How do you know when that burning sensation in your chest is heartburn or something that needs to get checked out by a physician?

Acid reflux or a feeling of heartburn is quite common, and a majority of adults have had an occasional bout of heartburn, particularly after a large meal. However, for those who have chronic symptoms, including a burning sensation in the chest or a feeling that food or bile is coming back up, the condition can be painful and disconcerting.

“To some degree acid reflux is normal,” explained NorthShore gastroenterologist Farhan Quader, MD. Reflux happens when the lower esophageal sphincter opens to vent stomach gasses and doesn’t fully close or opens too often, and acid produced by the stomach travels up into the esophagus.

Acid reflux becomes problematic when it causes persistent symptoms, including atypical symptoms like a cough or sore throat, or when it causes changes to the esophagus, Dr. Quader said.

There are some factors that can predispose people to chronic reflux including obesity, especially excessive abdominal fat; and eating large meals and lying down right after meals. Smoking, caffeine and being pregnant can also worsen and increase episodes of acid reflux, Dr. Quader added.

One common structural cause of acid reflux is a hiatal hernia—a condition where a portion of the stomach moves up into the chest limiting the protective barrier between the diaphragm and the esophagus. However, many times a structural cause for reflux is not found. Fortunately, there are great treatment options for chronic acid reflux.

Proton Pump Inhibitors (PPI) medications- both over-the-counter and prescription - stop the stomach from producing so much acid, and are often the first line of defense. For patients with esophageal hypersensitivity, sometimes PPIs alone are not enough and they are prescribed in combination with neuromodulator medications to reduce the sensitivity or blunt the response of the esophagus, explained Dr. Quader. For minor or infrequent symptoms, histamine channel blocks called H2 blockers or calcium carbonate supplements are often used.

Another group of people suffer from functional heartburn, a condition where there is no abnormal acid rising into the esophagus, but patients report the same chronic symptoms of heartburn. PPIs will not help these patients, but neuromodulators, including some anti-anxiety medicines, often provide great relief. Patients with functional heartburn can also benefit from meditation and mindful breathing.

It’s important for people who have new symptoms, especially if they start in the late 50s or beyond, or those with potentially serious issues like trouble swallowing or a regular feeling of something stuck in their esophagus, to see a gastroenterologist who can properly diagnose acid reflux and help rule out other more potentially serious conditions.

Dr. Quader advises patients to try and sleep at a 30-degree angle, with their head raised. If they are not able to buy a mattress that can raise the head, he suggests putting cinder blocks under the mattress at the head, as pillows tend to move and flatten during the night.

Regular exercise can help with symptoms and avoiding citrus fruits, caffeine and heavy fatty meals can also diminish acid reflux and chronic heartburn.