Dear Doctor, Whenever I eat supper, I experience severe heartburn and shortness of breath at night. I have been advised to take milk to prevent the pain but I am on a weight loss diet. How else can I relieve the pain and discomfort? Uwera Dear Uwera, Severe heartburn can be due to many causes. It can be due to taking heavy meals late in the evening, taking a heavy fatty meal, very hot and spicy foods, or constipation. Use of alcohol, caffeinated products in excess, sweet beverages, and smoking can also lead to heartburn in the night. The dyspeptic symptoms may be associated with sense of bloating of the abdomen, nausea, and or vomiting. GERD (gastroesophageal reflux disease) is a condition where there is regular reflux of acid from the stomach in the food pipe. There may be one or more other symptoms, like sensation of lump in the throat, difficulty in swallowing, bringing up sour liquid in the throat, asthma, pneumonia, cough, hoarse voice, difficulty in sleeping, and etcetera. Frequent episodes of heartburn can lead to inflammation of the inner lining of the food pipe leading to heartburn and difficulty in swallowing. Peptic ulcer in the stomach can also cause heartburn along with pain in the upper stomach which is aggravated after meals. There is associated belching, nausea and or vomiting. Hiatal hernia is a condition where part of stomach pushes through a hole in the diaphragm into the chest wall. It is more likely to occur in the elderly, in obese people and in those who smoke. These conditions are diagnosed by upper gastrointestinal endoscopy. Here, a tube is passed through the nose and food pipe, stomach and upper part of intestines are visualised. They are all treatable by dietary measures, posture adjustment while sleeping (hiatal hernia) and medicines. Breathlessness may be present along with heartburn in a person who is obese simply because of being overweight. It can be due to GERD. Breathlessness can also be due to associated heart problems like angina or heart attack. In this, the blood supply to the heart is reduced or cut off due to blockade caused by fat deposits in the inner lining of the blood vessels supplying the heart. Here, one or more risk factors of causing a heart problem may be present, like obesity, hypertension, diabetes, stress, use of alcohol and or tobacco. Symptoms of heartburn and breathlessness may be due to infections of the covering of heart or lungs. In this case, there may be other features like fever, breathlessness at rest, chest pain, and etcetera. For prevention of heartburn, avoid taking a heavy meal in the evening, avoid eating late in the evening, and avoid alcohol, tobacco and caffeinated products. Very spicy and hot foods should also be avoided. Try taking small frequent meals instead of one or two heavy meals. Meals should include lots of fibre as present in green leafy vegetables and fresh fruits. Drinking lots of water helps in preventing constipation and aids in digestion. If overweight, try to reduce weight by avoiding fatty and sugary foods and regular exercise. Any heart or lung problem can be easily diagnosed by tests like x-rays and are curable. Dr. Rachna Pande is a specialist in internal medicine.
