Heartburn and Acid Reflux
You may have experienced heartburn after eating or at other times during the day. Despite their menacing names, heartburn and acid reflux are common (yes, there is a slight difference between the two), and are not considered disorders on their own. They do, however, cause discomfort and can indicate a more serious problem if the sensation lingers for too long or occurs too often.
Acid reflux is a common condition in which stomach acid travels up from the stomach through the oesophagus. Heartburn is a burning sensation in chest and throat area caused by acid reflux. This has nothing to do with the heart.
These are both digestive disorders occurring in the oesophagus. The oesophagus is the “food pipe” that connects the throat to the stomach. It lies parallel to the trachea, the “windpipe” that begins just after the voice box and divides to connect with the two lungs.
At the top of the oesophagus is a specialized muscle called the upper oesophageal sphincter (UES) or cricopharyngeus muscle. Sometimes when we choke, we say that a bite of food went down the “wrong pipe”. This happens when we are eating too quickly and the UES is closed when we try to swallow, so that bite of food is diverted to the trachea instead of the oesophagus.
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The lower oesophageal sphincter (LES) is located at the bottom of the oesophagus, just above the stomach. It relaxes to let food into the stomach and generally does a good job in keeping it there.
Sometimes the LES also relaxes after we have eaten, releasing small amounts of stomach acid back into the oesophagus causing a burning sensation. If this only happens every once in a while and the sensation is not very strong, there is nothing to worry about. This type of acid reflux can be considered similar to burping, when we release air trapped in the stomach. 1 in 5 people occasionally experience acid reflux.
However, as you might imagine, air is not supposed to be trapped in your stomach and stomach acid is not meant to be outside of the stomach. In fact, the stomach lining is specially constructed to contain the powerful acids in the stomach to digest the food we eat and keep it from damaging other parts of the body. The more often you experience acid reflux, the more irritated your oesophagus will become, which will increase symptoms of heartburn.
If you have never experienced acid reflux, it might be hard to picture how it differs from a burp. The mechanism is the same, but instead of air rising up from the stomach you can feel a tiny amount of the stomach’s digestive acids being released upwards into your oesophagus and sometimes even to the throat and mouth. This is accompanied by an unpleasant burning sensation in these areas. Most often the feeling is focused in the chest area. Sometimes heartburn can be so sudden or strong that it is confused with a heart attack.
If you or someone close to you is experiencing pain or a burning sensation in their chest and you suspect a heart condition, seek medical help. Symptoms to look for include:
- Chest pain or strong pressure in your rib cage, especially if the pressure remains for an extended period of time and/or is pulsating
- Shortness of breath, wheezing
- Excessive sweating
- Vomiting or regurgitating blood
- Nausea, general weakness
- Pain or tightness in the shoulders or elsewhere in the body
The symptoms of acid reflux are usually less intense and can be recognized from the “burp-like” motion of the stomach.
What causes acid reflux?
The most common reasons the LES opens out of turn to release stomach acid into the oesophagus are connected with eating and lifestyle habits.
Overeating or eating too quickly can “overwork” the stomach by moving the upper and lower oesophageal sphincters too often and trapping air in the digestive system. The LES will relax to release surplus air by belching but stomach acids can also escape, especially if this happens often.
Wearing tight or restrictive clothing that puts pressure on your stomach can also cause irritation. Similarly, being overweight increases pressure on the abdomen and can cause irritation in the stomach.
Certain foods and drinks that are acidic, fatty, or otherwise irritating and can induce acid reflux:
- Caffeinated drinks
- Alcohol
- Carbonated or acidic drinks (soda, citrus juice, etc.)
- Acidic fruits and vegetables (tomatoes, citruses, pineapple, etc.)
- Chocolate
- Fatty and fried foods
- Spicy foods
- Garlic and onions
Smoking also contributes to acid reflux as the nicotine found in both regular and electronic cigarettes relaxes the LES directly, causing acid reflux.
Some medications and food supplements can also contribute to acid reflux or the intensity of heartburn, for example, pain relievers (e.g., ibuprofen and aspirin), antibiotics, iron and potassium supplements, progesterone.
These medications relax the LES and also may irritate the lining of your oesophagus, making it more sensitive to acid reflux and causing the symptoms of heartburn to be more severe.
Various narcotics and sedatives such as opioids and tranquilizers can also contribute to acid reflux by relaxing the LES.
If your LES is already relaxed, lying down after eating can cause it to release. Sometimes acid reflux occurs when bending down or carrying heavier objects.
Apart from pregnancy, many other causes of acid reflux and heartburn are directly connected with a stressful lifestyle. Stress is the root cause for many habits that instigate acid reflux and heartburn.
How to relieve acid reflux
Eat dinner approximately three hours before going to sleep so your stomach will have time to digest some of the food you have eaten before you lie down for the night and potentially release stomach acid into the oesophagus. Avoid lying down, bending, and starting your work out right after eating. (Grandma did have a point after all.)
Avoid acidic, fatty, and spicy foods if you know they tend to give you heartburn.
Reduce coffee and alcohol intake and consider quitting smoking if you do smoke. Given that nicotine is the substance that causes the LES to relax, electronic cigarettes should also be avoided.
Another approach is to raise your upper body slightly during sleep either using pillows or by propping your mattress up at an angle to help keep stomach acids in the stomach.
Work on maintaining a balanced and healthy lifestyle—avoid overeating, enjoy smaller meals regularly, maintain a good sleep schedule, exercise regularly, and look after your general wellbeing.
Over-the-counter-remedies such as antacids that help relieve symptoms of acid reflux can be bought in pharmacies and drugstores. Other medicines, such as Nexium (esomeprazole magnesium) and Prilosec (omeprazole magnesium), are prescription drugs that can help reduce the amount of acid your stomach produces but must first be approved by your doctor.
Fortunately, acid reflux is most often just a side-effect of a hectic lifestyle and irritating diet. With small lifestyle changes and healthier choices, the symptoms of acid reflux usually lessen quickly. A healthy lifestyle is also one of the only ways to reduce heartburn during pregnancy. But, if acid reflux and heartburn continue even after you have taken measures to relieve symptoms, other digestive issues should be considered.
What else might heartburn indicate?
Chronic heartburn is known as gastroesophageal reflux disease (GERD); this is when the sufferer regularly feels a burning sensation in the chest after eating. GERD can cause inflammation and ulcers, increases the risk of oesophageal cancer, and can also cause shortness of breath and induce an asthma attack. A chronic cough and difficulty in swallowing can also be symptoms of GERD.
Inflamed airways can create pressure on the internal organs such as the diaphragm, which in turn will irritate the stomach and potentially cause acid reflux.
If you wake up with a sour taste in your mouth or pain in your chest, this may indicate night-time acid reflux. This is an especially serious form of acid reflux because the escaped stomach acid stays in your oesophagus for a longer period of time and can damage its lining. Avoid eating and snacking before bedtime to reduce the potential for this problem.
Hiatal hernia is a condition in which the upper part of the stomach protrudes upwards into the oesophagus and causes excessive acid reflux. This can also be treated with lifestyle changes.
Various digestive conditions have also been linked to acid reflux, including:
- Indigestion
- Constipation
- Gastritis
- Lactose intolerance, celiac disease, and other types of food intolerance
- Irritable bowel syndrome (IBS)
Check with your health care provider if you experience frequent or severe symptoms of acid reflux. Surgery is a potential solution for the most severe cases of GERD.
Generally, acid reflux and the heartburn that follows are not serious on their own but can signal other underlying issues such as an unhealthy lifestyle, too much stress in your day-to-day life, or another, more serious health condition.
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