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Heartburn and acid reflux: what’s the difference?

If your most recent visit to your doctor’s office was due to symptoms stemming from acid reflux, you’re not alone. That’s because acid reflux is the fourth most common reason to visit your doctor with approximately 40 per cent of adults experiencing symptoms of the condition at least once per month.

But what makes heartburn and acid reflux so common today? Dr. Jeff Stal, gastroenterologist at Women’s College Hospital, explains what heartburn and acid reflux is, what aggravates the condition, the many treatment alternatives available, and how you can decrease your risk of developing the condition.

Often heartburn and acid reflux get confused as being two separate conditions, but in fact, heartburn is the most common symptom of acid reflux.  The uncomfortable burning sensation in the chest known as heartburn is one of the strongest indications of the condition.

“Heartburn is a symptom, which is usually described as a burning sensation in the mid-chest,” says Dr. Stal.

“Whereas acid reflux is a medical condition in which acid in the stomach travels backwards back into the esophagus, which may or may not cause symptoms.”

Dr. Stal notes patients may present with atypical symptoms other than heartburn caused by acid reflux, which include:

  • regurgitation
  • upper abdominal burning
  • chest pain

According to Dr. Stal, if you experience acid reflux frequently during the week, you may have a medical disorder called gastroesophageal reflux disease, also known as GERD.

There are several lifestyle implications that can exacerbate acid reflux; however Dr. Stal notes that the most common cause of acid reflux is the transient relaxation of the lower esophageal sphincter, also known as LES.

“The LES is the physiological valve where the esophagus connects to the stomach,” says Dr. Stal.

“The transient relaxation allows for the acid to travel up into the esophagus.”

Occasional acid reflux is affected by transient relaxation of the LES and can be affected even by your own lifestyle choices, which can often be managed with the proper changes.

Control your risk

Unbeknownst to you, your drink or meal of choice can possibly put you at risk of acid reflux. Certain foods, beverages and sedentary habits can exasperate a person’s acid reflux condition.

“Some people are more prone to developing acid reflux due to their lifestyle, which can either contribute or worsen their condition,” says Dr. Stal.

Be mindful of what you consume before you experience heartburn or other symptoms related to acid reflux. Dr. Stal notes that the following can increase the likelihood of developing acid reflux:

  • alcohol
  • caffeine
  • peppermint
  • foods high in trans fat
  • chocolate

If you have acid reflux, your doctor’s first word of advice will be to stop smoking if you do. Smoking is known to cause various health complications, and it also worsens a person’s acid reflux condition by weakening their LES. Kicking the habit will also allow you to produce more saliva, which helps to neutralize stomach acids that irritate the esophagus.

Dr. Stal notes that people who are obese are also more prone to acid reflux.  Your optimal diet solution for acid reflux is to consume foods that are low in fat, non-acidic or caffeine free beverages, and keeping alcohol consumption to a minimum.

There is no evidence in the medical literature to show that acid reflux is more common amongst women than men. However, Dr. Stal does mention one exception to this statement.

“Acid reflux is more common in pregnancy,” says Dr. Stal

“30 to 50 per cent of women will experience heartburn during their pregnancy, and it is most likely to occur in the third trimester.”

Dr. Stal mentions that the reason for this prevalence is due to increased abdominal pressure during pregnancy and the potential effect of hormones on the LES.

Seeking treatment

Fortunately there are many treatments available, which provide relief for occasional and persistent symptoms secondary to reflux.

Understanding that you have GERD is the first step to determine the most appropriate treatment for your condition.  According to Dr. Stal, your treatment depend on the following factors:

  • frequency of symptoms
  • severity of symptoms
  • presence or absence of complications

If you experience occasional reflux, which is less than twice per week, Dr. Stal proposes to start with a step-up strategy. The strategy consists of lifestyle modifications meant to decrease LES pressure.  Dr. Stal notes what can be done at home to relieve symptoms for GERD patients:

  • avoid lying down within three hours of a meal
  • elevate the head of your bed with blocks (under the legs)
  • avoid foods and beverages that exacerbate symptoms (e.g., alcohol, caffeine, chocolate, peppermint)
  • chew gum or use oral lozenges to increase salivation (to neutralized acid)

Over-the-counter medications (e.g., Tums or Rolaids) also serve as a solution for occasional acid reflux symptoms.

Dr. Stal notes that these readily available treatments only offer temporary relief and are best suited for people experiencing less severe symptoms.

“People will frequently seek over-the-counter treatments but they may not alleviate all of their symptoms,” says Dr. Stal.

“Over-the-counter treatments simply buffer the acid present in the esophagus.”

A popular over-the-counter alternative is Zantac. It is also known as an H2 blocker, which has been shown to be safe to use during pregnancy.  Dr. Stal notes that pregnant women can feel safe taking Zantac to alleviate heartburn and acid reflux; however they should still consult their doctor beforehand.

No luck with over-the-counter acid reflux medications? Dr. Stal recommends proton pump inhibitors (e.g., Omeprazole, Nexium, Tecta), medication prescribed by your doctor for those with frequent and severe symptoms. PPIs act to decrease the amount of acid produced in the stomach and help to prevent heartburn and other symptoms caused by acid reflux.

When to contact your doctor

Patients suffering from acid reflux who have yet to experience any improvement from over-the-counter medications should seek medical attention.  Dr. Stal also lists the following “red flag” symptoms that could indicate a potentially more serious health condition and should trigger urgent medical care:

  • difficulty swallowing
  • weight loss associated with heartburn
  • vomiting blood
  • black bowel movements

GERD can also contribute to the other (extra-esophageal) symptoms, which would also prompt someone to contact their doctor:

  • hoarseness
  • laryngitis
  • wheezing
  • symptoms similar to asthma
  • aspiration of  acid which can cause lung damage
  • erosion of teeth enamel

Dr. Stal notes the most common complications and conditions associated with severe acid reflux, which include:

  • reflux esophagitis: inflammation of the esophagus
  • esophageal ulcer:  sore in the lining of the esophagus
  • esophageal stricture: narrowing of the esophagus from scar tissue
  • Barrett’s esophagus: cells in esophagus are replaced by cells found in the intestine (intestinal metaplasia)

Barrett’s esophagus is a condition that puts people at increased risk for cancer of the esophagus. Dr. Stal notes that Barrett’s can be diagnosed with the use of a gastroscopy, which is a tube with a camera inserted into the patient’s mouth to visualize the esophagus and stomach.

“Patients with chronic reflux who are over the age of 45 to 50 are usually recommended to undergo a once-in- a-lifetime gastroscopy in order to rule out Barrett’s,” says Dr. Stal.

If you have been diagnosed with Barrett’s the safest precaution is to have a gastroscopy every few years and have the area of Barrett’s biopsied to ensure that there are no precancerous cells (dysplasia).

Dr. Stal suggests that women be aware of all of the helpful treatments available for their reflux given that it will bring relief to their acid reflux symptoms, as well as the fear of chronic complications.

“Reflux is very common and women should be aware of the lifestyle modifications and medications that can potentially improve their symptoms,” says Dr. Stal.

“Women should not be afraid to seek medical attention for their reflux because of the excellent efficacy of the medications available – particularly the PPIs.”



This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: September 2012

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