By Eduardo Gonzales, MD At night during sleep, gravity has no effect because you are supine, you do not swallow and your saliva secretion is reduced. Thus, heartburns are more common at night than during the day. In the past few weeks, I have been occasionally waking up in the middle of the night because of a burning sensation on my tummy and chest that sometimes radiates to my neck, throat, and face. Is this heartburn? What causes my problem? What can I do to relieve it? —[email protected] Yes, the burning sensation you feel just below or behind your breastbone that sometimes radiates to your neck, throat, and face is referred to as heartburn. It occurs when the acidic fluid in your stomach regurgitates back into your esophagus, an abnormal phenomenon technically called gastroesophageal reflux (GER). When you swallow food, the food passes through your throat and esophagus before reaching your stomach. Your stomach produces a lot of acid because its digestive enzymes need an acidic medium to work. The acid does not damage your stomach because it is protected by its lining cells, which produce a lot of protective mucus. Your esophagus, on the other hand, does not have mucous-secreting cells, thus when the stomach content flows back into it, it gets irritated and inflamed by acid and this brings about heartburn. Why heartburns are more common at night Your esophagus actually receives protection from acid reflux by several factors: gravity, swallowing, and saliva. Gravity keeps your stomach fluid within your stomach, swallowing returns any regurgitated stomach content back into your stomach, while saliva, since it is basic, neutralizes the acid that may find its way into your esophagus. But these protective mechanisms work only if you are upright and awake. At night during sleep, gravity has no effect because you are supine, you do not swallow and your saliva secretion is reduced. Thus, heartburns are more common at night than during the day. Measures to relieve heartburn Occasional heartburn, as in your case, is a generally benign condition that you may be able to eliminate if you:

• Refrain from taking food and beverages that are known to trigger heartburns, such as alcohol, coffee, chocolate, carbonated beverages, fruit juices, tomatoes, spicy or fatty foods, and dairy products.
• Review your maintenance medications with your physician, if you have some, to ensure they do not cause your heartburn.
• Eat smaller meals. Do not eat within two to three hours of bedtime. Do not lie down, bend over, or exercise just after eating.
• Do not wear clothes or belts that fit tightly around the waist.
• Sleep with your head raised about six inches.
• Do not smoke.
• Slim down to and maintain a desirable body weight.
• Avoid stressful situations, or unwind after going through one.

When is heartburn serious? If your heartburn is not relieved by the above suggested lifestyle modifications or if it starts to occur more often (i.e., more than twice a week), then it is time to consult a physician, preferably a gastroenterologist, because you can be suffering from gastroesophageal reflux disease (GERD), a condition that can cause serious health problems such as bleeding, ulcers, and narrowing of the esophagus that can make swallowing difficult. GERD, over time, can likewise cause the cells of the esophagus to assume abnormal forms, a situation that can eventually lead to esophageal cancer. GERD can also trigger or aggravate asthma, chronic cough, and pulmonary fibrosis. Aside from heartburn, other symptoms associated with GERD include a feeling that food is trapped in the esophagus, nausea after eating, cough or wheezing, difficulty in swallowing, hiccups, hoarseness, sore throat, and regurgitation of food. Factors that predispose a person to GERD include a hiatushernia (a condition in which part of the stomach moves above the diaphragm and protrudes into the chest); obesity; pregnancy; smoking; certain medications, such as anticholinergics, beta-blockers, and calcium channel blockers (for high blood pressure or heart disease), bronchodilators (for asthma), sedatives, and antidepressants; and, some food and beverages, notably alcohol, coffee, chocolate, carbonated beverages, fruit juices, tomatoes, spicy or fatty foods, and dairy products. Treatment for GERD depends on the underlying cause. It often initially involves the intake of medications that include antacids and/or a variety of drugs that inhibit acid production by the stomach.   Email inquiries on health matters to: [email protected]