Making merry is often synonymous with overindulging - whether from holiday feasts or rich desserts or alcoholic beverages - ringing in the holiday season as "heartburn season."
Heartburn - generally caused by naturally occurring acids splashing back up from the stomach - is often marked by a characteristic burning sensation that sufferers describe as rolling up into their chest. Fatty foods play a starring role in this process.
"Most of the time heartburn is a nuisance, not a tremendous threat to your health," said Dr. Stuart Spechler, professor of internal medicine in digestive and liver diseases at UT Southwestern Medical Center. "I tell most of my patients that it's going to be a tradeoff - is the food going to taste good enough to suffer through the heartburn?
"If you know you're going to eat something that ordinarily gives you heartburn, there are medications that you can take before eating that food that might help."
Prevention now emphasized
For decades, the plop-plop-fizz-fizz approach of antacids taken after people already were experiencing heartburn was the only therapy available. Emphasis has since shifted to prevention.
Those who are planning to indulge in foods likely to cause them heartburn can now take a histamine receptor blocker (H2 blockers), which slow the production of stomach acid and are generally available over the counter.
"Most people suffering from heartburn get it every now and then. Those are the people who really benefit from this on-demand therapy," said Dr. Spechler. "If you're going to eat something you know is going to give you heartburn, you can take one of those pills a half hour before your meal, and you may be able to prevent the heartburn."
The most powerful type of medicines, and the ones more suited for people who have ongoing heartburn, are called proton-pump inhibitors. There is only one brand of proton pump inhibitor, Prilosec, available over-the-counter.
"They're very powerful at stopping the stomach from making acid, but it takes a number of hours or even days for them to reach their full effect. So if you want to eat a pizza in the next half hour, it's not going to stop the acid that you're going to make in that time," Dr. Spechler said.
Antacids can help if foods consumed generate heartburn. Antacids act like a sponge to soak up the excess stomach acid, but they do nothing to prevent the stomach from creating more acid. So it may help to take some antacid tablets to soak up acid currently being produced and take an H2 receptor blocker to slow the stomach from producing further acid.
What is heartburn?
Heartburn is caused most often by the reflux or backwash of acid from the stomach up into the esophagus, which is the long tube that carries food from the throat to the stomach. A valve at the end of the esophagus is supposed to function as a one-way release, relaxing to allow food into the stomach and closing back up so food and acid in the stomach stay there while the food is digested. If there is a leaky valve, gastroesophageal reflux disease, or GERD, may result. The primary symptom is heartburn.
"As a general rule of thumb anything that tastes really good is likely to give you heartburn," Dr. Spechler said. "And the reason is the fat content. Fat does a lot of things that promote heartburn. It stops the stomach from emptying well, so now you have more material in the stomach that's ready to reflux. It also further weakens that leaky valve."
Eating or drinking certain types of foods, such as milk, in an attempt to reduce stomach acid generally doesn't work, said Dr. Spechler, who is a member of the American Gastroenterological Association's Committee on GI Research.
"We used to use milk as an antacid, but it's really a very poor antacid," he said. "Most of the foods that we eat buffer acid, but they also stimulate the stomach to produce acid later. That's why we don't recommend them as a specific treatment."
Avoiding foods that historically cause heartburn is the better strategy.
"As a group, anything fatty and anything chocolate is likely to be causing a problem," he said.
When to see a doctor
Unfortunately, there's no simple answer to when heartburn sensations should prompt a visit to the doctor.
Occasional heartburn usually doesn't signal a more complex problem, such as Barrett's esophagus or esophageal cancer. "But if you're taking medications daily, I think you should be concerned about it," Dr. Spechler said.
There are some warning symptoms that, if associated with chronic heartburn, may be signs of more serious problems. Questions to ask yourself:
1. Are you having difficulty swallowing?
2. Are you losing weight?
3. Does it hurt when you swallow?
4. Do you have fevers?
5. Do you have signs of bleeding? (Passing black stools is a sign there might be bleeding from the esophagus into the stomach.)
"If you have heartburn associated with those warning symptoms you really should get in to see your doctor as soon as you can," he said.