Heartburn: Causes, Symptoms, and Management

Overview

What is heartburn?

Heartburn is an uncomfortable burning sensation in the esophagus (food pipe) and the middle chest area just behind our breastbone. It is due to stomach acid coming back from the stomach to the food pipe. It is common in many individuals and not generally a cause of concern, and is treatable. But persistent heartburn can be a symptom of Gastroesophageal reflux disease (GERD).

GERD is a disease in which stomach content leaks back from the stomach to the food pipe.

Facts of heartburn

• Heartburn is also known as cardialgia, acid indigestion, or pyrosis
• Heartburn is quite common among the pregnant woman
• Heartburn could become a cause of concern if left untreated
• Around 15 million people in the United States experience heartburn every day ¹Overview| Researched based study from Biomedcentral.com ,²Overview| Researched based study from Sciencedirect.com .

Causes

Causes of heartburn

• When the lower esophageal sphincter is weak or does not close properly, the stomach acid from the stomach returns to the esophagus. It causes pain and a burning sensation in the chest area.
• An esophageal sphincter is a muscular valve that prevents stomach acid from returning to the food pipe ³Causes| Researched based study from Nlm.nih.gov .

Causes for weakening or improper closing of the lower esophageal sphincter

• Pregnancy
• Obesity (increased body weight)
• Constipation(difficulty in passing stool)
• Smoking
• Indigestion
• Bloating (stomach gas)
• A heavy meal that makes the stomach gets stretched
• Wearing tight-fitting clothing
• Lying down immediately after a meal
• Hiatal hernia (a disease in which the upper stomach bulges out through the diaphragm into the chest cavity) ³Causes| Researched based study from Nlm.nih.gov

Triggers

What food causes heartburn?

Food that triggers heartburn

• Chocolate
• Carbonated drinks
• Coffee
• Peppermint
• Tomatoes
• Garlic
• Onion
• Citrus fruits
• Spicy food
• Fried foods
• High-fat food
• Alcohol ⁴Triggers| Researched based study from Nlm.nih.gov

Symptoms

Symptoms of heartburn

Some common symptoms of heartburn are:

• A feeling of pain in the chest or throat
• A burning pain like that of indigestion
• An ache or pressure behind the breastbone
• Pain worsens while bending or lying down
• A sour taste in the mouth
• A feeling that food is trapped in the chest or throat
• Nausea (a feeling of uneasiness in the stomach)
• Vomiting
• Burping (expelling gas through the mouth)
• Coughing

Other uncommon symptoms:

• Hiccups
• Persistent cough
• Stomach gas
• Sore throat
• Difficulty in swallowing
• Pain and swelling of the voice box(laryngitis)⁵Symptoms| Researched based study from Nlm.nih.gov

Diagnosis

Diagnosis of heartburn

Esophageal pH monitoring

• It measures the amount of acid that flows back to the esophagus from the stomach.
• It is used to diagnose Gastroesophageal reflux disease(GERD)

Ambulatory acid (pH) probe test

• The test measures the duration and the amount of stomach acid entering the esophagus.
• A thin tube is put into the esophagus through the nose, the sensor at the end of the tube measures the stomach acid amount in the esophagus.

Upper Endoscopy

• The doctor inserts a tube with a camera through the throat into the stomach to examine the upper part of the digestive tract.
• It checks for ulcers in the esophagus or the stomach lining

Esophageal manometry

• The doctor puts a thin tube through the nose into the stomach to measure the esophagus contraction.
• The test looks for the proper functioning of the esophagus and esophageal sphincter.

Electrocardiogram (ECG)

• It checks for proper heart functioning and analyses the heart rate
• ECG is performed to confirm if the heart is the cause of the symptom

X-ray

• It uses electromagnetic waves to analyze the interior of the body, viz; esophagus, stomach, and intestine ⁶Diagnosis| Researched based study from Nlm.nih.gov

Vulnerability

People at risk of heartburn

• Aged person (as with age, muscles weaken, so the opening and closing of the muscular oesophageal valve gets affected)
• Pregnant woman
• Regular smokers
• Obese people
• Hiatal hernia patients(abdominal organs slip through the diaphragm)
• Hypertension patients on high blood pressure medication
• Patients with sleep disorders and are on sedatives ⁷Vulnerability| Researched based study from Nlm.nih.gov

Complications

Complications associated with heartburn

Recurrent injury to the esophagus lining can lead to the following complications

Intestinal metaplasia

• It is a precancerous condition in which the stomach lining cells are altered or renewed. The transformed cells are similar to the intestinal lining cells.
• The condition is Barrett’s esophagus, when tissues similar to the intestine replace the esophageal tissue.

Esophageal strictures

• The tissues of the esophagus are swelled constantly, and the tissue might get replaced with scar tissue.
• It leads to abnormal narrowing of the esophagus that ultimately causes swallowing difficulty.

Esophageal cancer

• The cells in the esophagus lining grow uncontrollably, forming tumors
• The risk is higher for individuals with untreated severe heartburn.

Some other complications include

• Gastritis (inflammation of the stomach lining)
• Stomach ulcers ( a painful sore in the stomach lining) ⁸Complications| Researched based study from Nlm.nih.gov

Treatment

Treatment of heartburn

Over-the-counter medication

Antacids

It nullifies the stomach acid and provides quick relief. Some common antacids are

• Gaviscon
• Mylanta
• Rolaids
• Mylanta

Proton pump inhibitors

It decreases the stomach acid and heals the damaged esophagus tissue. Some common proton pump inhibitors are-

• Omeprazole magnesium
• Omeprazole and sodium bicarbonate
• Lansoprazole
• Esomeprazole

Histamine-2(H2) blockers

It decreases the stomach acid secretion and treats duodenal ulcers(ulcers in the first part of the small intestine) Some common Histamine-2(H2) blockers are

• Nizatidine
• Cimetidine
• Famotidine

Alginates

• It is an edible sugar obtained from brown seaweeds
• It prevents acid reflux by acting as a barrier between the stomach and esophagus ⁹Treatment| Researched based study from Fda.gov

Alternative treatment for heartburn

Lifestyle modification

• Regular exercise and walking after meals help correctly digest food without acid reflux.
• Maintaining a healthy balanced diet and also eating on time prevents heartburn incidence.

Sitting correctly after eating

• Sitting upright can prevent heartburn
• An upright position puts less pressure on the abdomen and reduces the risk of acid reflux ¹⁰Treatment| Researched based study from Nlm.nih.gov

Elevating the upper body in bed

• Using extra pillows to raise the upper body can reduce heartburn
• Using an adjustable bed to raise the upper body from the waist helps better in reducing the symptoms of heartburn

Remedies

Home remedies for heartburn

Ginger

• Ginger (in small amount) in boiling water help relieve the symptoms of heartburn, such as nausea and vomiting.

However, consuming ginger in large amounts must be avoided as it may cause heartburn ¹¹Remedies| Researched based study from Nccih.nih.gov

Apple cider vinegar in water

• Adding one teaspoon of apple cider vinegar in 240-milliliter water and taking it after a meal helps improves digestion ¹²Remedies| Researched based study from Opss.org

However, more research is warranted to prove the effect of apple cider vinegar.

Baking soda with water

• Adding one teaspoon of baking soda to a glass of water and drinking it neutralizes the stomach acid ¹³Remedies| Researched based study from Nlm.nih.gov One should use this remedy sparingly and only occasionally.

Chewing sugar-free gum

• Chewing gums (sugar-free) after meals help reduce heartburn
• It increases the saliva secretion in our mouth and swallowing
• It helps to clear the stomach acid from the esophagus ¹⁴Remedies| Researched based study from Nlm.nih.gov

Licorice supplement

• Licorice root is an herb that grows in Asia and Europe and is a traditional herbal medicine.
• Licorice supplement
• It increases the mucous in the esophageal lining
• It protects the esophagus from stomach acid

It is always recommendable to consult a physician before using licorice supplements ¹⁵Remedies| Researched based study from Nlm.nih.gov

Prevention

Steps to prevent heartburn

• Waiting for hours before lying down
• Sleeping on the left side of the mattress
• Avoiding food and drinks that trigger symptoms
• Eating smaller meals at various times a day instead of 1 large meal
• Wearing loose clothes
• Loosening of the waistband while sleeping
• Maintaining body weight
• Complete cessation of smoking ¹⁶Remedies| Researched based study from Nlm.nih.gov .

Takeaway

Key Takeaways

• People frequently experience heartburn after a heavy meal or eating certain foods.
• The symptoms of heartburn might resemble other medical conditions
• Changing the lifestyle and eating healthy food can lower the risk of heartburn
• Persistent heartburn should not be neglected, and one should immediately take medical consultation to avoid future complications