The oesophagus connects the mouth to the stomach. It is composed of muscles which function to send food in rhythmic waves to the stomach. Once in the stomach, food is stopped from refluxing by a particular area of circular muscle situated at the junction of the oesophagus and stomach, known as the lower oesophagal sphincter (LES).
There occurs a pressure difference across the diaphragm, the flat muscle that divides the chest from the abdomen, moreover tends to keep stomach contents in the stomach. The stomach mixes acids, food, and enzymes to start digestion process.
Unique protective cells line the stomach to stop the acid from creating inflammation. The oesophagus does not have this protection, and if stomach acid & digestive juices reflux back into it, they can cause inflammation and harm to its unprotected lining.
Heartburn is not usually serious; when you get it often, it is termed gastroesophageal reflux disease or GERD. If you fail to get treatment, GERD may sometimes cause problems such as:
- Inflammation and ulcers in the esophagus
- Some types of lung disease
- Barrett's oesophagus (when your oesophagus is damaged by acid reflux)
- Hoarseness
Symptoms
Heartburn gives a burning sensation in the middle of your chest and throat. You may also have:
- Burning pain in your chest after you eat or at night
- An acidic, hot, bitter, or salty taste in the back of your throat
- A hard time swallowing
- Pain which worsens when you bend over or lie down
- A feeling of food "stuck" in the middle of your chest or throat
Causes
Heartburn is symptom of GERD (gastroesophageal reflux disease) & occurs because of acid refluxing into the oesophagus. Risk factors include those that elevate the production of acid in the stomach & structural problems that permit acid reflux into the oesophagus.
A few common foods we eat and drink trigger increased stomach acid secretion, setting the stage for heartburn. Over-the-counter medications may also initiate heartburn. Examples of these irritants include:
- Alcohol
- Caffeine
- Carbonated beverages
- Acidic juices (grapefruit, orange, pineapple)
- Acidic foods (tomatoes, grapefruit, and oranges)
- Chocolate
- Aspirin (Bayer, etc.)
- Ibuprofen (Motrin, Advil, Nuprin, etc.)
- Naproxen (Naprosyn, Aleve)
Smoking and eating high-fat foods can impact the lower oesophagal sphincter (LES) functions, making it relax from the stomach & acid reflux into the oesophagus.
A hiatal hernia, in which a part of the stomach lies within the chest instead of the abdomen, can impact the way the LES works & is a risk factor for reflux. Hiatal hernias do not create symptoms by themselves. It is only when the lower oesophagal sphincter fails that heartburn occurs.
Pregnancy may cause high pressure within the abdominal cavity, impact LES function, and predispose it to reflux.
Obesity may also cause high pressure in the abdomen and, hence, reflux in the same way.
Primary diseases of the oesophagus can also show with heartburn as a symptom. These include, among others, scleroderma types and sarcoidosis.
Risk factors
Specific foods can relax your LES or increase stomach acid:
- Citrus fruits
- Tomatoes
- Garlic and onions
- Coffee or caffeinated products
- Alcohol
- Foods high in fats and oils
- Chocolate
- Peppermint
You are also more likely to get heartburn if you:
- Eat right before bedtime
- Smoke, vape, or use tobacco products
- Wear tight-fitting clothing or belts
- Lie down or bend over after eating
- Are stressed out
- Are pregnant
- Take certain medications, including some antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Are constipated
Complications
Heartburn is not without complications. If neglected, oesophageal inflammation and recurrent inflammation can result in ulcers, which are small areas of tissue breakdown that can cause serious bleeding.
Scarring and stricture are other vital complications of GERD. Alterations in the type of cells lining the oesophagus may result from acid reflux, creating a condition called Barrett's oesophagus, which is related to an increased risk of oesophagal cancer.
Diagnosis
Your doctor needs your thorough history and physical to make the preliminary diagnosis of heartburn. To analyse if there is any damage & how severe your heartburn is, the doctor may recommend a few of the following tests:
Endoscopy: A flexible scope is passed down the oesophagus to analyse the oesophagus as well as the stomach. Biopsies can be taken if highlighted. This makes the doctor see if there is any apparent damage and also eliminates other reasons for the patient's symptoms (foreign body and malignancy).
Upper GI series: X-rays are taken after drinking a liquid that coats the inside of the digestive tract. These X-rays will display the outline of the digestive system.
Ambulatory pH testing: This test calculates the acidity in the oesophagus using a small tube that passes through the nose into the stomach.
Prevention
- Avoid eating before bedtime
- Avoid alcohol, aspirin, ibuprofen, and caffeine
- Eat smaller, more frequent meals
- Stop smoking
- Elevate the head of the bed (or use two or three pillows) to allow gravity to keep acid in the stomach & avoid acid reflux.
Summary
Frequent episodes of heartburn are pretty regular, and many individuals can efficiently address it by making small changes. However, if you experience persistent heartburn, seeking medical attention may be necessary.
Ignoring chronic heartburn can lead to potential harm. It indicates injury to the oesophagus, which can worsen over time. Additionally, chronic heartburn might be an indication of underlying issues that require treatment. It is suggested that you consult a healthcare professional regarding your chronic heartburn.
