes where heartburn’s concerned. “Not only can cigarette smoke irritate your throat, it also relaxes the oesophageal muscles that keep stomach acid where it belongs,” says Boardman.
Sit up straight
When we’re hunched over, it’s easier for acid to rise up the oesophagus – so when your mother told you to “sit up nicely” at the dinner table, she had a valid point! Avoid eating in front of the TV slumped over a low coffee table, and try to avoid bending forwards too much for a while after eating meals too. To highlight this point, Dr Jarvis recalls learning about the case of a heartburn sufferer who couldn’t work out why his stubborn symptoms wouldn’t go away, especially as he was otherwise fit and well – until a specialist revealed his racer bike was actually a factor; bending forwards over those low handlebars every day was causing awful acid reflux.
Keep stress to a minimum
Stress affects people in different ways, and it may - though not always - be a factor in heartburn. Avoiding stress entirely is not possible (and sometimes not necessary), but knowing our limits and learning to manage our stress levels before they make us unwell – by prioritising rest, relaxation and exercise, getting enough sleep and addressing any circumstances and situations that may be causing distress – can help keep us feeling tip-top and reduce the impact of symptoms when they occur.
Don’t eat too quickly
“Eating too much, too quickly, can increase heartburn, so take your time and enjoy mealtimes,” says Boardman. “Feeling stressed or rushed when you eat can also cause the stomach to produce more stomach acids.”
Watch your weight
Heartburn’s more common in those who are overweight, so aim to keep to a healthy weight by eating sensibly and taking regular exercise.