Heartburn: Causes and Treatment

Heartburn is a burning sensation in the chest, just behind the breastbone, that occurs when stomach acid backs up into the oesophagus (the tube that carries food from your mouth to your stomach).

Contrary to popular belief, heartburn is not the same as acid reflux. It is a common symptom of acid reflux, which happens when the muscle at the end of your oesophagus does not close properly, allowing stomach acid to leak back up. This can cause irritation and inflammation in the oesophagus, leading to the sensation of heartburn.

How long does heartburn last?

Heartburn episodes can vary in duration. Heartburn can be initiated by specific food and beverage choices or by overindulging in meals. While it may spontaneously resolve within a few minutes, it can also persist for extended periods, sometimes necessitating the use of over-the-counter remedies.

Is it a cause for concern?

Intermittent heartburn is generally not a cause for concern. However, when it becomes severe and recurrent, it indicates frequent or persistent acid reflux, commonly known as GERD (Gastroesophageal Reflux Disease).

In individuals with GERD, stomach acid frequently ascends from the stomach into the oesophagus, resembling water rising from a clogged drain, triggering the sensation of heartburn. It is commonly accompanied by a burning sensation in the throat and a tart taste in the mouth.

If you experience heartburn frequently, it is advisable to seek medical evaluation for potential GERD, which can increase the risk of these complications:

Oesophageal inflammation and ulcers
Barrett’s oesophagus
Oesophageal cancer
Respiratory problems due to aspiration of stomach contents

What are the causes?

Heartburn is primarily caused by acid reflux, which occurs when stomach acid flows back up into the oesophagus. Several factors can contribute to this reflux:

Dietary triggers: Certain foods and beverages can relax the muscle that controls the opening between the oesophagus and the stomach, allowing acid to flow back up. Common triggers include spicy or fatty foods, citrus fruits, tomatoes, chocolate, caffeine, and alcohol.

Overeating: Eating large meals or lying down after a meal can increase the likelihood of acid reflux because it puts pressure on the lower oesophageal sphincter (LES), the muscle that normally keeps the stomach contents from flowing back up into the oesophagus.

Obesity: Excess weight, especially around the abdomen, can put pressure on the stomach and LES, increasing the risk of acid reflux and heartburn.

Pregnancy: Hormonal changes and the growing uterus can put pressure on the stomach, leading to acid reflux and heartburn, especially in the later stages of pregnancy.

Smoking: Smoking can weaken the LES and increase acid production in the stomach, making reflux more likely.

Certain medications: Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, and certain heart medications, can relax the LES or irritate the oesophagus, leading to heartburn as a side effect.

Lifestyle factors: Stress, lack of sleep, and certain activities that involve bending over or lying down after eating can also contribute to heartburn.

What are the symptoms of heartburn?

Common symptoms of heartburn include:

Burning sensation in the chest that originates just behind the breastbone
Difficulty swallowing
A sour, acidic flavour lingering in the back of your throat
Discomfort that intensifies when reclining or bending forward
Chronic cough

Note: The symptoms of a heart attack and heartburn can sometimes be similar and cause confusion. Seek medical attention if your symptoms are worsening despite taking medications.

How is heartburn diagnosed?

Heartburn is often diagnosed based on symptoms and medical history, although sometimes further tests may be required to confirm the diagnosis or rule out other conditions.

Upper GI endoscopy: The most commonly used initial test to check for signs of irritation, ulcers, or strictures. Special tools can be used during this procedure to take a tissue sample (biopsy) if needed.

Barium study: Barium enhances the visibility of the oesophagus in the X-ray, aiding in detecting issues like hiatal hernias, oesophageal ulcers, or oesophageal narrowing (strictures). When this test also includes an examination of the stomach and the initial part of the small intestine, it is referred to as an upper GI series.

pH monitoring: In some cases, your doctor may recommend pH monitoring to measure the amount of acid in your oesophagus over a 24-hour period. This test can help determine if acid reflux is the cause of your symptoms and how severe it is.

How is it treated or prevented?

Heartburn treatments aim to alleviate symptoms and prevent potential complications. Here are some common approaches to managing heartburn:

Medications

Over-the-counter antacids, such as calcium carbonate or magnesium hydroxide, can provide quick relief by neutralising stomach acid.
H2 blockers like ranitidine or famotidine reduce the production of stomach acid and can provide longer-lasting relief compared to antacids.
Proton Pump Inhibitors (PPIs) like omeprazole, esomeprazole, and lansoprazole work by blocking the production of stomach acid and are highly effective for treating frequent or severe heartburn. These are usually taken once a day before a meal.
Prokinetics such as metoclopramide, help improve the movement of food through the digestive tract and can be used to treat GERD in some cases.

Lifestyle changes

Identify and avoid trigger foods that can exacerbate heartburn symptoms, such as spicy or acidic foods, caffeinated beverages, chocolate, and fatty foods.
Eat smaller, more frequent meals rather than large and steer clear of substantial, hearty dinners close to bedtime.
Excess weight, especially around the abdomen, can increase pressure on the stomach and worsen heartburn. Maintaining a healthy weight by incorporating a balanced diet and regular physical activity can reduce symptoms.
Quit smoking and limit alcohol intake.
Sleeping with the head of the bed elevated can help prevent acid reflux at night.
Check your medications that could cause acid reflux. Discuss with your doctor.

Make an appointment at Pantai Hospitals

If you are experiencing persistent heartburn that affects your daily life, get in touch with us to book an appointment today for a consultation, or visit our team of Gastroenterologists at your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.