Heartburn: Symptoms, Causes, Treatment

Heartburn is a bit of a misnomer. It actually doesn’t have anything to do with your heart at all! 

When it comes to heartburn, it’s all about digestion. If you experience heartburn on a regular basis, it can begin to affect your life in a negative way. 

Let’s talk about heartburn and what you can do about it.

What is heartburn?

Heartburn is incredibly common. In fact, it is one of the most common digestive symptoms presenting to general practitioners and gastroenterologists. 

It is even present in the younger population. Up to seven percent of school age children and up to eight percent of adolescents experience it.

Heartburn is a symptom of several conditions. Among these conditions are gastric acid reflux and gastroesophageal reflux disease (GERD). It involves a burning sensation in the chest. It is often worse after eating, in the evening, or when lying down or bending over.

Heartburn develops when the reflux of stomach contents causes symptoms or complications. It is no cause for alarm. Most people can manage it themselves with simple lifestyle changes and over the counter medications.

However, if it impacts your everyday life, then this could be a sign of a more serious condition that you should see your doctor about.

What does heartburn feel like?

Heartburn feels like a burning pain. The location of the pain is in your chest, just behind your breastbone. It can last just a few minutes or even a few hours.

The pain may get worse when you lie down or bend over. You may also get a hot, sour, acidic, or salty taste in the back of your throat. You may also have difficulty with swallowing and a sore throat.

Symptoms

The main heartburn symptoms include a burning pain in the chest. It usually happens after eating. Nighttime heartburn is also common. The pain tends to worsen when lying down or bending over. 

Other reflux symptoms include a bitter or acidic taste in the mouth. You may also notice some regurgitation into the esophagus. You can also have a chronic cough.

Causes

Heartburn happens when stomach acid backs up into the esophagus.

When you swallow, the band of muscle around your lower esophageal sphincter relaxes. This is to allow food and drink to flow into your stomach. After that, the sphincter is supposed to tighten again. 

But if this sphincter weakens or doesn’t tighten properly, then stomach acid can flow back up into your esophagus. This is heartburn.

Because of the effect of gravity, it can be worse when you bend over or lie down.

If your heartburn is not due to acid reflux, this could be functional heartburn. If you take a proton pump inhibitor prescribed by your doctor and are still getting heartburn, this could be functional heartburn.

A potential cause of heartburn is pregnancy. This is a common complaint in pregnant people. In fact, the incidence among pregnant people is between 17 and 45 percent.

Another cause is a hiatal hernia. This is an anatomical abnormality that causes the stomach to bulge up into the chest.

Certain prescription medications can also contribute to heartburn. This is also true of non-prescription anti-inflammatory drugs and aspirin.

Lifestyle habits can contribute to it, too. It could be triggered by the foods you eat, the size of your meals, and how close to bedtime you are eating. 

One study found that patients who consumed spicy foods ten or more times per week were 2.63 times more likely to have heartburn than those who never consumed spicy foods.

The following are other foods and lifestyle factors that can contribute to heartburn:

  • Spicy foods

  • Onions

  • Citrus

  • Tomato products (such as ketchup)

  • Fatty foods

  • Fried foods

  • Peppermint

  • Chocolate

  • Alcohol

  • Carbonated beverages

  • Coffee and other caffeinated beverages

  • Large meals

  • High stress levels

  • Being overweight

  • Being a smoker

  • Wearing tight clothes and belts

When to see a doctor

First of all, it’s important to get immediate help if you have severe heartburn, severe chest pain, or pressure. This is particularly concerning if you also have pain in the arm or jaw or difficulty breathing. That’s because these may be symptoms of a heart attack.

You’ll want to see your doctor if you’re getting chronic heartburn or heartburn more than twice a week. If you have used over-the-counter medications and they haven’t helped, then this is a good time to see your doctor too.

In order to get an official diagnosis of functional heartburn, you’ll need to see your doctor. They will perform or refer you for upper endoscopy with biopsies of your esophagus. This is to rule out any anatomic and mucosal abnormalities. They may also perform high-resolution esophageal manometry and pH monitoring to rule out any major motor disorders.

If you have any of the following symptoms, these are what we call alarm features. You should make sure to see your doctor if you have heartburn along with any of the following symptoms:

  • Difficulty swallowing

  • Persistent nausea

  • Persistent vomiting

  • Weight loss from poor appetite or difficulty eating

  • New-onset heartburn if you’re over age 60

  • Gastrointestinal bleeding

  • Pain with swallowing

It’s important to see your doctor to rule out serious conditions and prevent any complications, such as developing gastroesophageal reflux disease (called GERD for short). GERD is heartburn that happens frequently and interferes with your routine.

Treatment for GERD may require prescription medicine or even surgery. GERD can cause serious damage to the esophagus. It can also create precancerous lesions in the esophagus. This is what we call Barrett’s esophagus. This increases your risk of developing esophageal cancer.

Treatment

Conventional medicine offers four main types of heartburn treatment: lifestyle modifications, pharmacological, endoscopic, and surgical therapy.

Pharmacological

Your doctor might prescribe baclofen. This is a muscle relaxant and antispasmodic.

Omeprazole is often used. It is what we call a proton pump inhibitor. Most patients respond well to four to eight weeks of proton pump inhibitor therapy.

Another heartburn medication is called a histamine H2 receptor antagonist.

Your doctor may prescribe desipramine. This is a neuromodulator medication. The purpose of desipramine is to reduce your stomach’s hypersensitivity.

You can also take over-the-counter medications for heartburn, such as antacids. Antacids work by reducing the amount of stomach acid. The same medications can also help to soothe stomach upset, indigestion, and general stomach pain. 

Some antacids also contain simethicone, which helps by reducing gas. If you use an antacid, be sure to follow the directions on the packaging. Or, better yet, speak to a health care provider about how to take antacids properly.

Surgery

If medications don’t help, your doctor may send you for antireflux surgery. This type of surgery is called laparoscopic Nissen fundoplication.

Herbal therapy

A herb called Amla (Phyllanthus emblica L.) can be helpful. One study found that subjects had significantly less frequent heartburn and regurgitation after treatment with amla. 

This study also found that the heartburn and regurgitation severity was lower in the group taking amla compared to placebo.

Traditional Chinese Medicine

A study found that heartburn patients treated with Traditional Chinese Medicine had more positive effects than those undergoing routine pharmacotherapy. Acupuncture is a type of Traditional Chinese Medicine that is often used.

Home remedies for heartburn relief

There are some food and lifestyle changes that you can make to treat your own heartburn at home. 

These include the following:

  • Raising the head of your bed

  • Reducing the intake of fatty foods

  • Eating smaller meals

  • Reducing the frequency of your meals

  • Mind-body techniques

  • Improving your sleep hygiene

  • Increasing your physical activity

Conclusion

Even though occasional heartburn is relatively common, that doesn’t mean you should have to put up with it. That burning feeling in the chest is certainly unpleasant. See your doctor if your GERD symptoms are starting to become regular and you want a proper diagnosis.

When it comes to treatment, your healthcare provider can help you determine what lifestyle modifications, medications, or home remedies may be right for you. Book an appointment with your health care provider and discuss your options.

Explore More

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Sources

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