The differences between Heartburn, Acid Reflux and GERD: A doctor’s guide

Heartburn, acid reflux and GERD are common in Singapore, especially due to our love for spicy food and our irregular eating schedules on top of a hectic work life. Because of our sedentary lifestyle, obesity is becoming a more prominent issue, and its effects can lead to heartburn, acid reflux and GERD. So, what does this trio refer to exactly, and how can you avoid them?

What is heartburn, acid reflux and gastroesophageal reflux disease (GERD)? 

Many people get confused by these 3 terms, thinking they’re the same thing and using them interchangeably. In fact, heartburn is actually a symptom and not a disease. Heartburn is a classic symptom of acid reflux, whereby the acidic contents of the stomach are regurgitated, causing a burning sensation in the chest and throat. Gastroesophageal reflux disease or GERD is a chronic or severe form of acid reflux.

GERD may present itself with the following symptoms: 

  • Belching 
  • Chronic sore throat 
  • Chronic cough 
  • Water brash – excessive saliva mixed with acid that is refluxed into the mouth 
  • Hoarseness 
  • Sourness in the mouth 
  • Halitosis – chronic bad breath
  • Gingivitis – gum inflammation 
  • Tooth enamel erosion – due to the acid 

The term heartburn is misleading because it has nothing to do with the heart. Heartburn is a burning sensation that causes mild to severe pain in the chest that can sometimes be mistaken for heart attack pain. The pain can feel sharp, burning, or tight, but it comes from the oesophagus rather than the heart. 

Is it a heartburn or a heart attack? 

Heartburn

Heartburn presents itself as discomfort arising from the regurgitation of stomach acid up the oesophagus. The discomfort runs in a vertical line behind the breastbone and up into the throat. It can also lead to a sour or bitter taste in the back of the throat or mouth. Heartburn tends to worsen after eating or when lying down.

Heart attack 

A heart attack is a life-threatening condition where the arteries supplying blood to the heart are blocked, causing a lack of nutrients and hence death of heart muscle cells. It can lead to heart failure or abnormal heart rhythms that are potentially fatal. 

A heart attack feels more like a great pressure sitting on top of your lower chest, and this occurs over a wider area – something like a stone over your chest. The chest pain can move up the left side of the neck and travel down the left arm. Accompanying this would be nausea, dizziness, shortness of breath and perspiration. Heart attacks do not cause bloating or belching unlike during heartburns. 

What causes acid reflux or GERD? 

At the connection between the oesophagus and the stomach is a circular ring of muscle called the lower oesophageal sphincter that helps to tighten the oesophagus after food travels down to the stomach. It helps to prevent backflow of the stomach contents up the oesophagus. In acid reflux or GERD, this sphincter is weak and unable to tighten properly, leading to reflux of the stomach contents back up the oesophagus, thereby causing the burning sensation of heartburn.

Acid reflux not only causes heartburn, but also other symptoms including: 

  • Cough 
  • Sore throat 
  • Bitter and sour taste in the back of the throat 
  • Burning and pressure that extends up the breastbone 

GERD can be caused by the following: 

  • Being overweight or obese – this puts extra pressure on the stomach 
  • Hiatal hernia – this reduces pressure on the lower oesophageal sphincter 
  • Smoking 
  • Alcohol consumption 
  • Pregnancy 
  • Taking medicines that may weaken the lower oesophageal sphincter – antihistamines, calcium channel blockers, pain-relieving medicines, sedatives, antidepressants

Can acid reflux make your breath smell? 

Bad breath could be a sign of GERD. Heartburn or acid reflux could cause bad breath due to the excess acid that comes up from the digestive tract. The acids can have a sour odour that affects your breath and makes it smell bad. 

Note that bad breath could be a sign of other diseases such as kidney disease. If you have chronic bad breath, seek help from a doctor.  

Can you have GERD without heartburn? 

You can have GERD without heartburn. GERD can cause other problems in the throat, such as feeling like there is a lump in your throat, tightness of the throat, or hoarseness. It can also cause dry coughs or trouble swallowing. 

Can GERD go away on its own? 

GERD is a serious condition that will not go away on its own until you seek help from the doctor. Left untreated, GERD can lead to inflammation of the oesophagus and cause complications like ulcers, strictures (abnormal narrowing) or even increased risk of Barret’s oesophagus, a precursor to esophageal cancer

How can I avoid GERD?  

Here are some tips on how to prevent GERD:

  1. Maintain a healthy weight and diet – obesity puts pressure on the stomach, which may cause heartburn. 
  2. Eat small, frequent meals throughout the day.
  3. Reduce fat intake – avoid butter, gravy and full-fat dairy products.
  4. Sit upright when eating and stay upright for 45 – 60 minutes after eating.
  5. Do not eat before bedtime – having an increased volume of stomach contents while lying down can exacerbate heartburn, so keep a gap of 3 hours between mealtime and bedtime. 
  6. Elevate your head by 6 to 8 inches when sleeping. 
  7. Do not wear ill-fitting or tight clothes. 
  8. Do not smoke. 
  9. Reduce consumption of trigger foods like spicy foods. 
  10. Reduce alcohol intake – alcohol relaxes the muscles at the gastro-oseophageal junction and increases the fluid content of the stomach, leading to heartburn. 

What foods trigger GERD? 

Certain foods can cause increased acid production or delayed gastric emptying, or a reduction in the pressure of the lower oesophageal sphincter, all of which could worsen acid reflux. The foods you should avoid if you are experiencing GERD are: 

  • Coffee 
  • Alcohol 
  • Chocolate 
  • Mint 
  • Spicy foods 
  • Acidic foods and beverages – soft drinks
  • High fat foods – greasy or fried 
  • High carbohydrate foods 

When will I recover from heartburn? 

The discomfort from heartburn can last about 2 hours or longer, depending on its cause. Mild heartburn that arises from eating spicy or acidic foods may last until the food has been digested, though symptom relief takes about 24 – 48 hours. Heartburns may cause erosions of the digestive tract that can take about 8 weeks to 3 months to fully recover from, depending on the severity of the erosions. 

When should I see a doctor for heartburn?

You should see a doctor for heartburn if:

  • The heartburn happens more frequently than twice a week.
  • The symptoms persist despite using over-the-counter medication like antacids.
  • You have difficulty swallowing. 
  • You have persistent nausea and vomiting.
  • There is significant weight loss from poor appetite and difficulty eating.

What are some home remedies that can help with heartburn? 

People with heartburn normally go for antacids or other over-the-counter medications that can neutralise stomach acid. Alternatively, certain foods can do the same to relieve heartburn, such as: 

Nonfat milk and low-fat yoghurt 

Note that milk comes in many different forms, there’s full-fat milk, skim or nonfat milk. Fat in milk can aggravate acid reflux, so be sure to choose only nonfat milk if you want to soothe your heartburn. Nonfat milk can act as a temporary buffer between acidic contents of the stomach and the stomach lining. Similarly, low-fat yoghurt can help in the same way, besides the fact that they also provide probiotics which enhance digestion. 

Ginger

Ginger has medicinal properties and helps with digestion. It is naturally alkaline and anti-inflammatory, helping to soothe any form of irritation of the oesophagus that may be caused by acid reflux. If you have acid reflux, try a cup of hot ginger tea to ease your symptoms.

Apple cider vinegar 

Apple cider vinegar has been thought to be helpful for heartburns, but there is a lack of research on it. Take note not to drink it at high concentrations because it can be acidic. We recommend diluting it with warm water before drinking. 

Honey lemon water 

Lemon juice is usually acidic, but when a small amount of lemon juice is mixed with warm water and honey, it actually has an alkalising effect that could neutralise stomach acid. Honey also comes with natural antioxidants to help protect cells. 

What are some treatments for GERD/acid reflux/heartburn? 

For those people who have been trying to manage their diet and lifestyle but still face the problem of acid reflux, there is a surgical procedure that can help. It is known as Laparoscopic Nissen Fundoplication, also called anti-reflux surgery. 

Anti-reflux surgery is performed laparoscopically through a keyhole technique that is minimally invasive. The upper part of the stomach or the fundus is wrapped around the lower oesophagus to prevent acid reflux and reconstruct the lower oesophageal sphincter. 

Although useful, the surgery may not completely cure GERD and patients still need to manage their dietary habits and lead a healthy lifestyle if they want to prevent a reoccurrence of GERD. That said, the surgery can be highly effective and allow you to be free from the pain of heartburn for a good many years. 

In some cases, a gastroscopy might be needed to view the inside of the oesophagus, stomach and small intestine. 

Conclusion

If your symptoms are mild, I suggest trying some of the home remedies out there or just making simple lifestyle changes that could go a long way in recovering from heartburn or preventing them altogether. As always, if you are unsure or if your symptoms do not abate, I highly recommend that you seek treatment with a specialist. 

References

  1. Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal reflux disease (GERD). Missouri medicine, 115(3), 214.
  2. Antunes, C., Aleem, A., & Curtis, S. A. (2017). Gastroesophageal reflux disease.
  3. Newberry, C., & Lynch, K. (2019). The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. Journal of thoracic disease, 11(Suppl 12), S1594.

This article was written and medically reviewed by Dr. Ganesh Ramalingam, M.D.