Q. Do you get more heartburn when you are older?

More than 60 million Americans experience heartburn at least once a month. More than 15 million Americans experience heartburn daily. Heartburn is more common among the elderly.

Heartburn two or more times weekly may be caused by gastroesophageal reflux disease (GERD). See a doctor if you have heartburn too often. The doctor can test for GERD.

In the upper GI series, you swallow a liquid barium mixture. Then a radiologist watches the barium as it travels down your esophagus and into the stomach. Another test is an endoscopy, in which a small lighted flexible tube is inserted into the esophagus and stomach. There are other tests.

GERD makes stomach acid flow up into your esophagus. There is a valve at the lower end of the esophagus that is designed to keep acid in the stomach. In GERD, the valve relaxes too frequently, which allows acid to reflux, or flow backward.

A hiatal hernia may contribute to GERD. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, which is the muscle wall separating the stomach from the chest. The diaphragm helps the valve keep acid from coming up into the esophagus.

When GERD is not treated, you can suffer from severe chest pain, narrowing or obstruction of the esophagus, bleeding, or a pre-malignant change in the lining of the esophagus. One study showed that patients with chronic, untreated heartburn were at substantially greater risk of developing esophageal cancer.

The following are some symptoms that may mean there has been damage to your esophagus: difficulty swallowing, a feeling that food is trapped behind the breast bone, bleeding, black bowel movements, choking, shortness of breath, coughing, hoarseness and weight loss.

You can control infrequent heartburn by changing your habits and using over-the-counter medicines.

Avoid heartburn-producers such as chocolate, coffee, peppermint, tomato products, alcoholic beverages and greasy or spicy dishes. Quit smoking because tobacco inhibits saliva that helps with digestion. Tobacco may also stimulate acid production and relax the esophageal valve. Lose weight. And, don't eat two hours before you go to sleep.

For infrequent episodes of heartburn, take over-the-counter antacids, such as Alka-Seltzer and Rolaids. Or, you can take an H2 blocker. H2 blockers are available in both over-the-counter and prescription forms. For example, Pepcid and Zantac are over-the-counter H2 blockers which are available by prescription at higher doses.

There are proton pump inhibitors (PPIs), a group of prescription medications that prevent the release of acid in the stomach and intestines. Doctors prescribe PPIs to treat people with heartburn, ulcers of the stomach or intestine, or excess stomach acid. PPIs include Prilosec and Prevacid.

GERD is a chronic disease that calls for continuous long-term therapy. To decrease the acid in your esophagus, raise the head of your bed or place a foam wedge under the mattress to elevate the head about 6-10 inches. Avoid lying down for two hours after eating. And don't wear tight clothing.

Prescription medications to treat GERD include the H2 blockers and the PPIs, which help to reduce the stomach acid and work to promote healing at prescription strength. In addition, there are agents that help clear acid from the esophagus.

Surgery is an option if other measures fail. A surgeon can improve the natural barrier between the stomach and the esophagus that prevents acid reflux.

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