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If you have just finished a long, spicy meal, and feel the clutch and burn behind your breastbone, you are in very good company. It is estimated that 60 million Americans suffer from intermittent heartburn. Most of the time heartburn does not represent a serious medical condition, but it is always a source of discomfort.

There are a wide range of both lifestyle changes and medications that can ease your suffering. Below, gastroenterologist Dr. Steve Peikin of the Robert Wood Johnson School of Medicine, introduces a full range of techniques to tame the flames of heartburn, and talks about the symptoms that may be a sign of something more serious.

How prevalent is heartburn in the United States?
Heartburn is extremely common in the United States. It's one of the most common reasons why people go to gastroenterologists or their family doctor. Actually about 25 percent of the population takes antacids at least once or twice a month, and 7 percent of the population experience heartburn every day.

What do you recommend to patients that can help alleviate heartburn and reflux?
“I tell patients to avoid foods that can precipitate heartburn,” says Peikin. These are foods that can relax the little valve at the end of the esophagus that tries to prevent the acid from coming up. The foods that tend to do that are peppermint, chocolate, nuts, caffeine and greasy foods. Carbonated beverages may cause a lot of gas, which causes belching and brings the fluid back up with it.

Also, a lot of reflux occurs at nighttime. When you're lying down, it's easier for stomach contents to travel backwards into the esophagus. So elevating your head at night in bed can help prevent reflux. “I advise patients not to eat for three or four hours before lying down,” says Peikin, “because eating food causes a surge in acid secretion.”

Since most people who have heartburn don't have serious complications, it's perfectly reasonable to self-medicate with over-the-counter remedies available at the drugstore.

With these lifestyle changes and an occasional antacid or H2 blocker, some people will find relief. But other people are going to need prescription medication. The options are prescription strength H2 blockers, or more commonly, the proton pump inhibitor class of drugs, which are very potent and very effective in treating reflux.

How do antacids work to fight heartburn?
Antacids neutralize acid in the stomach so that when the fluid from the stomach comes back up into the esophagus, it's less acidic. The benefit of an antacid is that it works immediately. You don't have to wait for it to be absorbed by the body. The bad news is that it doesn't last that long and you may end up having recurrent heartburn and need to take antacids more frequently.

How do H2 blockers work?
Histamine is a chemical in the body, and it is a very potent stimulator of acid secretion. The H2 blockers block the ability of histamine to attach to the surface of acid-secreting cells in the stomach, so acid formation is blocked. But the only way for the blocker to attach to the cells is for it to get absorbed through the intestine and into the blood stream. This absorption process takes time, anywhere from 20 minutes to an hour, but H2 blockers last longer than antacids.

There are products that combine an antacid and an H2 blocker, so you get the quick onset of action from the antacid and a sustained relief from the H2 blocker. If you are going to have meal or alcohol that will cause heartburn you could take an H2 blocker, or a combination H2 blocker/antacid before the meal, and try to ward off heartburn symptoms.

What is a proton pump inhibitor and how does it work?
Proton pump inhibitors are some of the most effective medications available for heartburn.

There are actually three different ways that the acid-producing cells in the stomach are stimulated to secrete acid. One is with histamine. Another is through gastrin, which is a hormone in the body that stimulates acid secretion. The third is with acetylcholine, which, again, stimulates acid secretion. Each of these ways stimulates specific stomach cells to produce acid. The acid is released from these cells by a pump, called the "proton pump". The proton pump inhibitors, or PPIs, block the pump from releasing the acid.

What if lifestyle modifications and OTC medications don't work?
If you have found that the lifestyle changes and over-the-counter medications have not worked, you could consider prescription medication, like a prescription-strength H2 blocker or a proton pump inhibitor. Also, if you have more unusual symptoms like reflux-laryngitis, chronic cough, or non-cardiac chest pain, you probably should use a PPI.

When is heartburn a sign of a more serious condition?
You should be more concerned if you experience so-called "alarm" symptoms. If you have trouble swallowing, have burning in your esophagus when you swallow, experience choking at nighttime, have frequent coughing at nighttime, or have black, tar-like stools-these are all alarm symptoms.

Also, if you have heartburn on a regular basis, even just one or two times a week, then sometimes you can develop complications of reflux. It could be bleeding from ulcers in the esophagus. It could be a narrowing of the esophagus from scarring, which could give you trouble swallowing. Finally, sometimes acid can damage the lining of the esophagus causing a precancerous condition of the esophagus called Barrett's esophagus, which may lead to cancer of the esophagus. Some of the risk factors for Barrett's esophagus include: if you've had heartburn for many years, white, male or over the age of 50.

How common is Barrett's esophagus and cancer of the esophagus?
It is not common. In general, of those people who have acid reflux, less than 10 percent are going to develop Barrett's esophagus, the precancerous changes. And those people who develop Barrett's esophagus, less than 10 percent of those will go on to develop cancer of the esophagus. So you shouldn't worry too much.

Nevertheless, if you've had heartburn for many years and you are over the age of 50, you should most likely see a specialist.

What do you think is the most misunderstood aspect of heartburn and its management?
You don't need to suffer from heartburn. There are a lot of good ways to manage it with lifestyle changes, over-the-counter remedies available for self-medication, or effective prescription drugs. Heartburn can really affect quality of life, and it doesn't need to. There are very good remedies for this condition.