What is Heartburn?
Heartburn (pyrosis) is a burning and sometimes painful sensation felt in the chest, usually behind the breastbone.
Many people experience this from time to time. It happens when stomach acid or food comes back up from the stomach. It can be accompanied by a sour taste in the mouth.
It is estimated that 20 percent of people in the western population will experience heartburn. (1)
Heartburn, as we have mentioned, happens when acid or food comes back up from the stomach. When these acids stay in the esophagus for any length of time a burning sensation is felt.
There is a muscle or sphincter that allows food to pass into the stomach and then closes. When this muscle relaxes reflux allows stomach contents back into the esophagus. If this happens on a regular basis then it is classed as gastrointestinal reflux disease or GERD. (2)
We will detail some of the causes of occasional heartburn.
Eating a Large Meal
Heartburn is often felt after eating a large meal. This happens as the stomach might stretch and allow the sphincter between the stomach and esophagus to open temporarily.
Acid and stomach contents leak out and the esophagus can be irritated causing burning and pain. (3)
Some foods and drinks can exacerbate heartburn. These include chocolate, spicy or greasy foods, acidic foods like tomatoes, peppermint and coffee. (4)
An aperitif before or a glass of wine with dinner could aggravate heartburn.
It is thought that the acidic nature of alcoholic drinks can damage the mucus in the stomach and esophagus. This is particularly the case with hard liquor. It could also play a part in relaxing the sphincter and therefore allowing reflux. (5)
Smoking cigarettes can interfere with the production of saliva. The act of smoking also affects the pressure in the esophagus and can cause the sphincter to relax.
As a consequence, stomach acid is more likely to reflux and cause heartburn. (6)
Being overweight can predispose you to heartburn, especially if you carry excess weight around your abdomen. The pressure this creates adds to the chances of acid reflux. (7)
Heartburn during pregnancy is common and can affect up to 45 percent of pregnant women. The reasons are multifaceted and include hormone changes and physical changes in the body.
An increase of progesterone can cause muscle relaxation in the sphincter. The position of the sphincter can change and cause stomach acid to enter the esophagus. Added to that you have increased pressure on the stomach from the growing baby.
The result of any of these factors is heartburn. (8)
Lying down can affect acid reflux, especially if you eat close to bedtime. If you are prone to heartburn make sure you have at least 3 hours after dinner before going to bed.
Whilst medications are used to treat various conditions they can have side effects. Those that interfere with acid reflux include, painkillers, antihistamines and antidepressants. (11)
Stress can result in many things that affect the body. It could be worrying about work, relationships, money or grief following the death of a loved one. Whatever the cause of stress it can result in an increase of acid reflux. (12)
Heartburn is a symptom in itself rather than a condition. It happens as a result of stomach acids and food entering the esophagus from the stomach.
The result is irritation to the esophagus causing a painful burning sensation behind the breastbone. As a result of regurgitated food an unpleasant sour taste can linger in the mouth and at the back of the throat..
There are other symptoms which might indicate heartburn is a sign of gastrointestinal reflux disease. These include bad breath, nausea and vomiting.
You can have difficulty or find it painful swallowing. Constant acid from the stomach leaking into the esophagus and mouth can cause the teeth to deteriorate. It also causes chest pain and respiratory problems. (13)
If you have heartburn and other symptoms you should seek medical advice.
There are over the counter medications your pharmacist can advise you about which will treat heartburn. Yet avoiding things that you know will trigger heartburn can also help. However if your heartburn is persistent or causing you concern, see a doctor.
The doctor will take a full medical history and review the symptoms you are experiencing. If necessary they can refer you for tests to see if you have gastrointestinal reflux disease.
These tests are likely to include: (14)
Upper Gastrointestinal (GI) Endoscopy and Biopsy
This test involves an examination of your upper gastrointestinal (GI) tract including your esophagus and stomach.
A medical professional uses a thin hollow tube with a camera attached to look at the inside of your GI tract. This piece of equipment is called an endoscope and sends images to a monitor.
The endoscope also allows the doctor to take a biopsy, a sample of tissue, from the esophagus lining. This will later be analyzed in a laboratory.
You will likely be sedated for this procedure and the inside of the upper GI tract will be anaesthetized.
Upper GI Series
This test is an imaging test that examines the shape of your upper gastrointestinal tract.
You might have to stop eating and drinking for a while before this test which involves an x-ray. To enable the features of the upper GI to be seen on imaging you will be given a drink called barium. This is a metallic compound that will show up on x-rays as it moves through the GI tract.
The x-rays can identify features which could be related to acid reflux like a narrowed esophagus, ulcers or hernias.
Esophageal pH and Impedance Monitoring
This involves measuring the acid levels in your esophagus as you go about your everyday life.
It places a thin tube into your esophagus through your mouth or noise. This can be done at the same time you have an endoscopy.
The end of the tube outside your body attaches to a monitor that measures pH levels for 24 hours. Along with a record of what you eat and your symptoms, the results can indicate triggers of acid reflux. (15)
What is heartburn? Heartburn (pyrosis) is a burning and sometimes painful sensation felt in the chest, usually behind the breastbone.
What causes heartburn? Several factors can contribute to the likelihood of heartburn. These include: eating large meals, eating spicy or fatty foods, smoking, alcohol, being overweight, pregnancy, stress and lying down after eating.
How do doctors test for heartburn? Heartburn is generally a symptom not a condition. It results from stomach acid or food entering the esophagus from the stomach. If it is persistent then the doctor might require tests to rule out gastrointestinal reflux disease. These include endoscopy, imaging tests and tests of the acid balance in your esophagus.
When should you go to the doctors with heartburn? Occasional heartburn can be treated with over the counter medications or modifying the foods that you eat. If it is recurring or causing concern then you should visit a doctor.
Can you prevent heartburn? Avoiding food and drink that you know will trigger an episode of heartburn can prevent it happening. Don’t eat before going to bed and avoid overeating. Maintaining a healthy weight, not smoking and not drinking alcohol can also help.
What can relieve heartburn? Over the counter medications like antacids can relieve the symptoms of heartburn. Wearing loose fitting clothing around your middle will stop your stomach being squeezed and acid being pushed into your esophagus. If you are overweight, try and lose a few pounds and if you smoke, quit. (16)
What food should you eat to avoid heartburn? Following a healthy balanced diet and restricting the intake of fatty foods can help. You might also find that eating smaller meals more often rather than three large meals a day will be of benefit. (17)
Are there any natural remedies for heartburn? Anecdotally there are many natural remedies that purport to help with heartburn from chamomile tea to apple cider vinegar. Some natural remedies have been shown to help with the symptoms of heartburn. These include baking soda, ginger, licorice and aloe vera syrup. The practice from chinese medicine of acupuncture can improve reflux, nausea and vomiting. (18,19,20)
Heartburn (pyrosis) is a burning and sometimes painful sensation felt in the chest, usually behind the breastbone. Heartburn is generally a symptom not a condition and results from stomach acid or food entering the esophagus from the stomach.
Several factors can contribute to the likelihood of heartburn. These include: eating large meals, eating spicy or fatty foods, smoking, alcohol, being overweight, pregnancy, stress and lying down after eating.
The good news is changing lifestyle habits in the way we eat and the types of food we eat can relieve acid reflux. There are also many over the counter medications and natural remedies that can help.
However if heartburn is frequent and persistent it could be a sign of gastrointestinal reflux disease and needs to be checked out by a doctor.