Heartburn and reflux
Heartburn is a burning feeling behind the breastbone that rises towards the throat. It happens when acidic stomach contents flow back into the oesophagus (gullet), whose lining is not adapted to acid. It often appears after a large meal, at night in bed or when bending over and lifting.
Occasional heartburn is not a disease. We speak of reflux disease when symptoms recur every week, when they disturb your sleep or when you change the way you eat because of them. At that point the question is no longer how to put out the symptom, but why it keeps coming back.
Besides the burning feeling, people describe a sour or bitter fluid in the mouth, frequent belching, a feeling of fullness after small meals and pain in the upper abdomen.
When reflux does not show up as heartburn
Some people do not feel heartburn at all. Instead they have a dry cough lasting weeks, hoarseness in the morning, a feeling of a lump in the throat, frequent throat clearing or recurring sore throats.
Acid can also wear away tooth enamel, which is sometimes first noticed by the dentist. If you have already been seen for a chronic cough or hoarseness without a clear answer, reflux is one of the causes worth checking.
Chest pain with reflux is not rare and people often mistake it for heart pain. Telling them apart by how it feels is not reliable, so do not put your first chest pain down to your stomach.
When to call 112 or seek emergency help
If you have crushing pain or pressure in the chest that spreads to the arm, neck or jaw and is accompanied by a cold sweat, shortness of breath or nausea, call 112. This is not heartburn until proven otherwise, and delay is the costliest mistake in a heart event.
Vomiting blood or black, tarry stool mean bleeding in the digestive tract and require immediate treatment at an emergency medical service.
You also need prompt assessment by a doctor, not a wait, if you have difficulty swallowing, a feeling that food is getting stuck, repeated vomiting, unintentional weight loss or diagnosed anaemia.
What makes the symptoms worse
Large and late meals, fatty and fried food, alcohol, coffee, fizzy drinks and smoking are among the most common triggers. Lying down in the first two hours after a meal makes almost everything worse.
Increased body weight and waist size raise the pressure in the abdomen, so reflux often gets worse as you gain weight and settles when you lose it. The same applies to pregnancy.
A hiatus hernia and some medicines, including non-steroidal anti-inflammatory drugs, which are often used to relieve pain and inflammation (e.g. Nalgesin), can also contribute. If you take them regularly, mention this at the examination instead of stopping them on your own.
How the cause is found and what follows
With a typical picture and no warning signs, care often starts with adjusting habits and with medicines that reduce acid production. The response to this treatment is itself useful information.
Gastroscopy is considered for persistent or recurring symptoms, when there are warning signs, with long-standing reflux and when the state of the oesophageal lining needs to be assessed or other causes ruled out. During the examination small tissue samples can be taken and a test for the bacterium Helicobacter pylori carried out.
If symptoms persist for years despite medicines, also talk to your chosen personal doctor (GP) about the possibility of surgical treatment. Whether a procedure makes sense is assessed by a thoracic surgeon.
Gastroscopy is carried out with a referral under the Health Insurance Institute of Slovenia (ZZZS) and on a self-pay basis. Preparation instructions, including when to have your last meal and what to do with your regular medicines, are given when you book with the clinic that runs the service.