Understanding the pain of heartburn and GERD

Heartburn hurts. You have a heavy meal, and later that night you feel a fierce burn in your esophagus, low in your chest. That's the greeting of acid spilling back through the opening between your esophagus and stomach.

A band of muscle near the bottom of your esophagus called the esophageal sphincter relaxes to let food and water through, and then it squeezes shut again. However, if the muscle weakens or relaxes too often, you suffer from acid backup. The pain may get worse when you bend over, lie down, eat, and when you go to bed.

Most people have an occasional bout of heartburn. However, if you have heartburn more than twice a week, you likely have GERD, or chronic gastroesophageal reflux disease.

Over time, the ongoing backflow of acid can inflame and damage the esophagus, leading to a condition called Barrett's esophagus, in which the cells of the esophagus start to change. Those changes are thought to increase the risk of esophageal cancer.

About 12 percent of those with GERD develop Barrett's; 5 to 10 percent of those develop cancer. In short, heartburn isn't something to take lightly.

You have an increased risk of developing heartburn if you're overweight or have one of a number of conditions including hiatal hernia (a protrusion of part of your stomach into your chest), pregnancy, asthma, diabetes, stomach blockage, and connective tissue disorders, such as scleroderma.

Certain medications, such as narcotics and some antidepressants and antihistamines, can also slow the emptying of your stomach, which can cause acid backup.

If your doctor suspects GERD, he'll confirm the diagnosis by looking at your esophagus with a small lighted instrument called an endoscope and, in some instances, by monitoring the pH level of the esophagus using a tiny probe passed through a nostril. People who have GERD who don't respond to nonsurgical therapies may need more serious measures.

• Fortunately, most heartburn is mild and easily treated, perhaps with over-the-counter medications and a few changes in diet.
•  Lose 10 to 15 pounds, say researchers, and you can cut your risk of heartburn by 40 percent.
• People who suffer heartburn several times per week may need prescription medications, and some may even need surgery.