Understanding heartburn: expert answers to 5 common questions

Heartburn in all its intensities affects millions of Canadians every day. Nearly complete relief is possible with a combination of lifestyle changes and the right medications. Here are some questions you may have about heartburn.

You get a sudden, severe attack of heartburn. So you figure you'll brush it off with a couple of antacids. But before you do, just remember that the pain of a heart attack can be almost indistinguishable from that of severe heartburn. Call 911 if what you think is heartburn is accompanied by any of these symptoms, which can indicate a heart attack:

• Pain that radiates into your jaw or out your left arm.
• Tightness or pain in the centre of your chest.
• Cold sweats, nausea and vomiting.
• Dizziness and shortness of breath.
• Increased pain when you exert yourself.

One type of hernia isn't so easy to spot — and some doctors think it may be a major reason you develop gastroesophageal reflux disease (GERD).

• A hiatal hernia happens when a portion of your stomach protrudes through an opening in your diaphragm (the muscular wall separating your chest from your abdomen). Its origin isn't always known — it may be something you were born with, or perhaps the result of a trauma, such as a car accident.
• Whatever its cause, doctors surmise that it may weaken the sphincter that leads into your stomach and cause acid to back up into your throat, leaving you with heartburn.
• The surprising thing is how common it is: more than 40 percent of people have a hiatal hernia, though few are aware of it. If you seem to be suffering from moderate to severe heartburn, make sure your doctor checks you for this type of hernia. In the worst cases, a surgeon can operate to reduce its size.

This condition is a complication of GERD that only appears in a small number of people.

• It occurs when the cells lining the esophagus are over­exposed to gastric juices, be­come permanently damaged and enter a precancerous state.
• Some people with Barrett’s esophagus go on to develop esophageal cancer. For that reason, it’s a good idea to have an endoscopy if you've had heartburn for more than a few years. A doctor will slip a thin, lighted tube down your throat to check for any signs of cancer.
• One study found that esophageal cancer caught early by endoscopy led to much higher survival rates over five years.

That seems logical, but the answer is no.

• The H2 blockers and proton pump inhibitors do reduce acid levels in your stomach, but enough acid remains to kill off most microbes that make it into your stomach.
• You can still get sick if you eat spoiled food, but no more frequently than someone not taking heartburn medicine.

Yes. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) may make your heartburn worse.

• One large three-year study of 25,000 people found that frequent users of NSAIDs were twice as likely to have GERD symptoms as those who didn't use them.
• Familiar NSAIDs to watch out for include ibuprofen and naproxen, among others.
• A good substitute for a headache or other mild pain is the drug acetaminophen.

Hopefully this guide has helped answer some of your questions about heartburn. If you have additional questions, be sure to ask your doctor.