Why Do I Get Heartburn?

You are munching on your favorite food and suddenly feel a burning sensation in your chest. Or you are pregnant and craving for yummy food, but can't eat them. Because you start experiencing the chest wrenching and burning sensation. All this will make you question 'why do I have heartburn?' 

Almost everyone must have experienced heartburn at some point in time. Occasional heartburn is common and not anything that requires medical attention. It is a common complaint in pregnant women. But frequent heartburn can be serious and it is better to consult a doctor. Because If it is not treated in a timely manner, it might turn into cancer. Also, there are chances that a heart attack might be misinterpreted as heartburn.

If you are in search of answers regarding your heartburn or acid indigestion, you are at the correct place. Let's delve deeper and see what causes heartburn and what treatment or prevention measures can be adopted.

What is heartburn? 

Heartburn is the burning sensation felt in the chest. The pain or sensation is felt just behind the breastbone. Let us explain the human body anatomy in simple words that can give you an idea about this condition. When we eat food, it passes through the food pipe or oesophagus into the stomach. There are sphincters (think of them as doors) at the stomach entrance which prevent the food and the stomach acids from going back up into the oesophagus. They are called lower oesophageal sphincters (LES). Once the food is in the stomach, the digestion and excretion process should happen. But, if the sphincters are weak, they might allow a little bit of the acid reflux back into the oesophagus. This acid in the oesophagus creates the burning sensation. There are various other conditions resulting from heartburn.

Gastroesophageal reflux disease (GERD): When there are frequent episodes of heartburn, it is termed as Gastroesophageal reflux disease. In this condition, frequent heartburn causes the oesophagal lining to get damaged by the stomach acids.

Barrett's oesophagus:¹ It is the change occurring in the oesophageal lining. There is not much research about the reasons for this change. But experts agree that GERD is related to Barrett's oesophagus. This condition is also associated with an increased risk for a rare type of oesophageal cancer.

According to the British Society of Gastroenterology, 

• Almost 10% of the population suffers from heartburn every week.
• Half a million people in the UK have Barrett's oesophagus. Many of them might not be aware that they actually have this condition.
• 1 out of 10 people with Barrett's oesophagus in the UK might develop oesophageal cancer.
• In the UK, oesophagal cancer is the seventh most common cause of cancer-related deaths.

Causes of heartburn 

There are several reasons for experiencing heartburn or acid indigestion. Let's discuss the causes.²

• Pregnancy: It is a common complaint during pregnancy. As the pregnancy progresses, the developing uterus puts pressure on the stomach and acid might reflux back to the food pipe or oesophagus. If it is bothering you too much, it is better to consult your General Practitioner (GP).
• Foods: There are certain food and beverages that can cause heartburn such as citrus fruits and juices, fatty foods, tomatoes, onions, alcohol, caffeine and carbonated drinks. 
• Overweight: The extra fat tissue in overweight people puts pressure on the stomach. This causes acid reflux and heartburn sensation.
• Smoking: Smoking increases acid production in the stomach. These might leak out and cause heartburn.
• Stress: Stress can also increase acid production in the stomach causing acid reflux.
• Clothing: Wearing tight clothes or belts might put pressure on the stomach and cause the sphincters to open leading to heartburn. 
• Hiatus hernia: In this, a part of the stomach moves into the chest. This can cause acid reflux which is mostly seen in people above 50 years of age.
• Hormones: Sometimes, the reflux can be caused due to increased levels of some hormones such as progesterone and oestrogen.
• Medications: Some anti-inflammatory painkillers such as ibuprofen can lead to acid reflux and heartburn.

Signs and symptoms of heartburn 

Below are the symptoms of heartburn according to Cleveland clinic.²

• Burning sensation in the chest behind the breastbone
• Chest pain while lying down
• Burning or acidic feeling in the throat
• Difficulty in swallowing the food
• Bad breath
• Cough or hiccups

Management and treatment for heartburn 

Heartburn or acid indigestion symptoms mostly get worse after eating or lying down. Getting heartburn once in a while is normal and nothing to worry about. But if it happens frequently, some dietary and lifestyle changes are needed.² Even after these lifestyle changes,if the symptoms don't go away, then it will be better to get medical attention.

• Meal: Try eating smaller portions of food at a time. Give time to your stomach to digest it. And then have another meal after some time.
• Weight: Obesity leads to acid reflux as the weight puts pressure on the stomach. So, losing weight is a good way to reduce heartburn.
• Bedtime: Avoid going to bed with a full stomach. So, eat your dinner at least an hour before bedtime.
• Clothing : Avoid wearing tight-fitting clothes and belts as they put pressure on your stomach causing acid reflux. Fashion is not more important than health, so try wearing properly fitted clothes.
• Foods: Avoid spicy foods, and fatty foods as they are a big cause of heartburn. Try to keep a log of which food causes heartburn. Also, try to avoid acidic foods or drinks.
• Smoking and alcohol: Smoking and alcohol are not good for health, including heartburn symptoms. So it is a good idea to get rid of these habits.
• Sleeping position: Experts advise that sleeping on the left side is good to get rid of stomach acids from the oesophagus.
• Head position: Try to raise the head of your bed. This might ease the heartburn symptoms.
• Exercise: Exercise after at least 2 hours of meal consumption.
• Water: Adequate hydration is one of the best ways to keep heartburn symptoms away.
• Medications: Antacids and acid blockers are helpful to treat heartburn. These medications are mostly taken with food or just after eating. Antacids reduce the stomach acids, thus relieving the symptoms. Side effects might include diarrhea or stomach pain. But, antacids are a temporary solution. Acid blockers reduce the production of stomach acid and they can be availed by prescription. Your GP might prescribe you a proton pump inhibitor (PPI) to reduce the production of acids in your stomach. These medications need to be taken for at least 4-8 weeks depending on the symptoms.

FAQs

How common is heartburn?

Almost 10% of the UK population experiences heartburn every week. Occasional heartburn is common and not to worry about.

What does heartburn feel like?

Heartburn feels like a burning sensation in the chest, an acidic feeling in the throat, or even bad breath.

Can I prevent heartburn?

Yes, you can prevent heartburn. Dietary and lifestyle changes are often helpful in relieving heartburn symptoms. Adequate hydration, avoiding spicy food, losing extra weight, and wearing loose clothes are good to prevent heartburn.

When to see a doctor?

It is better to visit a doctor or healthcare provider if heartburn is frequent, symptoms persist even after the use of over-the-counter medications, weight loss due to inability to eat food, difficulty in swallowing, or nausea.³

Summary 

Heartburn or acid indigestion can cause gastroesophageal reflux and can even develop into oesophageal cancer. There are few medical conditions that might seem like just a heartburn, but they are more than that.⁴ 

As we have already discussed, gastroesophageal reflux is the feeling of persistent heartburn. The weakened sphincters let the acids back into the oesophagus. This constant presence of acids might lead to changes in the oesophageal lining. This causes Barrett's oesophagus which increases the risk of oesophageal cancer. 

Abdominal pain along with heartburn can be due to gastritis. Gastritis is the inflammation of the stomach lining. It can also occur due to the presence of the bacteria Helicobacter pylori. This bacteria is present in many people but it can cause severe indigestion symptoms in some individuals. A breath test or stool test might be used to confirm the presence of this bacteria.

GERD can also cause oesophagitis, which is inflammation of the oesophageal tissue. This causes heartburn and difficulty in swallowing food.

Nausea and vomiting might be related to GERD or oesophagitis. Too much vomiting might be a sign of a heart attack. So, monitor your symptoms closely as chest pain, back pain, or neck pain along with heartburn symptoms might be something serious. Always contact your GP if you feel unwell.