There are many medical conditions that have heartburn and dysphagia or difficulty swallowing as their symptoms such as gastro esophageal reflux disease (GERD), esophageal spasm, esophagitis, esophageal stricture, etc. Heartburn is burning in the chest just behind the breastbone, which usually begins after eating and could remain there for just a few minutes or for several hours. Heartburn occurs when there is regurgitation of stomach acid into the esophagus, thereby, irritating the esophageal lining. The regurgitation of acid occurs due to weakening of the muscle situated at the bottom of the esophagus.

Possible Causes of Heartburn with Difficulty Swallowing and How to Manage Them

1. GERD (Gastro Esophageal Disease)

Frequent heartburn is called Gastro esophageal reflux disease (GERD). Other associated symptoms are difficulty swallowing, belching, cough, discomfort or pain in chest, sore throat, choking, regurgitation of stomach acid or food, hoarseness and wheezing at night. According to estimates around one in 20 individuals in the USA have GERD.

How is GERD managed? 

Treatment usually starts with OTC medications and antacids to decrease stomach acid. If your symptoms are not relieved by OTC medicines you may require prescription medicines or surgery. PPIs or proton pump inhibitors are the medicines that decrease stomach acid and ease symptoms related to GERD. They also help in healing esophageal erosion that is caused by reflux of stomach acid. Some of the commonly used PPIs are esomeprazole, omeprazole (Prilosec), rabeprozole, lansoprazole and pantaprazole. PPIs are taken once a day. Other GERD medicines are H2 blockers, which also decrease symptoms, but they are not able to actually heal your esophagus.

Self care

• Avoid drinks and foods that worsen your symptoms.
• Avoid eating large meals; instead eat small meals at regular intervals.
• If you are overweight, losing weight can help relieve your symptoms.
• Reduce your stress levels.
• Quit smoking.
• Don’t lie down for at least 2-3 hours after having a meal.
• GERD symptoms are made worse by alcohol, chocolate, caffeine, spicy, fatty or fried foods; hence, avoid these.
• Wear loose fitting belts and clothing.
• Visit your physician in case you take OTC medicines for heartburn greater than two times a week or if you have severe or frequent symptoms of GERD.

2. Esophagitis

Another medical condition that has heartburn with difficulty swallowing as a symptom is esophagitis. It is characterized by inflammation of the esophageal lining. The regurgitation of acid that occurs in GERD is the most common cause of esophagitis. It can also be caused by medicines that are stuck in esophagus. In persons whose immune system weakens due to HIV, esophagitis may occur as a result of infection with viruses, bacteria and fungi. It may be caused by leukemia, diabetes, radiation therapy and chemotherapy. Other associated symptoms of esophagitis are discomfort or pain in the chest, vomiting or nausea, mouth sores and red colored or bloody vomit.

How is esophagitis managed?

Treatment depends on the cause of esophagitis:

• For GERD, the treatment is described above.
• If esophagitis is caused due to a medicine, your physician may stop the drug till the time the esophagus heals.
• Antibiotics may be prescribed to treat the infections. You may also be prescribed painkillers to decrease symptoms.               

Self care

You can make some lifestyle changes to decrease the attacks of esophagitis. These are:

• Lose weight.
• Quit smoking.
• Avoid excessive use of caffeine and alcohol.
• Take medicines with lots of water and that too in upright position.
• Eat smaller meals.
• Avoid eating spicy and citrus foods such as peppers, tomatoes, onions, peppermint.
• Keep the head of the bed elevated by a few inches.
• Do not eat before bedtime.
• Visit your physician if your chest pain gets worse suddenly or the pain becomes too severe that you are unable to drink or eat anything.

3. Esophageal Spasm

Another medical condition that has heartburn with difficulty swallowing as symptoms is esophageal spasm also referred to as esophageal dysmotility. Esophageal spasm is characterized by sudden and painful contraction of the esophageal muscles that last for a couple of minutes. There is no surety about its exact cause; however, swallowing a large morsel of food or a pill, or drinking very cold or very hot drinks may trigger it. Individuals who suffer from heartburn are more prone to have it. The pain caused due to esophageal spasm may be so intense that it can be mistakenly taken as a heart attack. The majority of the cases of esophageal spasm don’t require treatment; however, chronic esophageal spasm may be disabling and may require drugs or surgery as treatment.

How is esophageal spasm managed?

People who have severe esophageal spasm may require:

• Better control of medical conditions, which increase the risk of esophageal spasms such as anxiety disorders or GERD.
• Nitroglycerin tablets.
• Antidepressants (which may relieve the pain cause due to esophageal spasm).
• Calcium channel blockers (medicine used to treat hypertension).
• Medications to relax esophageal muscles.
• Botulinum toxin injections.
• Surgery.

Self care

• Avoid very cold or very hot drinks and foods as they may trigger esophageal spasm.
• Ensure that you chew food thoroughly before swallowing. Don’t swallow very large chunks of food.
• Reduce your stress levels by doing meditation, breathing exercises, yoga, etc.
• If you develop any sudden, severe pain in chest, visit emergency room immediately as it is difficult to differentiate between heart attack and esophageal spasms.

4. Esophageal Stricture

Esophageal stricture is one of the other medical conditions that have heartburn with difficulty swallowing as symptoms. Esophageal stricture is characterized by narrowing of the esophagus at a certain spot. Due to esophageal stricture food may get stuck. Strictures may be caused by chronic GERD, injuries and scar tissue. They may also be caused by more serious medical illnesses such as tumors or autoimmune diseases, although this rarely happens. Other associated symptoms of an esophageal stricture are discomfort or pain in chest, regurgitation of liquid or food and pain while swallowing. Untreated esophageal strictures worsen over time. Initially you have difficulty while swallowing; however, eventually, complete blockage of esophagus may occur. It may become impossible to swallow foods and drinks. Persons having esophageal stricture may inhale foods or drinks accidently, which may result in lung infections.

How is esophageal stricture managed?

Your physician may dilate your esophagus. In this procedure, the physician puts a device or tube into the esophagus and pushes on the walls and widens it. Other treatment modalities include:

• Medications to control acid reflux, including proton pump inhibitors.
• Muscle relaxants.
• In rare cases, surgery may be required.

Self care

If you suffer from GERD, control it with dietary and lifestyle changes and medicines. Chew your food thoroughly b