Heartburn and GERD: Symptoms, Triggers, and Management Strategies
Heartburn (pyrosis) is a burning retrosternal sensation caused by gastric reflux into the esophagus. GERD (Gastroesophageal Reflux Disease) is diagnosed when reflux causes troublesome symptoms or complications (≥2×/week or mucosal injury).
Typical Symptoms
- Heartburn (worse after meals, lying down, bending)
- Regurgitation (sour/bitter taste)
- Dysphagia (difficulty swallowing)
- Chest pain (non-cardiac)
- Chronic cough, hoarseness, asthma exacerbation (extra-esophageal)
- Globus sensation (lump in throat)
Common Triggers
- Dietary: Large meals, fatty/fried foods, chocolate, caffeine, alcohol, citrus, tomato, mint, spicy foods, carbonated drinks.
- Lifestyle: Obesity, smoking, late-night eating (<3 hrs before bed), tight clothing.
- Medications: NSAIDs, bisphosphonates, calcium channel blockers, nitrates, theophylline, anticholinergics.
- Anatomic: Hiatal hernia, pregnancy, gastroparesis.
Management
Lifestyle Modifications (First-line)
- Weight loss if BMI >25 (even 5–10% helps).
- Head of bed elevation 6–8 inches (blocks, not just pillows).
- Small, frequent meals; avoid eating 3 hrs before sleep.
- Identify and avoid personal trigger foods.
- Smoking cessation.
Medications
| Class | Examples | Onset / Duration | Use |
|---|---|---|---|
| Antacids | Tums, Maalox, Mylanta | Minutes / 1–2 hrs | Occasional breakthrough |
| H2RAs | Famotidine, cimetidine | 30–60 min / 6–10 hrs | Mild/intermittent; nighttime |
| PPIs | Omeprazole, esomeprazole, pantoprazole | 1–4 hrs (peak 2–3 days) / 24 hrs | Frequent symptoms, erosive esophagitis; take 30 min before breakfast |
| P-CABs | Vonoprazan | Faster, longer | Newer; acid-related disorders |