What causes heartburn, GERD and indigestion?

Posted 7/22/22

Esophageal reflux is a serious problem, that can result in heartburn, “indigestion,” hemorrhaging, scarring with food …

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What causes heartburn, GERD and indigestion?


OKEECHOBEE — Esophageal reflux (stomach acid going backwards into the esophagus) is a serious problem, that can result in heartburn, “indigestion,” hemorrhaging, scarring with food getting stuck and causing vomiting (often fatal when inhaled), cancer, asthma, sinus inflammation, sore throat, chest pain, laryngitis and chronic fatigue.  It is the most common cause of voice box (larynx) cancer and emphysema in non-smokers.  Its a common cause of chronic cough.  

Much of the time it occurs without symptoms - most people only experience heartburn when the problem is moderately severe.  A “hiatal hernia” means part of the stomach is in the chest.  While severe hiatal hernias have Gastroesophageal reflux disease (GERD) -- and sometimes need surgery -- the percentage of people suffering from heartburn who have hiatal hernias is approximately the same as those who don’t.  Most chest pain problems that are not heart related are due to spasm of the esophagus from GERD (it appears to cause the emotional sensation of “heartache” as well).  Many people undergo needless cardiac catheterizations because of untreated GERD.  Ulcers have similar but different symptoms - 20% of people who bleed to death from ulcer have no symptoms!  The diagnosis is made by history, response to medications, X-rays, and direct visualization (endoscopy).

Treatment usually involves the use of “PPI” medications such as omeprazole.  H2 medications like Pepcid (famotidine) and Zantac (ranitidine) are usually not as effective as the PPI’s.  Antacids such as Tums, Maalox, Mylanta or Riopan can provide temporary relief.

Long term use of PPI’s is associated with an increased risk of pneumonia, osteoporosis, and bowel infections.  For those with significant GERD symptoms or precancerous esophageal changes (Barrett’s esophagus) the benefits of the medications will outweigh the risks. 


 “GERD precautions” are non-medical and safe treatments - they include: raising the head of the bed 4-6 inches (put wooden or concrete blocks under the head posts - wedges and extra pillows don’t work), wearing loose fitting clothing, avoid being overweight, eat sitting up and remain upright for 30 minutes after eating, avoid lying down after eating, avoid meals before bedtime, and avoiding alcohol, caffeine, coffee, chocolate, and any food that causes symptoms.  Surgical procedures are sometimes necessary. 

Okeechobee Family Practice, Dr. Leland Heller