Heartburn is a burning sensation felt in one’s throat or chest. It is a painful burning feeling behind the sternum (breastbone) in your esophagus and radiate to the throat. It is caused when stomach acid moves up into the esophagus. Esophagus (food pipe) is a part of digestive system which transports the food mixed with saliva from mouth to stomach. At the bottom of the esophagus (junction between esophagus and stomach), a band or ring of muscle called the lower esophageal sphincter (LES) is present. This muscles helps the food to enter the stomach and prevents the upward movement of food and stomach acid to esophagus by a gated movement. Stomach acids flow out to esophagus when the muscle gated movement is disturbed due to some reasons and this outward flow causes heartburn. It is also called as acid indigestion, pyrosis or cardialgia. Heartburn is a common discomfort seen in all age group people and it can be managed by a little medications, food habits and life style changes if it is occurring occasionally. But frequent heartburn may be a symptom of serious gastroenterological conditions. Heartburn causes discomfort on daily activities, sleep and quality of life.
Heartburns serve as a symptom of many gastroenterological diseases like Gastroesophageal reflux disease (GERD), Irritable bowel syndrome (IBS), dyspepsia, hiatal hernia and heart attacks. GERD is a major disorder caused by heartburn and regurgitation of gastric juices. IBS is a bowel disorder caused due to the changes in bowel habits. It causes frequent diarrhea and constipation. Dyspepsia is an epigastric pain caused in the upper abdomen with heartburn and regurgitation. Pregnancy, certain food items and alcohol also cause heartburn. Heartburn has a link with body weight. Overweight people suffer from continuous heartburn. Constant relief from heartburn is majorly obtained by a change in lifestyle and diet. Antacids, antihistamines and proton pump inhibitors (PPI) provide temporary relief to heartburn and subsidies the pain in the chest.
Causes of Heartburn
Some of the key causes of heartburn include:
Disfunction of lower esophageal sphincter muscles (LES) : LES is a band of muscles that pass food into the stomach from esophagus and prevent the outward flow of food and gastric acid to esophagus. These muscles do not work properly if you are overweight, if you lie down soon after eating, if you have hiatal hernia or if you are pregnant.
Excessive Intake of caffeine : Food containing caffeine consumed frequently can cause heartburn and aggravate its pain. Caffeine relaxes the LES muscles which cause the stomach acid to flow out into the esophagus.
Alcohol consumption and Smoking : Stomach acid production increases due to alcohol consumption. Alcohol and chemicals in cigarette also relax the LES muscles causing the reflux of stomach acids to esophagus.
Intake of certain Medicines : Certain medicines used for heart diseases, blood pressure regulation can cause heartburns (eg: Beta blockers, calcium channel blockers). Tricyclic antidepressants and insomnia tablets (tablet prescribed for sleeping problems) can also result in heartburns.
Unhealthy food habits and Obesity : Consumption of spicy, fried and fatty food in excess slow down digestion and causes indigestion. These foods stay in the stomach for a long time, causing pressure on LES muscles and weaken it. This causes the reflux of stomach acids. These types of food consumed daily leads to obesity, particularly abdominal obesity which result in exerting high pressure on LES muscles and causes GERD.
Pregnancy : Pregnancy causes lower esophageal sphincter muscle relaxation due to the presence of progesterone (female sex hormone). Heartburns worsen as pregnancy advances. Some controversial studies show that increase in intra-abdominal pressure due to uterus enlarging can weaken the LES muscles and causes reflux. Delayed bowel transit also causes heartburn.
Symptoms of heartburn
Some of the major symptoms of heartburn include:
Burning sensation in lower chest: The reflux of stomach acid to the esophagus causes burns in the inner lining of esophagus which lacks epithelial cells. The burning sensation starts from the upper abdomen behind sternum and radiates to the neck and throat.
Acid Regurgitation: Regurgitation is a sensation of acid flow into your throat. It can produce a sour taste in mouth. Severe regurgitation can cause chronic cough, dental erosion or idiopathic pulmonary fibrosis.
Possible Health Consequences on Heartburn
Frequent heartburn can have mild to severe side effects on body health. Some of the major health consequnces of heartburn include:
Functional heartburn is a gastrointestinal disorder. It is not related to gastroesophageal reflux. It is composed of several distinct subgroups. Functional heartburn is an episodic retrosternal burning sensation seen in nonerosive reflux disease. Pathophysiology of functional heartburn is still unknown and most of the painkillers recommended lack appropriate clinical trial. No esophagitis is noticed in endoscopy, which clearly reveals that reflux related symptoms are absent in functional heartburn. It is noticed that the response to antireflux treatments is very limited in functional heartburn disorder. It shows no improvement after treatment with proton pump inhibitors.
Esophagitis is a condition caused by prolonged heartburn and acid regurgitation. It causes irritation in the esophagus by damaging the inner lining of esophagus and causes bleeding and ulcer. Inner lining which is sensitive to acid is ruptured because of the reflux of stomach acid to esophagus.
Barrett’s esophagus is a condition caused by prolonged heartburn. It can progress to adenocarcinoma. The esophageal tissue lining is replaced by tissue similar to the intestinal lining. The squamous epithelial cell in esophagus is replaced by the goblet cells. Infection caused by bacterium the Helicobacter pylori may decrease the development of Barrett’s esophagus.
Esophageal cancer is a rare cancer develops in esophagus. It is of two types – squamous cell carcinoma and adenocarcinoma. Barrett’s esophagus condition increases the risk of development of adenocarcinoma. It starts developing in the inner lining of esophagus and spread outwards to other tissues. Squamous cell carcinoma is found in squamous cells that lining the esophagus. Adenocarcinoma develops in glandular cell lining of the lower part of esophagus. The major symptoms of esophagus cancer are
- Weight loss
- Severe heartburn and acid regurgitation
- Pain behind the sternum
- Difficulty in swallowing
- Hoarseness and cough
Pathogenesis remains unclear for esophageal cancer. Smoking or gastroesophageal reflux is found as the major causative factor for development of cancer. These factors cause esophagitis and increased cell turnover that initiates the tumor growth. The tobacco carcinogens particularly nitrosamines react with esophageal mucosa. Controlling smoking habit can prevent esophagus cancer.
Dyspepsia is a gastroesophageal disorder causes pain and discomfort in the upper abdomen. The disorder is classified into subgroups based on the symptoms. They are ulcer-like dyspepsia, dysmotility-like dyspepsia and reflux-like dyspepsia. Reflux-like dyspepsia shows symptoms of severe heartburn and acid regurgitation.
Treatment and Prevention of Heartburn
Heartburn is not difficult to prevent at all it just requires to be disciplined.
Changing the food habits and life style can produce drastic changes in the discomfort caused by heartburns, GERD, esophagitis. There are eight major lifestyle factors that can cause heartburn and should be changed for better daily life. They are
- Inadequate sleep
- Habit of smoking
- Habit of quick eating
- Habit of midnight snack
- Dinner just before bedtime
- Habit of alcohol consumption
- Frequent lack of breakfast
- Lack of habitual physical exercise
From studies conducted, it was identified that good quality of sleep, orderly eating habits and control of body weight is important for avoiding heartburn and GERD. Inadequate sleep is a major factor for GERD. Irregular food habits persists the symptom of heartburns even if you use digestive drugs like Proton Pump inhibitor (PPI) or Histamine H2-receptor antagonist (H2RA).
Certain foods like citrus juices, carbonated beverages, coffee and caffeine, chocolate, spicy food and late evening meals are identified as esophageal irritants. Avoiding these foods will help in decrease the discomfort of heartburn. Obesity is another major factor for heartburn. There are many studies conducted which prove that the body mass index variation has a causative effect in heartburn and other gastroesophageal disorders. In epidemiological studies, it was found that being obese and overweight were associated with GERD symptoms. It was also found that increased abdominal obesity was an independent factor for reflux symptoms among the white population. A lower carbohydrate and fat diet and high fiber diet reduce the reflux symptoms and reflux episodes. Caseation of smoking and alcohol consumption reduces the reflux episode in GERD patients. However the effective management of the eight lifestyle factors can reduce the symptoms of GERD and present a peaceful daily life.
The usages of antacids offer short term relief from heartburns and acid regurgitation. Antacids do not contribute in the healing of GERD symptoms. It only gives temporary remedies. Histamine H2 – receptor antagonists (H2RA) also provide temporary relief. The usage of prokinetic medications cures the delayed esophageal clearance in GERD patients. Proton pump inhibitors (PPI) are widely used treatment for GERD. PPIs block the gastric acid pump of the parietal cells in the stomach. It provides faster relief than prokinetics and H2RA.
In short heartburn is a major symptom of many gastroesophageal disorders. The acid regurgitation and heartburn occurs in all age groups of people. Many medications available offer only a short term relief from the symptoms. Modification in lifestyle can effectively control the reflux episodes. High fiber and low fat diet are the best remedy for the weight loss which reduces the reflux episodes. The effective modifications in one’s lifestyle prevent the progression of symptoms of heartburn to be aggressive and prevent one from dreadful diseases like esophageal cancer.