Digestive Disorders > Symptoms

Heartburn: The Essential Guide to Symptoms, Causes, Treatments, & Home Remedies

Dr. Sarah Toler, CNM, DNP

Dr. Sarah Toler, CNM, DNP

Heartburn, also known as acid indigestion, is a burning pain behind the breastbone usually caused by acid refluxing back from the stomach into the esophagus. There are many causes and triggers for heartburn. It is often triggered by alcohol, nicotine, some medications, stress, certain sleep positions, and sweet, fatty, or acidic foods. It may also be exacerbated when a person is obese.

Even though occasional heartburn is harmless, consulting a doctor is recommended, if it persists over a period of time or is recurring. Heartburn could be caused by other, more serious stomach conditions like lesions of the stomach and esophagus inner lining (mucosa). Long-term acid reflux that goes untreated can lead to respiratory problems.

What is heartburn? What are the symptoms of heartburn?

Heartburn describes a painful and burning sensation in the chest, mostly located behind the breastbone, throat, and upper middle of the abdomen. It is usually caused by acid reflux. This is when the ring-shaped muscle called the lower esophageal sphincter (LES), located at the junction between the stomach and esophagus doesn’t tighten as it should. Acid and stomach contents back up from the stomach, through the esophagus into the throat, and sometimes the mouth. People often report that the pain rises from the stomach and can go up to the throat. The pain can be sharp, burning, or be felt as a tightening sensation.

Occasional heartburn is quite common and can occur after eating fat and sweet meals or while lying down. It is also a common symptom in pregnancy. If it occurs more frequently or over a longer period, a healthcare provider should be consulted.

Heartburn vs. acid reflux vs. GERD

Heartburn: Heartburn is a symptom of both acid reflux and gastroesophageal reflux disease (GERD). Other conditions like functional heartburn, gastritis, or esophagitis can also cause heartburn.

Acid reflux: Acid reflux is a common condition that can range from mild to serious, while GERD is a more serious manifestation of acid reflux. Not all acid reflux episodes provoke heartburn.

GERD: Long-term, chronic heartburn can be due to GERD, but GERD is also possible without experiencing heartburn.

What are other symptoms that accompany heartburn?

Heartburn is a symptom of acid reflux. It can also be accompanied by following symptoms:

  • A metallic, bitter or sour taste in the mouth or in the throat
  • Acid regurgitations
  • Bad breath
  • Feeling full
  • Stomach pain
  • Nausea / vomiting
  • Difficulty swallowing or pain when swallowing
  • Cough and hoarseness
  • Wearing of tooth enamel
  • Breathing difficulties

What causes heartburn?

Heartburn is usually caused by the rise of stomach acid in the esophagus. The esophagus is separated from the stomach by a circular muscle called the lower esophageal sphincter or LES. 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 doesn’t tighten properly or if the pressure in the stomach is too high, stomach acid can return into the lower part of the esophagus. There are several reasons for what’s called incompetence of the lower esophageal sphincter.

The following causes can promote acid production, acid reflux, and heartburn:

  • Increased pressure in the abdominal area can be caused by pregnancy, weight, or tight clothing
  • Physical activity, especially when training abdominal muscles
  • A flat sleeping position on the back or abdomen
  • Some medications like painkillers, medicines for heart diseases, psychopharmaceuticals, or antibiotics
  • Nicotine and alcohol reduce the muscle tone of the sphincter and can promote heartburn
  • Late-night snacking or eating near bedtime
  • Foods that often include highly sweetened, fatty, or acidic products, like tomatoes
  • Stress
  • Asthma flare-ups can cause the lower esophageal sphincter to relax
  • In hiatal hernia, parts of the stomach slide into the chest because of a widened opening in the muscle separating chest and diaphragm
  • Stomach or esophageal inflammation, called eosinophilic esophagitis, causes accumulation of a certain type of white blood cells
  • Distension of the esophagus; can be caused by eating a large meal
  • Motility disorders, describing disturbed movement and pressure in the digestive tract
  • _Functional heartburn _is a condition which can be diagnosed if no signs of reflux are found during a pH measurement and gastroscopy and if other conditions causing heartburn have been ruled out, and the exact cause remains unclear. In this case, it is assumed that the affected person's esophageal mucosa is more sensitive and thus reacts faster with pain to various stimuli.
  • Many babies and infants have an immature sphincter and can therefore suffer from reflux in the first year of life. They often spit out or regurgitate milk.

How is heartburn diagnosed?

Since many people experience heartburn and the symptoms associated with heartburn are usually typical, it’s not uncommon for a person with heartburn to try heartburn treatment without undergoing a thorough examination. If this can alleviate the symptoms and the heartburn eventually returns after stopping the therapy, one can assume a reflux disease.

However, if the symptoms do not change, if they worsen, or if the heartburn has been around for a long time, it is recommended to undergo a esophagogastroduodenoscopy or EGD, also known as gastroscopy. The pH, which describes how acidic or alkaline a liquid is, is measured with a small monitoring device placed onto the esophageal wall during a gastroscopy. An x-ray will be performed to examine the shape and location of the stomach and esophagus. Movement and pressure of the esophagus can be checked with esophageal motility testing.

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What drugs are used to treat heartburn?

Lifestyle measures, like reducing weight or smoking cessation can sometimes prevent and reduce heartburn.

When heartburn is due to acid reflux, drugs can also be used to neutralize stomach acid or reduce the production and secretion of it.

  • Proton-pump inhibitors (PPIs), like omeprazole, pantoprazole, and esomeprazole, are used to reduce gastric acid secretion to a minimum.
  • H2-receptor blockers or histamine-2 receptor antagonists such as ranitidine or cimetidine can alternately be used to reduce gastric acid production.
  • Antacids aim to neutralize stomach acid, but don’t lead to heal the damaged tissue.

Medication should initially only be used for a short time. The ideal goal is to aim for long-term improvement through lifestyle changes. In cases of hiatal hernia, this can be corrected surgically to reduce the frequency of heartburn.

In 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, a type of laparoscopic surgery, so that no large scars remain.

If the lower esophageal sphincter is not strong enough, a device called a LINX device can be wrapped around to strengthen it.

Which home remedies can help heartburn?

Some cases of heartburn may require complicated solutions, but others may have simple fixes. The following tips and trips have been studied and determined to be effective at reducing heartburn:

  • Reducing weight in order to reduce pressure on the stomach
  • Avoiding late-night snacks or meals before going to bed
  • Elevating the head of bed or using a pillow to raise the head, as muscular tone is reduced at night and a flat position facilitates stomach acid to reflux
  • Avoiding alcohol and smoking cessation
  • Medication mentioned above to reduce gastric acid

It is unclear if reducing caffeine consumption has an impact on heartburn or not.

Plenty of home remedies are not backed by scientific evidence but still used by many people with reported success. These include:

  • Drinking water (not sparkling) or tea to dilute the stomach acid. Chamomile ribwort, kummel, anis, fennel, and melissa are recommended. Peppermint tea is not recommended as it might lower the esophageal sphincter tone and promote reflux.
  • Drinking a glass of milk in order to neutralize the gastric acid. This is controversial as some researchers have reported that heartburn might be worsen by milk products because of their acidic pH.
  • Eating a piece of white bread
  • Mustard to stimulate digestion and soothe the mucosal irritation
  • Chewing gum to stimulate saliva production and to bind acid in the esophagus
  • A spoonful of baking soda to neutralize the gastric acid – be careful as too much baking soda can induce abdominal gas formation, and an overdose can also lead to metabolic alkalosis, which might be life-threatening

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 inner lining, called gastritis, inflammation of the esophagus,called esophagitis), as well as sores in the stomach and small intestine wall, called ulcers. If stomach pain occurs over a long period of time, a gastroenterologist should be consulted and a gastroscopy performed if necessary.

Several conditions, like changes in the stomach inner lining, can lead to an increased gastric acid formation. One of the reasons is gastritis caused by colonization with a bacteria called Helicobacter pylori or H. pylori. If these bacteria are detected during gastroscopy or through a specific breath test, they can be removed with special antibiotic therapy.

Medication like aspirin or ibuprofen can irritate the stomach, reduce protection mechanisms, and increase the gastric acid secretion, which may lead to ulcers and bleeding in the digestive tract.

What are the risks of heartburn?

The tissue of the stomach is very well adapted to the stomach’s gastric acid and presents different protective mechanisms that the body’s other tissues. Its surface is protected by a layer of mucus. If the protective mechanisms are defective, stomach lesions can result. The esophageal mucosa is less well adapted to the acidic pH. Therefore, when gastric acid backs up into the esophagus, this can lead to injuries and inflammation of the esophageal mucosa.

The result can be either sores in the mucosa called ulcers or a narrowing of the esophagus called esophageal stricture. If the acid reflux persists over a longer period, the esophageal tissue tries to adapt to the new state and the normal esophagus cells change into another type of cells. This is called Barrett's esophagus and is a precancerous condition. In one to five people, Barrett's esophagus may evolve into esophageal adenocarcinoma, a type of esophagus 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. This is referred to as Mendelson syndrome, a type of aspiration pneumonia. Asthma and respiratory difficulties can also be encountered as well as a chronic throat irritation, leading to cough, and hoarseness.. The acid can also lead to tooth damage in some cases.

Is there a link between heartburn and irritable bowel syndrome?

People who have irritable bowel syndrome (IBS) might also experience upper gastrointestinal symptoms like belching, a feeling of fullness after eating, choking up food, regurgitation, and heartburn. Symptoms of conditions like functional heartburn, functional dyspepsia, or gastroesophageal reflux disease (GERD) might overlap. A changed pain perception as well as anxiety might be common factors. In addition, acid reflux can be triggered if constipation increases the pressure in the abdomen. However, no link has been found between irritable bowel syndrome and esophageal mucosal lesions due to acid, or erosive esophagitis.

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Dr. Sarah Toler, CNM, DNP

Dr. Sarah Toler, CNM, DNP

Sarah Toler is a Certified Nurse Midwife, Doctor of Nursing Practice, and science writer. She focuses on improving women's health and access to health care by working with digital health platforms. Her area of expertise is mental health, particularly the physical manifestations of stress and anxiety.

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