Heartburn: Causes, Treatment and Complications

Symptoms of Heartburn

• Burning Sensation in the Chest: A sharp, burning feeling behind the breastbone, especially after eating or when lying down or bending over.
• Sour or Bitter Taste: A backflow of stomach acid may cause a bitter or sour taste in the mouth or throat.
• Pain After Eating: Discomfort typically arises after meals, especially if the food was spicy, acidic, or high in fat.
• Difficulty Swallowing (Dysphagia): A sensation that food is stuck in the chest or throat during swallowing.
• Chronic Cough or Hoarseness: Repeated exposure of the throat to stomach acid can irritate the lining, leading to a dry cough or sore throat.
• Nausea and Bloating: Some people experience stomach discomfort, bloating, or nausea along with heartburn.

Causes of Heartburn

Common Causes of Heartburn include:

• Acid Reflux: When the lower esophageal sphincter (LES) becomes weak or relaxes at the wrong time, stomach acid flows back into the esophagus, leading to a burning sensation.
• Large or Late Meals: Eating heavy meals or eating close to bedtime increases pressure in the stomach, making it easier for acid to escape into the esophagus.
• Trigger Foods: Spicy dishes, citrus fruits, onions, garlic, tomatoes, chocolate, caffeine, and greasy or fried foods can weaken the lower esophageal sphincter (LES) and allow acid reflux.
• Alcohol and Smoking: Both habits can relax the LES and increase the production of stomach acid, raising the risk of heartburn.
• Pregnancy: Hormonal changes and pressure from the growing uterus can push stomach contents upward, causing reflux.
• Hiatal Hernia: A condition where part of the stomach pushes through the diaphragm, disrupting normal digestion and allowing acid to rise.
• Obesity: Excess body weight can press on the stomach, increasing the chance of acid moving into the esophagus.

When to Visit a Doctor?

Though common, heartburn can lead to serious health issues. You should contact your doctor if:

• Your heartburn persists or worsens.
• It is difficult or painful to swallow.
• Your heartburn causes vomiting.
• You've had significant and unexpected weight loss.
• You need over-the-counter antacids for more than two weeks.
• You experience severe hoarseness or wheezing.
• You have severe or crushing chest pain, shortness of breath, jaw pain, or arm pain.

Diagnosis of Heartburn

Heartburn is a common complaint, although it can be confused with other chest-related illnesses, including:

• Myocardial infarction
• Pulmonary embolism
• Carbonated drinks
• Pneumonia
• Chest wall pain

Diagnosis begins with a thorough history and physical exam, which is often sufficient for initial treatment. Persistent heartburn may indicate GERD, requiring further evaluation.

But to find out how severe it is, they can run several tests, including:

• X-Ray: You drink a barium solution that coats your upper GI tract, allowing doctors to see defects.
• Endoscopy: A gastroenterologist uses a flexible endoscope with a camera to view the esophagus and stomach, identifying inflammation, ulcers, and obtaining biopsies to check for cancerous cells.
• Outpatient acid probe test (esophageal pH monitoring): An acid monitor is placed on the esophagus to measure acid reflux duration, connected to a small computer that you wear.
• Esophageal motility (esophageal manometry): Pressure sensors measure esophageal pressure and movement, used when traditional treatments fail or symptoms are atypical.

Treatment of Heartburn

Depending on your diagnosis, your doctor may offer treatments to reduce or eliminate symptoms. For occasional heartburn, options include antacids, H2-receptor antagonists like Pepcid, and proton pump inhibitors that block acid production.

• Antacids: These medications decrease stomach acid and relieve heartburn pain. Sometimes, they can also help with stomach aches, indigestion, and gas.
• Acid blockers and proton pump inhibitors: These drugs decrease the amount of acid your stomach makes. They can also ease the symptoms of acid indigestion.
• H-2 receptor antagonists (H2RA): Which can reduce stomach acid. H2RAs do not work as quickly as antacids, but they can provide longer relief.

Prevention of Heartburn

• Avoid trigger foods and activities.
• Take chewable antacids before meals to prevent symptoms.
• Ginger (snacks or tea) can act as a natural remedy.
• Maintain a healthy lifestyle by avoiding alcohol and tobacco.
• Avoid eating late at night and wait at least four hours before bed.
• Eat smaller, more frequent meals to reduce digestive strain.

Lifestyle Changes for Heartburn

• Stay upright for at least three hours after meals.
• Lose weight to reduce pressure on the stomach.
• Avoid trigger foods like carbonated drinks, citrus, tomatoes, mint, fried foods, and alcohol.
• Avoid smoking, as it relaxes the lower esophageal sphincter, allowing acid to rise.

Home Remedies for Heartburn

• Ginger tea or snacks help reduce symptoms.
• Chamomile tea can soothe the stomach lining.
• A mixture of water and baking soda can neutralize stomach acid.
• Eating bananas or apples can help coat the stomach and reduce irritation.
• Maintain a healthy weight to reduce stomach pressure.
• Avoid trigger foods like chocolate, alcohol, caffeine, spicy, and acidic foods.

Complications Associated with Heartburn

Heartburn, if left untreated or occurring frequently, can lead to various complications. These complications may cause long-term damage to the esophagus and other parts of the digestive system, such as:

• A prolonged cough
• Laryngitis
• Inflammation or ulcers of the esophagus
• Difficulty swallowing due to a narrow esophagus
• Barrett's esophagus is a serious complication where the cells in the esophagus change due to chronic acid reflux, increasing the risk of esophageal cancer.