Before knowing what causes heartburn, it’s important to know what Heartburn is. Heartburn is best described as a painful and burning feeling in the chest portion of the body. It can sometimes extend to the throat.
What Causes Heartburn?
Heartburn is a condition caused due to gastric juices in the stomach. It occurs when the gastric fluid enters the esophagus, the tube-like organ which connects the mouth to the stomach. This is the same organ through which food enters the stomach from your mouth. The name ‘heartburn’ is very misleading as it has nothing to do with the heart at all. However, some symptoms are common to symptoms of a heart attack.
A heartburn can last up to an hour, but the effect goes away completely only after ten hours. If a heartburn occurs often i.e. more than twice a week it is called GERD (Gastroesophageal reflux disease). GERD is a digestive disorder, more severe than a heartburn and it occurs frequently due to a damage in the LES or lower esophageal sphincter. This is a muscle between the esophagus and the stomach and if it is weak, the stomach acid enters the food pipe causing a burning pain. A heartburn results in discomfort in the upper belly and in the area below the breastbone.
The reason a heartburn occurs is exactly like that of GERD. The LES (lower esophageal sphincter) is a valve like muscle which connects the stomach to the esophagus. It is located to the left of the body, slightly below the ribcage. Normally, When the LES is closed, it keeps the stomach acid in the stomach with the help of gravity. It opens to let food into the stomach and to sometimes burp and then closes again. But if the LES opens often or does not close correctly and tightly, it allows stomach acid to enter the esophagus, causing that horrible, burning sensation. Two things contribute to the LES not closing correctly. One is overeating, causing the stomach acid to overflow and the second is pressure on the stomach, causing the stomach to contract and push everything upwards. This can occur due to pregnancy, constipation, and obesity.
Foods that weaken the LES or increase the volume of stomach acid are: Tomatoes, Coffee, Chocolate, citric fruits, onion, garlic peppermint and alcohol. Food high on spice, oil and fats lead to heartburn and sometimes even medication can cause heartburn as a side effect. Stress and sleeplessness increases the volume of acid the stomach makes and can result in heartburn. In pregnant women, the hormone progesterone is produce to relax and stretch the stomach and uterus area and can result in relaxation of muscles and the LES, causing heartburn.
Heartburn is a common occurrence and does not cause a major issue. It occurs once a week at least for up to 25% of the people and it is very common in pregnant women, especially in the third trimester as the uterus becomes big and squeezes the stomach and the LES gets relaxed due to the hormone progesterone. Heartburn also occurs when very spicy and oily food is consumed as it increases the stomach acid. In India, which is the spice capital of the world, several people experience a mild heartburn after meals and is not harmful. But very frequent heartburn also known as GERD, might cause some serious issues like inflammation of the esophagus, continuous cough, laryngitis, problems swallowing and sometimes even esophageal cancer.
Treatment of Heartburn
Below are the natural and medical remedies for heartburn. Avoiding heartburn is ideal but in some cases, it cannot be helped:
There are several natural ways to get relief from the sensation of heartburn. It includes elevating the head during sleep time, losing weight and avoiding eating oily food during the night time. Eating less and eating often also gives relief from heartburn as the stomach never really becomes very full. Avoiding highly fatty and friend items, over intake of caffeine, spicy food and carbonated beverages lowers the risk of heartburn significantly. Avoiding suffocating the stomach region with tight clothes and refraining from smoking and drinking are some measures to avoid suffering from a heartburn.
If the heartburn gets too severe it is better to treat it with medicine. Over the counter drugs like Antacids, bismuth subsalicylate (BSS), PPIs, H2RAs are effective OTC drugs which can be used to successfully treat heartburn.
Do not consume any medicines without a doctor’s prescription.
Antacids give quick relief of heartburn when it is mild and infrequent, but the relief is temporary (about 30 minutes). Liquid syrup usually acts faster than the tablets which are chewable, but tablets provide the fastest symptom relief. Antacids might contain calcium and alginic acid, which createsa foam like protective barrier on the esophagus, which may decrease discomfort associated with intestinal gas.
Magnesium and aluminum containing antacids are also available but they can cause constipation when the dosage is high. Aluminum-containing antacids cause constipation at higher daily dosages. Calcium-carbonate and sodium-bicarbonate containing antacids might cause burping. Interaction between two drugs can be avoided by having antacid medicines before or after 2 hours. Also, the daily antacid dosage must be controlled. If antacids are often used, the doctor must replace it with an OTC drug like H2RA or PPI.
The Over the counter drugs H2RAs – cimetidine, famotidine, nizatidine and ranitidine, can be used for treating mild to moderate heartburn. Lower OTC dosages must be prescribed for mild symptoms, whereas the high dosage is given to for moderate symptoms. Relief is almost immediate and can last upto ten hours. These drugs must be consumed only when there is a heartburn. Having both an antacid and a H2RA results in immediate relief of heartburn and also for a larger duration. H2RAs side effects are rare but it might cause, dizziness, drowsiness, headache, and diarrhea. People who continue to have heartburn even after treatment might require a PPI or must consult the doctor immediately.
The PPI drugs are prescribed for people with frequent heartburn who might have GERD as they have the symptoms for more than two weeks. Omeprazole is currently the only available over the counter PPI, but there are other PPI drugs undergoing clinical trial. Relief from the symptoms takes 2 to 3 hours, and lasts up to 24 hours. PPIs must be consumed 30 to 60 minutes prior to eating every day, for 14 days continuously. PPIs are tolerated generally well and but have very rare side salts effects which are like the H2RA side effects. If the heartburn recurs the patient must be taken for further medical evaluation.
This is not an antacid, but might be given along with the above for treatment. Bismuth has a range of side effects. It might cause the tongue to turn black. BSS must be avoided in children as they might develop Reye’s syndrome if there is already a predisposition to it. In general, it must be used with caution.
While the above cure heartburn, medications which irritate the esophagus are Aspirin, chemotherapy, and potassium chloride. While this list is not exhaustive, it is an indication that treatment of headache and cancer might cause conditions like heartburn.
To summarize, Heartburn is a painful burning sensation in the chest area or throat. It occurs because the stomach acid enters the esophagus and food pipe either due to excess of it or due to the LES muscle valve not functioning properly. This can result in several complications if it occurs frequently such as weight loss, nutritional imbalance and in extreme cases esophageal cancer. It occurs frequently in pregnant women and can be avoided by not eating fatty, spicy, and oily foods and avoiding discomfort to the stomach area. Medications like Antacids, PPIs and H2RAs are also effective in curing heartburn.