What is heartburn?
Heartburn, also known as acid reflux or gastroesophageal reflux, is a common symptom that occurs when stomach acid flows back up into the esophagus. This happens when the lower esophageal sphincter – a ring-shaped muscle that normally prevents reflux – does not close properly. When acid comes into contact with the lining of the esophagus, which is not designed to tolerate such acidity, it causes a burning and unpleasant sensation behind the breastbone.
Heartburn often occurs after eating a large meal, lying down, bending forward, or lifting something heavy. It can also be worsened by certain foods, stress, or other lifestyle factors. The symptom is very common – especially among adults – and may be occasional or recurrent.
If symptoms are frequent or occur daily, it may indicate an underlying condition such as gastroesophageal reflux disease (GERD). This is a condition where reflux happens so frequently or intensely that it causes inflammation in the esophagus and affects quality of life. If heartburn becomes chronic, it's important to investigate the cause and receive appropriate treatment to avoid complications.
Symptoms of heartburn
The most common symptoms of heartburn include:
- Burning sensation behind the breastbone: Often after eating or when changing position.
- Acid regurgitation: Liquid or stomach acid rises up into the mouth or throat.
- Difficulty swallowing: Feeling like food gets stuck in the chest.
- Hoarseness and coughing: Especially in the morning if acid irritates the vocal cords.
- Discomfort in the upper abdomen: Pressure or a bloated feeling.
Heartburn may be worsened by fatty or spicy foods, coffee, alcohol, smoking, and stress.
What causes heartburn?
Heartburn occurs when the lower esophageal sphincter relaxes inappropriately, allowing acid to flow back into the esophagus. Common causes include:
- Eating habits: Large, fatty, or spicy meals can trigger reflux.
- Overweight: Increases abdominal pressure and risk of reflux.
- Pregnancy: Hormones and increased abdominal pressure contribute to symptoms.
- Smoking and alcohol: Weaken the muscles of the lower esophageal sphincter.
- Medications: Certain drugs, such as NSAIDs and some blood pressure medications, may contribute to heartburn.
When to seek medical advice
Heartburn is often harmless, but persistent or worsening symptoms may indicate GERD or complications like esophagitis (inflammation of the esophagus). You should contact a healthcare provider if you:
- Experience heartburn more than twice a week
- Wake up at night due to acid reflux
- Lose weight without explanation
- Have difficulty swallowing or pain when swallowing
- Vomit blood or have black, tarry stools
Examinations and diagnosis
A doctor can often diagnose heartburn based on symptoms. If reflux disease or complications are suspected, the following tests may be recommended:
- Gastroscopy: A camera examination of the esophagus, stomach, and duodenum.
- pH monitoring: Measures acidity in the esophagus over 24 hours to confirm reflux.
- Blood tests: To rule out infection, anemia, or other underlying conditions.
Treatment of heartburn
Treatment aims to reduce acid reflux and relieve inflammation:
- Lifestyle changes: Avoid trigger foods, elevate the head of the bed, and eat small meals.
- Antacids: Over-the-counter medications that neutralize stomach acid.
- H2 blockers: Reduce acid production in the stomach.
- Proton pump inhibitors (PPI): Effective treatment for severe or long-term symptoms.
Prevention and lifestyle advice
To reduce the risk of recurring heartburn, the following is recommended:
- Avoid coffee, chocolate, citrus fruits, fatty foods, and alcohol
- Quit smoking
- Avoid eating late at night
- Maintain a healthy weight
- Reduce stress – stress can affect digestion