Heartburn: Causes, symptoms, and treatments

Heartburn is a symptom of acid reflux. It creates a burning pain in the lower chest.

Acid reflux is a condition where some of the stomach contents travel back up into the esophagus or food pipe.

Persistent acid reflux that happens more than twice per week is what experts call gastroesophageal reflux disease (GERD).

A person will feel heartburn when stomach acid flows back up into the esophagus, the pipe that carries food from the mouth to the stomach. Heartburn is a symptom of GERD.

The American College of Gastroenterology estimate that more than 15 million people in the United States experience heartburn symptoms every day.

In this article, we discuss heartburn, including its causes, symptoms, and treatment.

It is common for people to experience occasional heartburn, and it is rarely a significant cause for concern.

However, a doctor may diagnose recurrent acid reflux as GERD. This condition can have a serious impact on health, and it can indicate other underlying health issues.

People of all ages may develop GERD. Some of the most common causes include obesity and smoking.

The most frequent symptom of acid reflux or heartburn is a feeling of warmth, heat, or burning in the chest and throat. This is due to the stomach acid flowing back up into the esophagus.

Other symptoms include:

• a burning sensation in the middle of the chest
• a burning, indigestion-like pain
• a foul, acrid taste in the mouth

If a person experiences acid reflux symptoms often, they should consult a doctor, who may refer them to a gastroenterologist — a specialist in gut medicine — for further investigation.

Using some lifestyle and behavioral tips can help prevent or reduce heartburn. Suggestions include:

• following a healthy diet, with a limited fat intake
• avoiding eating 2–3 hours before bedtime
• elevating the head of the bed before lying down
• avoiding wearing tight-fitting clothes
• avoiding heavy lifting and straining
• avoiding food triggers, such as alcohol, caffeine, spicy food, acidic foods, or foods causing gas and bloating
• reaching or maintaining a moderate weight
• quitting smoking, if applicable
• exercising regularly
• eating smaller meals more frequently

It is of note, however, that these lifestyle modifications may not work for everyone.

According to the Office on Women’s Health (OWH), heartburn and indigestion are common in pregnancy due to hormonal changes and the baby pressing against the stomach.

The OWH suggest some diet and lifestyle changes that may help relieve the symptoms. These include:

• eating five to six small meals throughout the day
• not lying down within an hour of eating
• avoiding fatty and spicy foods

A heart attack is when the arteries connected to the heart become blocked. Heartburn, on the other hand, occurs when stomach acid travels back up the esophagus.

Some symptoms of heartburn and a heart attack could be similar, such as chest pain. As a result, some people who are having a heart attack do not take action as they think they have heartburn.

If a person experiences heartburn pain alongside shortness of breath or sweating, this could be a heart-related issue.

Other symptoms of a heart attack can include:

• discomfort in the chest, such as squeezing, fullness, pressure, or pain
• nausea
• lightheadedness
• pain or discomfort in one or both arms, stomach, neck, jaw, or back

If a person has some or all of these symptoms, they should seek emergency medical attention. In the words of the American Heart Association (AHA), “If in doubt, check it out.”

Knowing how to distinguish a heart attack from heartburn can save lives.

Learn more about the differences between heartburn and a heart attack here.

A person may alleviate symptoms of heartburn by using drugs such as:

• antacids, which are over-the-counter (OTC) medications that help relieve mild heartburn
• proton pump inhibitors (PPIs), which reduce the amount of stomach acid
• h3 blockers, which are a type of medication that reduces the stomach acid levels and may help heal the esophageal lining

It is important to note that PPIs heal the esophageal lining and treat GERD symptoms more effectively than h3 blockers.

Additionally, h3 blockers can produce various side effects, such as diarrhea, constipation, upset stomach, and headaches.

In 2020, the Food and Drug Administration (FDA) requested that manufacturers remove all forms of prescription and OTC ranitidine (Zantac), an h3 blocker, from the market because of its unacceptable levels of N-Nitrosodimethylamine, a probable carcinogen.

Changes to lifestyle and behavior can prevent or improve heartburn symptoms.

A person may prevent heartburn by avoiding acidic foods and drinks that contain caffeine.

Getting more exercise, reaching or maintaining a moderate weight, eating smaller meals, and sitting upright after eating may also help avert heartburn.

Many people experience heartburn occasionally. Usually, it is no cause for concern.

However, if a person has heartburn regularly, they should contact a healthcare professional, who may recommend dietary changes and regular exercise and make suggestions with regard to posture, among other things.

If lifestyle and behavioral changes do not prove effective, a doctor may recommend OTC medications, such as antacids or h3 blockers.

If a person is unsure whether they are experiencing symptoms of heartburn or a heart attack, they should seek immediate medical attention.

How to Tell the Difference

Heartburn and indigestion are common gastrointestinal (GI) problems that are often discussed interchangeably. While they may occasionally occur at the same time, these are considered separate GI issues.

So, if you’re experiencing an upset stomach, acid regurgitation, or a burning chest, how do you know whether you’re dealing with indigestion or heartburn?

Read on to learn the signs and causes of these GI issues, and how you can manage and prevent them.

You may be able to tell the difference between heartburn and indigestion based on the location of your symptoms.

While indigestion primarily affects the abdominal area, heartburn symptoms can be felt in the chest and esophageal areas. Keep in mind that it’s also possible to experience both indigestion and heartburn at the same time.

Here’s a breakdown of symptoms commonly associated with both heartburn and indigestion:

As they are different conditions, heartburn and indigestion can have very different causes. But there is some overlap.

Heartburn

Heartburn occurs when stomach acid backs up into your esophagus due to a weak or relaxed lower esophageal sphincter. It may also be a symptom of a chronic condition called gastroesophageal reflux disease (GERD).

Over time, GERD may damage the esophagus, leading to complications such as esophageal cancer or Barrett’s esophagus.

Risk factors for heartburn include:

• being overweight or obese
• pregnancy
• smoking or secondhand smoke exposure

In some cases, certain foods can trigger heartburn. These include:

• fatty foods
• alcohol
• coffee
• chocolate
• fried foods
• spices
• tomatoes
• onions
• garlic
• peppermint
• citrus fruits/juices

Indigestion (dyspepsia)

Some of the same food triggers for heartburn may bring on a case of indigestion, including caffeine, spicy or acidic foods, and alcohol. Indigestion may also be caused by eating large meals or eating too fast.

Indigestion could also be caused by underlying GI disorders, including:

• stomach cancer
• GERD
• irritable bowel syndrome (IBS)
• lactose intolerance
• gallbladder disease
• peptic ulcers
• gastritis
• bacterial infections, such as Helicobacter pylori
• gastroparesis

Anxiety and depression may also upset the stomach on a regular basis in some people, leading to indigestion issues. Research also suggests that indigestion may have a genetic component.

Both heartburn and indigestion may be treated with over-the-counter (OTC) products, such as:

• Antacids for mild, occasional heartburn symptoms. Antacids work by neutralizing stomach acid. They may be taken as soon as you experience symptoms, or before eating trigger foods to prevent them. Antacids aren’t meant to be taken every day, unless otherwise instructed by your doctor. Daily use can cause GI upset.
• Proton pump inhibitors (PPIs) for long-term treatment. PPIs work by decreasing the amount of acid in your stomach, allowing your esophagus to heal.
• Histamine-h3-receptor antagonists (h3 blockers). These are also designed to decrease stomach acid, but they aren’t as strong as PPIs.

Ask your doctor before taking any herbal remedies for GI issues, as you may unintentionally make your heartburn or indigestion worse.

Occasional heartburn or indigestion is largely preventable. Prevention methods are the same for both conditions.

Here are some of the ways you can help decrease a flare-up of heartburn and indigestion symptoms:

• Eat smaller, more frequent meals. Chew your food slowly to help aid digestion.
• Avoid your specific food triggers. If you’re not sure what foods trigger your symptoms, consider eliminating common culprits from your diet and slowly adding them back in. Examples include coffee, spices, onions, and acidic fruits.
• Eliminate fried, fatty foods from your diet. These foods are common triggers for heartburn and indigestion.
• Don’t eat within a few hours before bedtime. Also, avoid laying down or bending over after meals.
• Avoid drinking alcohol and smoking. This can help the lower esophageal sphincter to properly function.
• Consider raising the head of your bed. Experts recommend raising the upper part of your mattress by 6 to 8 inches. This may be accomplished via an adjustable mattress, or by adding a wedge underneath a traditional mattress.
• Lose weight, if your doctor recommends it. Excess body fat can place more pressure on your upper abdomen and esophageal sphincter, triggering both indigestion and heartburn, respectively.
• Avoid tight-fitting clothes. This can prevent pressure around the lower esophageal sphincter and the abdomen.

These preventive measures may also help alleviate symptoms of chronic heartburn or indigestion, but you’ll need to see your doctor to help treat the underlying causes to help prevent further complications.

If your symptoms of heartburn and/or indigestion don’t improve after a few weeks of home remedies and preventive measures, see your doctor.

Chronic heartburn or indigestion issues could be a sign of an underlying medical condition that needs treatment. To get to the root of chronic indigestion or heartburn issues, your doctor may order a few tests, including:

• a physical exam of your abdomen
• acid probe tests to measure when (and how much) stomach acid reaches back into your esophagus
• imaging tests, such as X-rays and endoscopies (especially if you’re over the age of 60), to look at your esophagus and stomach
• blood or stool tests to rule out bacterial infections that may be causing indigestion

Call your doctor if you experience any of the following symptoms that could indicate GI complications:

• pain in your abdomen that doesn’t go away
• frequent vomiting
• blood in vomit or stools
• tar-colored stools
• difficulty swallowing
• yellowing of the skin or eyes (jaundice)
• appetite loss
• unintentional weight loss

Seek emergency medical attention if heartburn or indigestion are accompanied by the following potential symptoms of a heart attack:

• pain or squeezing sensations in your chest that spread to your arms, back, neck, and jaw
• dizziness or lightheadedness
• sudden fatigue
• cold sweats
• shortness of breath
• nausea or vomiting

Both heartburn and indigestion have similar causes, and may be alleviated with similar lifestyle changes and OTC treatments.

It’s important, however, that you determine whether your symptoms are heartburn- or indigestion-related, so you can discuss them with your doctor.

If you find that you need antacids every day, or if your heartburn or indigestion symptoms last longer than a few weeks, you may need to see your doctor for further testing.

Treating an underlying GI issue can help alleviate your symptoms while also preventing further complications.

Heartburn – Hadassah Medical Moscow

Enroll

Heartburn is an unpleasant sensation, up to a burning pain in the upper abdomen. Many people experience discomfort regularly or occasionally, especially after overeating or drinking alcohol. If it happens from time to time, it does no harm. With frequent episodes, we are talking about the development of reflux disease. Heartburn occurs

when the contents of the stomach back up into the esophagus – this backflow is also known as reflux. Thus, heartburn is not an independent disease, but is a consequence.

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Symptoms of heartburn

Heartburn is not a disease, but a manifestation of reflux. Discomfort in the chest and neck is aggravated by leaning forward, physical activity and eating. Patients complain of the presence of sour belching and an unpleasant aftertaste in the oral cavity. Additional symptoms depend on the severity of the reflux disease. Thus, the patient may experience a violation of food intake and a manifestation of indigestion. Sometimes there is no discomfort at all.

Additional symptoms of heartburn that indicate the presence of reflux disease:

• increased salivation;
• nausea and bitterness in the mouth;
• discomfort when swallowing food;
• occurrence of bad breath;
• lump in throat and characteristic burning;
• chronic cough and hoarseness;
• sleep problems;
• poor appetite.

In the chronic form of the disease, there are violations of the respiratory system. Inflammation of the lungs may develop, which occurs due to the reflux of gastric juice into the respiratory tract. Bronchial asthma can be complicated by frequent attacks.

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Causes of heartburn

Heartburn can have several causes. In most cases, they remain unclear. Most often, heartburn develops against the background of an unhealthy lifestyle and diet, which overload the stomach. For example, stress can literally hit the stomach and cause heartburn because it stimulates stomach acid production, delays emptying, and promotes reflux.

Other factors that can cause heartburn include:

• excessive body weight;
• alcohol abuse;
• smoking;
• inclusion in the diet of fatty and fried foods;
• eating hot spices such as garlic, mustard or horseradish;
• meal before going to bed.

Medicines are also among the causes of heartburn. They can both cause heartburn and increase existing discomfort. For some medications, reflux is a possible side effect. Painkillers from the group of so-called non-steroidal anti-inflammatory drugs cause heartburn especially often. Therefore, those who are prone to heartburn should prophylactically take a gastric protector during drug therapy.

In addition, there are some diseases that sometimes cause heartburn, for example:

• functional dyspepsia;
• diaphragmatic hernia;
• gastritis and gastric ulcer;
• stenosis and achalasia of the esophagus.

Delayed gastric emptying can also lead to heartburn and reflux. Usually, solid food stays in the stomach for 1 to 5 hours. Liquids are absorbed much faster – with an empty stomach, they enter the small intestine in an average of 10-20 minutes.

Methods for diagnosing heartburn

If you experience such a symptom as heartburn, you should make an appointment with a gastroenterologist. The doctor will take a history of the disease and conduct an initial examination. Comprehensive diagnostics for heartburn allows you to obtain accurate information about the state of the gastrointestinal tract (gastrointestinal tract) of the patient. To determine the cause of heartburn, the specialist will prescribe the following tests:

Esophagogastroduodenoscopy

examination of the mucous membrane of the esophagus, duodenum and esophagus

X-ray of the esophagus

Diaphragmatic herniation and complications of reflux disease

Electromyography

Examination of the muscles of the esophagus

Treatments for heartburn

Medication is given to reduce stomach acid, relieve symptoms, and address the cause of heartburn. In addition to drugs, the gastroenterologist prescribes a diet that allows you to normalize the activity of the intestines and stomach.

Medicines used to treat heartburn:

• Antacids. Neutralize acid, relieve discomfort and pain from heartburn.
• Proton pump inhibitors and H2-histamine receptor blockers. They inhibit the production of hydrochloric acid and improve the condition.

Medication for heartburn can last from 2-3 weeks to 6 months. Each stage of therapy is additionally controlled by a doctor to adjust dosages and eliminate the likelihood of complications.

Surgical intervention for heartburn is necessary only when another pathology was identified during the diagnosis, leading to dysfunction of the digestive tract.

Prevention and treatment programs for heartburn at the Hadassah Clinic

As a preventive measure for heartburn, standard medical recommendations are used to prevent the reflux of gastric contents into the esophagus:

• lose extra pounds;
• avoid spicy, salty and fatty foods;
• give up alcohol and cigarettes;
• do not eat 2-3 hours before bedtime.

The Hadassah clinic in Moscow performs two types of operations to eliminate the cause of heartburn:

• Radiofrequency ablation of the esophagus – normalization of the functions of the esophageal sphincter.
• Endoscopic application – prevents the backflow of acid into the esophagus.

#EgorovaON

Egorova
Olga Nikolaevna

Gastroenterologist

Work experience: 17 years

Published: 06/16/2023

The information provided on the site is for reference only and cannot serve as a basis for making a diagnosis or prescribing treatment. Internal consultation of the expert is necessary.

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Heartburn – the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Heartburn is a feeling of burning, heaviness or pain behind the sternum. This condition significantly impairs the quality of life, reduces performance, disturbs sleep.

What diseases cause heartburn?

Heartburn can have a variety of causes that need to be identified in order to be diagnosed and treated.

Gastroesophageal reflux disease

This disease is accompanied by reflux (reflux) of the contents of the stomach into the esophagus, the walls of which are more sensitive to acidic irritants than the gastric mucosa.

Gastroesophageal reflux disease is quite common in the adult population and, if left untreated, can lead to persistent narrowing of the esophagus, bleeding, and ulcers.

The basis of the development of the disease is a violation of motility, or dyskinesia of the gastrointestinal tract. First of all, this is a dysfunction of the lower esophageal sphincter and a violation of the peristalsis of the esophagus. Periodic uncontrolled relaxation of the lower esophageal sphincter leads to the entry of stomach contents into the esophagus, which can be exacerbated by esophageal hernia, which increases the frequency of reflux.

Hiatal hernia also causes heartburn. In this case, it may be accompanied by belching, reflux of the contents of the stomach into the oral cavity. Pain that occurs in the lower part of the sternum may radiate to the back, to the left shoulder and left arm, as with angina pectoris. Pain or burning sensation often occurs when lying down, when bending forward, after eating, i.e. when intra-abdominal pressure rises.

Peptic ulcer of the stomach. Heartburn in gastric ulcer may occur due to increased production of hydrochloric acid in the stomach and its reflux into the esophagus, especially at night. This condition is called a nocturnal acid breakthrough, and it seriously aggravates the condition, causing pain and burning in the chest and disturbing sleep.

Cancer of the cardia of the stomach.

In this disease, heartburn may be the dominant symptom.

First, there is a burning sensation and “scratching” when food passes through the esophagus. Then there is difficulty in swallowing, pain behind the sternum, often radiating to the region of the heart.

Hypersensitive esophagus.

Heartburn can be a symptom of hypersensitivity of the lining of the esophagus.

This individual feature can be explained by an increased perception of pain by the esophageal receptors, a violation of the integrity and increased permeability of the mucous membrane, a violation of the perception and processing of incoming signals in the central nervous system.

Functional heartburn. This concept has appeared relatively recently and refers to heartburn, which excludes gastroesophageal reflux disease, structural and motor disorders of the esophagus. The mechanisms for the development of such heartburn are not yet clear and can be explained both by the increased sensitivity of the esophagus and by the characteristics of the nervous system. At the same time, there is no connection between heartburn and diseases of the esophagus and motility of the gastrointestinal tract.

Other possible causes

Functional dyspepsia

Under functional dyspepsia, conditions are combined that are caused by a temporary disruption of the activity of the stomach, duodenum and pancreas.

The causes of the disease are violations of gastric secretion, motility of the gastrointestinal tract, increased sensitivity of the mucous membrane. Complaints of patients with dyspepsia include: pain or discomfort in the epigastric region, heaviness, a feeling of fullness after taking the usual amount of food, bloating, diarrhea, nausea, vomiting, belching, heartburn. Various toxic infections can also provoke functional dyspepsia. An important role in the occurrence of the disease belongs to psychosomatic disorders. Patients with functional dyspepsia are often characterized by anxiety. Given that the symptoms of the disease may disappear after taking antacids, doctors often note the leading role of the acid factor, which triggers the pathological process. When examining such patients, it is often not possible to detect organic diseases (ulcers, tumors or pancreatitis).

Taking medications. This is a fairly common cause of heartburn. In this case, such a symptom is caused by drugs that reduce the tone of the lower esophageal sphincter: non-steroidal anti-inflammatory drugs, glucocorticosteroids, calcium antagonists, beta-blockers, anticholinergics, theophylline, progesterone, antidepressants, nitrates, doxycycline, quinidine.

Conditions accompanied by increased intra-abdominal pressure. These conditions include pregnancy, enlarged liver, spleen, chronic obstructive pulmonary disease. The result is a change in the position of the stomach and easier entry of its contents into the esophagus.

Which doctors should I contact?

Heartburn can be a sign of a serious illness, so self-medication with prolonged and repeated manifestations of it is unacceptable.

If heartburn occurs at least twice a week, it is imperative to visit
therapist or
gastroenterologist to get a referral for examination of the gastrointestinal tract. If a concomitant anxiety-depressive state is detected, a psychoneurologist’s consultation is necessary.

Diagnostics and examinations

As a rule, upon presentation of complaints of heartburn observed for at least three months, the gastroenterologist interviews the patient about the time, frequency, provoking factors of heartburn. First of all, as with other diseases, the doctor prescribes a general blood test and a biochemical blood test.

If a disease of the esophagus is suspected, an endoscopic examination is prescribed to identify a possible hernia, neoplasm, and assess the condition of the mucous membrane.

You can also diagnose a narrowing (stricture) or expansion of the esophagus using x-ray, which allows you to see a violation of the passage of barium suspension into the stomach and expansion of the esophagus.

To rule out infection with Helicobacter pylori, a C-urease breath test is prescribed.

If the mucous membrane of the esophagus is unchanged and there is no hernia of the esophagus, the doctor may prescribe daily monitoring of the pH of the esophagus. Ultrasound will help to exclude tumors and diseases of the liver, gallbladder and pancreas.

To assess the contractile activity of the esophagus and the coordination of the work of its sphincters, esophageal manometry is performed.

Treatment

Heartburn is only a symptom of pathologies of the gastrointestinal tract, so its effective elimination is possible only in the treatment of the underlying disease.

If heartburn is caused by a stomach ulcer, gastroesophageal disease, a doctor may prescribe treatment with antacids, proton pump inhibitors or H2 blockers, prokinetics. The treatment regimen is determined only by the doctor.

Patients should be aware that taking antisecretory drugs without a doctor’s prescription can greatly worsen the prognosis of the disease and lead to the ineffectiveness of subsequent treatment.

Often the need for surgical intervention is caused by the unsystematic use of antacids or antisecretory drugs. In addition, heartburn can be caused not only by hydrochloric acid, but also by bile, which has a strong irritating effect.

If the examination reveals Helicobacter pylori infection, antibiotic therapy should be given to prevent stomach cancer.

In anxiety-depressive conditions, a psychotherapist or neuropsychiatrist supplements treatment with tricyclic antidepressants, selective serotonin reuptake inhibitors, and neuroleptics.

With the ineffectiveness of drug treatment and complications in the form of esophagitis, impaired patency of the esophagus, deformities of the stomach, they resort to surgical intervention.

What should I do if I have symptoms?

First of all, it is desirable to switch to fractional nutrition, i.e., reduce the intervals between meals (no more than three hours) and reduce portions.

It is not recommended to eat very hot or cold dishes, food must be chewed thoroughly. Do not bend over or lie down immediately after eating. The last meal should be at least 3-4 hours before bedtime.

It is recommended to get rid of bad habits (smoking and drinking alcohol).

Since a significant role of neuropsychiatric disorders in the development of gastrointestinal diseases has been proven, the daily regimen should be stabilized, paying attention to health-improving physical activity.

The work of the gastrointestinal tract is closely related to daily biological rhythms, so it is very important to follow a diet.

Sources:

1. Clinical guidelines “Peptic ulcer of the stomach and/or duodenum” (children). Developed by: Union of Pediatricians of Russia, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Russian Association of Pediatric Surgeons, Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists. – 2021.
2. Clinical guidelines “Cancer of the stomach”.