Heartburn is a burning pain behind the breastbone that is common with acid reflux from the stomach. This reflux is exacerbated by alcohol, nicotine and food that is too sweet, fatty or acidic. If acid reflux is not treated, changes in the esophageal tissue can occur. Other causes of heartburn can be eosinophilic esophagitis or functional heartburn. Many sufferers of irritable bowel syndrome and irritable stomach suffer from heartburn and similar symptoms at the same time. The following text explains the various causes and treatment options for heartburn.
What is heartburn?
Heartburn describes a burning pain behind the breastbone. People often report that the pain rises from the stomach and can go down to the throat. Occasionally, stomach contents may rise up into the mouth during heartburn. Heartburn can be normal after eating fat and sweet meals, and it is a common symptom in pregnancy. However, if it occurs more frequently and over a longer period, a doctor should be consulted.
Symptoms that can occur in connection with heartburn include cough, a metallic taste in the mouth, nausea, a feeling of fullness and stomach pain.
How is heartburn triggered?
In the vast majority of cases, heartburn is caused by the rise of aggressive stomach acid. The esophagus is usually separated from the stomach by a muscle ring called the esophageal sphincter. This muscle is responsible for ensuring that food can enter the stomach in portions through the esophagus, but does not flow back into the esophagus. If the muscle is not strong enough, stomach acid can get into the lower part of the esophagus. There are many reasons for this so-called sphincter insufficiency.
- Many newborns have an immature sphincter and can therefore suffer from reflux in the first year of life. They often spit out milk, for example
- Nicotine and alcohol reduce muscle pressure and can promote heartburn. Increased pressure in the abdomen can also lead to reflux. Among other things, this is the case with overweight, tight-fitting clothes or pregnancy
- Since heartburn symptoms depend on how much stomach acid rises into the esophagus, certain foods can increase heartburn by stimulating stomach acid production. These foods include highly sweetened, very fatty and very acidic products, such as tomatoes.
- The position of the stomach is changed in many patients with heartburn. With a hiatal hernia, the space in the diaphragm through which the esophagus leads into the stomach is widened so that parts of the stomach slide into the chest. This change in location can favor heartburn.
Are there any risks that can result from heartburn?
The tissue of the stomach is very well adapted to the stomach acid. Its surface is protected by a layer of mucus. However, if the stomach acid rises into the esophagus, it meets tissue that is less well adapted to the acidic pH. This can lead to injuries and inflammation of the esophageal mucosa. If the acid reflux persists over a longer period, the esophageal tissue tries to adapt to the new conditions. The first stage of such a change in surface tissue is called Barrett's esophagus. If acid reflux is not treated at this point, the altered cells can result in esophageal cancer.
Acid reflux can also have other complications. If, for example, some stomach acid accidentally gets into the airways while lying down, pneumonia can develop from this. This is referred to as so-called aspiration pneumonia. The rising acid can also lead to tooth damage or bad breath in some cases.
How is heartburn diagnosed?
Since many people suffer from heartburn and the symptoms can usually be described very characteristically, a therapy attempt is often made directly instead of with an expanded diagnosis. If this can alleviate the symptoms and the heartburn does not return after stopping the therapy, one can assume a reflux disease.
However, if the symptoms do not change or if the heartburn has been around for a long time, it is recommended to have a so-called esophagogastroduodenoscopy (EGD) performed. In this examination, often abbreviated as gastroscopy, a tube with a camera is inserted through the mouth (similar to a colonoscopy). The examining gastroenterologist can use this camera to examine the lining of the esophagus, stomach and duodenum. In addition, samples can be taken from the organs, which are later examined under the microscope. The examination can clarify how the symptoms come about and rule out that there have already been changes due to acid reflux.
During an EGD, a measuring probe can be placed in the esophagus, which measures the pH value at certain intervals over 24 to 48 hours and transmits it to a recorder by radio. The probe detaches from the esophageal tissue after approximately 48 hours and is easily excreted. Alternatively, the pH measurement can also be carried out using a probe cable that is placed over the nose into the esophagus and remains there for 24 hours.
How is heartburn treated and which home remedies help?
A lot of home remedies are said to have a heartburn-relieving effect. These include teas with chamomile and ribwort, which are said to have anti-inflammatory effects. In addition, drinking large amounts of liquid alone has a positive effect, since the stomach acid is somewhat diluted. In acute heartburn attacks, some people are helped with a piece of white bread or a sip of milk. Basically, too sweet, too fatty and too acidic foods should be avoided in the diet. Smoking and alcohol consumption should also be restricted, as nicotine and alcohol lead to burdening of the esophageal sphincter. In order to reduce the pressure on the stomach, weight reduction makes sense if you are overweight, and your belt should not sit too tight on your stomach. If the heartburn gets worse, especially at night, your can raise your pillow to help prevent stomach acid from flowing back.
What drugs are used to treat heartburn?
One of the cornerstones of heartburn therapy is the reduction of stomach acid. So-called proton pump inhibitors (e.g. omeprazole, pantoprazole, esomeprazole) are used in most cases today. They reduce gastric acid production to a minimum. Alternatively, histamine receptor blockers such as ranitidine or cimetidine can be used for this effect.
Science does not yet agree whether prolonged use of proton pump inhibitors changes the intestinal flora and thus favors the risk of bacterial overgrowth. For this reason, medication should initially only be used for a short time and long-term improvement through lifestyle and diet changes should be aimed for.
If there is a hiatal hernia, this can be corrected surgically and thus the heartburn frequency can be reduced. In so-called fundoplication, the stomach is pulled back into the abdominal cavity, and a cuff is placed around the end of the esophagus and attached to the diaphragm. This surgery can be performed using keyhole techniques, so that no large scars remain.
What else needs to be considered with heartburn?
Heartburn and acid reflux are often associated with other gastrointestinal disorders. This includes inflammation of the stomach (gastritis), as well as stomach and small intestine ulcers. If stomach pain occurs over a long period of time, a gastroenterologist should be consulted and a gastroscopy performed if necessary. In some cases gastritis is also caused by colonization with Helicobacter pylori bacteria. If these bacteria are detected during gastroscopy or through a specific breath test, they can be removed with special antibiotic therapy and the inflammation of the stomach lining can heal better.
Are there other reasons that can lead to heartburn?
One disease that has only recently been demonstrated more frequently during gastroscopy is eosinophilic esophagitis. This is an inflammation of the esophagus, in the mucous membrane of which many immune cells, the eosinophils, have accumulated. This type of cell is always particularly present when there is an allergy. Those affected do not necessarily have other allergy symptoms such as hay fever or asthma. However, it is important for the treatment to find out what the people affected are allergic to - in this case it is often a food allergy. Once the responsible allergen has been identified, it can be avoided and the esophagitis can heal. In some cases, additional medications such as corticosteroids like cortisone or prednisolone are used to reduce inflammation.
If no signs of reflux are found during a pH measurement and gastroscopy, it may be a case of functional heartburn for which there are no demonstrable causes. How this kind of heartburn develops is unclear so far. However, it is assumed that the affected person's esophageal mucosa is more sensitive and thus reacts faster with pain to various stimuli.
Is there a link between heartburn and inflammatory bowel disease?
Many people who have irritable bowel syndrome also have problems with heartburn. Symptoms that can also occur include regurgitation, a feeling of fullness and choking up food. Heartburn in irritable bowel patients can be caused by either acid reflux as well as functional heartburn. In the latter case, it is suspected that changed pain perception is a common factor. This hypersensitivity of the organs is also an important cause of irritable bowel syndrome. In addition, acid reflux can be triggered if constipation increases the pressure in the abdomen. However, no connection has been found between irritable bowel syndrome and acid injury to the esophagus (erosive esophagitis or reflux esophagitis).