Heartburn

What is hearburn? (click to close)

Heartburn occurs when the acid contents of the stomach pass backwards up into the food pipe (called the gullet or oesophagus). This is also known as stomach acid reflux.
Most people have stomach acid reflux at some point in their lives, either as heartburn or acid regurgitation.
Heartburn typically occurs after eating a large meal or drinking a lot of alcohol. Some people get heartburn when they bend over or lie down.
The frequency of stomach acid reflux varies from one person to another. For most people, it happens very rarely. But weekly or daily incidents of heartburn or acid regurgitation may occur.

How do we get heartburn? (click to close)

When you swallow, the lower oesophageal sphincter, a circular band of muscle around the bottom part of your oesophagus, relaxes to allow food and liquid to flow down into your stomach. Then it closes again.

However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your oesophagus, causing frequent heartburn. The acid backup is worse when you are bent over or lying down.

This constant backwash of acid can irritate the lining of your oesophagus, causing it to become inflamed.

What are the symptoms of heartburn? (click to close)

Chest pain

  • A burning feeling is experienced in the upper part of the stomach and this feeling tends to move upwards behind the breastbone. The pain may be felt only in this area or occasionally it may be felt right up to the throat. Sometimes the pain can come on suddenly and severely and even radiate to the back and arms, symptoms that are very similar to those experienced during a heart attack.

Regurgitation of food or sour liquid

  • This is caused by the food and acid contents in the stomach flowing back up as far as the throat.

Difficulty in swallowing

  • This is caused by a mechanical blockage in the oesophagus. This can be caused by scarring because of long-term reflux of acid resulting in damage and therefore narrowing of the oesophagus.

Coughing, wheezing, asthma, hoarseness or sore throat

  • Stomach acid can also wash back up the oesophagus and into the respiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth).

What makes us at risk? (click to close)

Age

  • The symptoms or reflux and oesophagitis occur more commonly in people aged fifty five and over. Heartburn is not a condition normally experienced in childhood, although symptoms can occur in young adults.

Obesity and diet

  • Excess weight puts extra pressure on your stomach and diaphragm (the large muscle that separates your chest and abdomen). This forces open the lower oesophageal sphincter and allows stomach acids to back up into your oesophagus. Eating very large meals or meals high in fat may cause similar effects.

Hiatus hernia

  • In this condition part of your stomach protrudes into your lower chest. If the protrusion is large, a hiatus hernia can worsen heartburn by further weakening the lower oesophageal sphincter muscle.

Pregnancy

  • Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower oesophageal sphincter.

Asthma

  • Doctors are not certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering regurgitation of stomach acid into your oesophagus. Some asthma medications that widen airways may also relax the lower oesophageal sphincter and allow reflux. Or it is possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your oesophagus and pharynx, damaging lung airways.

Diabetes

  • One of the many complications of diabetes is results in a disorder in which your stomach takes too long to empty (this is caused by nerve damage). If left in your stomach too long, stomach contents can regurgitate into your oesophagus and cause heartburn.

Peptic ulcer

  • An open sore or scar near the valve (pylorus) in the stomach that controls the flow of food into the small intestine can keep this valve from working properly or can obstruct the release of food from the stomach. Food doesn’t empty from your stomach as fast as it should, causing stomach acid to build up and back up into your oesophagus.

Medication

  • Some medication, used to treat heart disease, asthma, schizophrenia and depression can cause heartburn.

Other disease states

  • Other, more unusual disease states affecting stomach emptying, stomach acid production and the muscles of the stomach and oesophagus can also lead to heartburn.

What are the complications of heartburn? (click to close)

In addition to irritation and inflammation of your oesophagus, long-term reflux of stomach acid into your oesophagus can lead to one or more of the following conditions if left untreated:

Oesophageal narrowing (stricture)

  • Damage to cells in the oesophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing large chunks of food to get caught up in the narrowing, and can interfere with swallowing.

Oesophageal ulcer

  • Stomach acid can severely damage tissues in the oesophagus, causing an open sore to form (an ulcer). The oesophageal ulcer may bleed, cause pain and make swallowing difficult.

Barrett’s oesophagus

  • In Barrett’s oesophagus, the long-term reflux of acid causes a change in the lining of the oesophagus. Because of this people with Barrett’s oesophagus are at increased risk of developing oesophageal cancer and have to be checked regularly by doctors.

When should you a doctor about your heartburn? (click to close)

Most problems with heartburn are fleeting and mild. But if you have severe or frequent discomfort, you may be developing complications that need more intensive medical treatment and prescription medications. Talk to your doctor if you have:

  • Heartburn several times a week
  • Heartburn that returns soon after an antacid wears off
  • Heartburn that causes night awakening.
  • Use of H2 antagonist preparations for longer than two weeks pain that radiates into the jaw or arms and that is experienced when exercising or on exertion (this may be angina)

You may need further medical care, possibly even surgery, if you experience any of these:

  • Symptoms that persist even though you’re taking prescription medications
  • Difficulty swallowing
  • Regurgitated blood
  • Stools that are black
  • Weight loss

What is the best treatment for heartburn? (click to close)

The symptoms of occasional heartburn respond well to treatments which are available over-the-counter. Many over-the-counter preparations are not suitable for those who are pregnant and may not be suitable for other individuals, so make sure you talk to your local Haven Pharmacist for advice.

Haven Health Tip! (click to close)

You may eliminate or reduce the frequency of heartburn by making the following lifestyle changes:

Control your weight

  • Being overweight is one of the strongest risk factors for heartburn. Excess weight puts pressure on your abdomen, pushing up your stomach and causing acid to back up into your oesophagus.

Eat smaller meals

  • This reduces pressure on the lower oesophageal sphincter, helping to prevent the valve from opening and acid from washing back into your oesophagus.

Avoid tight-fitting clothes

  • Clothes that fit tightly around your waist put pressure on your abdomen and the lower oesophageal sphincter.

Eliminate heartburn triggers

  • Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.

Avoid stooping or bending

  • Bending over for long periods especially after meals may increase the risk of heartburn.

Don’t lie down after a meal

  • Wait at least three to four hours after eating before going to bed and do not lie down directly after eating.

Raise the head of your bed

  • An elevation of the head of the bed by about six to nine inches means gravity helps stop acid reflux. You can do this by placing wooden or concrete blocks under the feet at the head of your bed. If it is not possible to elevate your bed, you can insert a wedge between your mattress and the base of your bed to elevate your body from the waist up. Raising your head only by using pillows is not a good alternative.

Stop smoking

  • Smoking may increase stomach acid. The swallowing of air during smoking may also aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of oesophageal cancer.
Find out more about hearburn from your local Haven Pharmacist.