What Is Heartburn? What Causes Heartburn?

Heartburn is an uncomfortable warm and burning sensation in the chest, usually just behind the sternum (breastbone) that typically comes in waves. The pain may start in the chest area and make its way up to the neck, throat and jaw. The pain usually gets worse when the patient lies down or bends over, and is more common immediately after eating.

The condition is medically known as pyrosisor acid indigestion.

The word "heartburn" is a popular lay term that has nothing to do with the heart.

Heartburn is usually linked to gastric reflux - the regurgitation of gastric acid; one of the main symptoms of GERD (gastroesophageal reflux disease).

As heartburn may also be a symptom of ischemic heart disease, it is important that doctors bear this in mind and do not jump to a GERD diagnosis too rapidly.

Some people use the terms "dyspepsia" and heartburn interchangeably. There is a difference: Dyspepsia is a combination of heart burn and epigastric pain, which is from the sternum to just above the umbilicus (navel, belly-button).

It is common for people to have heartburn occasionally, and it is usually nothing to worry about. With some lifestyle changes, and perhaps an OTC medication you can manage the discomfort without having to seek medical help.

If heartburn symptoms are experienced frequently and start affecting a person's daily routine, they should check with a doctor in case it is a sign of something more serious.

What are the signs and symptoms of heartburn?

A symptom is something the sufferer feels and describes, such as a headache or dizziness, while a sign is something other people can detect, such as a rash.

Signs and symptoms of heartburn include:

• An uncomfortable sensation of warmth or burning in the chest. This tends to occur after eating, or during sleep. It can last from a few minutes to several hours.

• When bending over or lying down the pain gets worse

• Some patients may experience a burning sensation in the throat

• Sometimes there is a chronic cough, sore throat or hoarseness

• When swallowing, there may be a sensation of food sticking in the middle of the chest or throat

Many of the heartburn symptoms may overlap with those of GERD, simply because heartburn is one of the symptoms of GERD.

Diagnosing heartburn

Physicians can usually diagnose heartburn by asking the patient to describe his/her symptoms.

A doctor may wish to determine whether the heartburn is a symptom of a wider condition, such as GERD. If so, the following tests may be ordered:

• X-ray - the patient drinks a liquid that coats the inside lining of the digestive track. When X-rays are taken of this area, the liquid shows up in the images. The physician is able to make out a silhouette of the esophagus, duodenum and stomach, and determine their shape and condition. This type of X-ray is called a barium swallow.

• Endoscopy - a thin, flexible tube with a light and camera at the end - an endoscope - is inserted through the throat and down to the esophagus and stomach. The doctor can see the esophagus and stomach on a monitor. This type of internal examination is useful for determining whether there are any complications of reflux, such as Barrett's esophagus. The doctor can also take a biopsy using an endoscope.

• Ambulatory acid (pH) probe tests - a device is used to determine when gastric acid seeps back into the esophagus and how long for. It may be a catheter that is threaded through the patient's nose into his/her esophagus. The catheter (tube) is connected to a computer that is worn around the patient's waist or strapped over their shoulder. Signals are transmitted to the computer for a period of about two days.

• Esophageal motility testing - this measures the movement of the esophagus as well as its pressure. A catheter is threaded through the patient's nose, down to his/her esophagus.

• Manometry - this assesses how well the LOS (lower esophageal sphincter) works by measuring the pressure inside the sphincter muscle. Doctors may order this test if an endoscopy finds no evidence of damage to the esophagus. A small tube is threaded through the nose into the esophagus to where the LOS is. It contains several pressure sensors, which send data to a computer.

  The patient is asked to swallow some food and liquid to determine how well the LOS is functioning. The whole test takes about thirty minutes to complete. Manometry is useful to confirm a diagnosis of GERD, as well as detecting rarer conditions related to the functioning of the LOS, such as achalasia or muscle spasms.

What are the treatment options for heartburn?

There are some steps patients can take themselves to reduce their risk of developing heartburn:

• Lose weight - obese or overweight individuals may experience fewer bouts of heartburn if they lose weight, because there will be less pressure on the stomach.

• Quit smoking - smoking irritates the digestive system and can worsen symptoms of heartburn and GERD

• Eat smaller meals - people who eat more smaller meals each day rather than three large ones may find their heartburn symptoms either improve or go away altogether

• The evening meal - have it at least three hours before going to bed

• Avoid food triggers - some foods and drinks may trigger heartburn in some patients. Typical ones include coffee, alcohol, tomatoes, fatty or spicy foods, and chocolate. Identify your triggers and avoid them.

• Your bed - if you raise the head end of your bed, your heartburn symptoms might improve

Symptoms of heartburn can usually be effectively treated with OTC (over-the-counter) medications.

• Antacids - these neutralize stomach acid and provide rapid relief. It is important to follow the manufacturer's instructions and not to overuse them. Overuse can lead to constipationor diarrhea.

• H-2-receptor blockers - they work more slowly than antacids, but provide longer relief. There are two types, OTC ones and stronger prescription ones.

• Proton pump inhibitors - these block the production of acid, giving damaged esophageal tissue time to repair itself. Patients over 50 should be careful not to use proton pump inhibitors for extended periods - according to the US Food and Drug Administration (FDA), they may increase the risk of hip, wrist or spine fractures.

What Is Acid Reflux? What Causes Acid Reflux?

The word "reflux" comes from the Medieval Latin word refluxus which comes from the Latin word refluere, meaning "to flow back, to recede". If you suffer from acid refluxthe acids from your stomach "flow back" into your esophagus, causing discomfort and pain - this discomfort is known as heartburn.

What is the esophagus?

In simple terms, the esophagus is the tube between the stomach and the pharynx, which is at the back of your throat. According to Medilexicon's Medical Dictionary, "the esophagus is the portion of the alimentary canal between the pharynx and stomach. It is about 25-cm long and consists of three parts: the cervical part, from the cricoid cartilage to the thoracic inlet; the thoracic part, from the thoracic inlet to the diaphragm; and the abdominal part, below the diaphragm to the cardiac opening of the stomach."

The esophageal sphincter

The esophageal sphincter lies at the junction where the stomach and the esophagus join. Your stomach produces strong acids and enzymes (gastric juices) which are used in food digestion. The inner lining of your stomach has several mechanisms to protect itself from the effect of the gastric juices on itself, but the lining of the esophagus does not. There is a valve that stops the gastric juices from going up the esophagus - it is called the lower esophageal sphincter. 

When the lower esophageal sphincter becomes weakened gastric juices can seep upwards into the esophagus. 

Most of us have acid reflux problems now and again. In majority of cases this is harmless. If the problem becomes persistent and goes untreated, the heartburn can develop into GERD (Gastroesophageal Reflux Disease). In chronic and severe cases the esophagus can become scarred - the patient may have difficulty swallowing, and the risk of developing cancer of the esophagus increases significantly.

What is the difference between acid reflux and heartburn?

Acid reflux is the action, while heartburn is the sensation. The pain is heartburn, while the movement of acid into the esophagus from the stomach is acid reflux.

What are the symptoms of acid reflux?

• Asthma - gastric juices seep upwards into the throat, mouth and air passages of the lungs

• Chest pain - part of the heartburn sensation

• Dental erosion

• Dysphagia - difficulty swallowing

• Heartburn - a burning feeling rising from the stomach or lower chest towards the neck

• Hoarseness

• Regurgitation - bringing food back up into the mouth

What causes acid reflux?

Acid reflux commonly occurs when the lower esophageal sphincter (LES) does not work properly, and allows acid to seep upwards from the stomach to the esophagus. Although we know that a faulty LES is a common cause, we are not sure why it becomes faulty. One of many reasons could be that pressure in the stomach rises higher than the LES can withstand.

Here are some common causes of acid reflux:

• Pregnancy - more commonly found during the third trimester of a pregnancy. As the growing baby presses on the stomach, contents may back up into the esophagus. Doctors say antacids will not relieve acid reflux caused by pregnancy. Patients find that if they eat smaller meals but eat more meals per day, it helps. In the vast majority of cases the acid reflux will disappear soon after the baby is born.

• Large meals and eating habits - people who have large meals will usually find that their acid reflux will improve if they cut down portion sizes. Patients who kept a food diary, noting down everything they ate and linking certain foods to incidences of acid reflux, have experienced a reduction in acid reflux.

• Bending forward - this movement will not usually cause acid reflux unless there is another underlying trigger or problem.

• Hiatus hernia (hiatal hernia) - a condition where the upper part of the stomach protrudes into the chest through a small opening in the diaphragm. Hiatal hernias are commonly caused by severe coughing, vomiting, straining, sudden physical exertion, pregnancy, and obesity.

• Peptic ulcers and insufficient digestive enzymes - peptic ulcers and not enough digestive enzymes in the stomach may slow down the digestive process, causing an accumulation of gastric acids that back up into the esophagus.

• Asthma - experts still argue about which came first, the asthma or the acid reflux - did the asthma cause the acid reflux or did the acid reflux cause the asthma? Nobody has a definite answer to the relationship between asthma and acid reflux. Some say that the coughing and sneezing brought on by asthmatic attacks can cause changes in the chest which trigger acid reflux. Others blame asthma medications - they are taken to dilate the airways, but might also relax the esophageal sphincter. 

  Most asthma sufferers say that their asthma is worsened by acid reflux because the acid that seeps into the esophagus from the stomach stimulates the nerves along the neck into the chest, causing bronchial constriction and breathing problems.

• Smoking - research has shown that the saliva of smokers contain lower levels of bicarbonates, which neutralize acids. Cigarette smoking also reduces the production of saliva. Smoking also stimulates the production of stomach acid, weakens the esophageal sphincter, promotes the movement of bile salts from the intestine to the stomach (making the acids more harmful), and slows down digestion (making stomach pressure last longer because it takes more time to empty).

• Alcohol - patients have commented that quitting alcohol, or cutting down consumption significantly improved their symptoms.

What is the treatment for acid reflux?

Diet

The vast majority of people with acid reflux will get better if they make some changes to their diet. Some foods are safe for heartburn sufferers, while others are major triggers of it. 

It would be easy to say that there is a reflux diet. Unfortunately, we all react differently to different foods. 

Below is a list of foods/drinks that commonly cause irritation and/or heartburn:

• Alcohol

• Black pepper

• Chili and chili powder

• Citrus fruit, pineapple

• Coffee

• Garlic

• Spicy food

• Tea

• Tomatoes, tomato sauce, tomato juice, ketchup

• Vinegar

Some patients with acid reflux say these gassy foods cause discomfort:

• Beans

• Broccoli

• Brussel Sprouts

• Cabbage

• Cauliflower

• Kale

• Fizzy drinks (sodas)

Medications

• Acid suppressant - these have been shown to be effective, such as histamine2-receptor antagonists (blockers). Histamines are good at reducing inflammation. An inflamed stomach produces more acid - blocking this extra production of acid helps prevent the acids from building up and seeping upwards.

• Propton pump inhibitors - these reduce the production of acid in the stomach. They act on cells in the stomach wall and produce stomach acids.

• Prokinetic agents - these promote the emptying of the stomach, stopping it from becoming overfull.

• Antiacids - commonly used to treat mild acid-related symptoms, such as heartburn orindigestion. They neutralize the acids in the stomach. These are not recommended for frequent heartburn for patients with GERD.