Heartburn causes, treatment

Dr Maxwell Adeyemi

WHILE WE often put unpleasant feelings of heartburn down to a big meal or stress, there are actually several possible causes, with one in four adults regularly experiencing heartburn.

Heartburn is a burning sensation in the chest, which can travel up to the throat as acid reflux, sometimes leaving a sour taste in your mouth. It happens when the valve at the top of your stomach, called the lower oesophageal sphincter, isn’t working as it should to keep the acid within your stomach.

In pregnancy, it affects many women in their second and third trimesters. In this case, it can be caused by fluctuations in your progesterone and oestrogen levels and your baby pressing against your stomach. This is often what causes bloating too.

But, as women age, heartburn can be caused by several factors, including menopause and changes to your digestive system. It could be something you're eating, drinking, or doing that makes the symptoms worse, so it's best to find out what the cause of the heartburn symptoms is to try and stop it happening.

What causes heartburn

1. Food and drink

Everyone’s digestive system is different but some foods and drinks can lead to heartburn after a meal. In fact, diet is what causes heartburn for most people – just in the same way that some foods cause bloating. Coffee, tomatoes, alcohol, chocolate and fatty or spicy foods can all lead to acid reflux.

Fatty foods stay in the stomach longer before digestion, increasing the chance of reflux. They also help release cholecystokinin, a hormone that causes the lower esophageal sphincter to relax, meaning acid is regurgitated.

Another hormone that causes this part of the digestive system to relax is serotonin, which can be triggered for release by certain foods like chocolate, which is why some people report heartburn after only eating a small amount.

2. Excessive weight

In some cases, heartburn can be caused by excess weight. Fat around the middle puts pressure on the stomach and causes acidic fluid to travel up your food pipe.

Obesity may increase intra-abdominal pressure, impair gastric emptying, decrease lower esophageal sphincter (LES) pressure and possibly increase transient LES relaxation, all of which could lead to increased esophageal acid exposure.

3. Smoking

We don't need to be told twice that smoking is harmful to us – but did you know it's what causes heartburn as well as other negative health conditions for many people?

The chemicals inhaled with smoking create more acid in the stomach, which causes the LES to relax, which in turn causes indigestion and heartburn. Saliva helps neutralise stomach acid normally, but smoking also prevents proper saliva production.

Second-hand smoke can also lead to heartburn as you're still breathing in the same chemicals, though to a lesser degree.

4. Stress and anxiety

We know there's a strong link between our brain and digestive system – known as the gut-brain axis. Those who struggle to maintain a balanced diet are more susceptible to stress, as the amino acids in food help create many of the body's hormones and neurotransmitters. When these are in short supply, that can disrupt the body's nervous system and, in turn, slow the digestive system down, causing issues like heartburn.

Stress and heartburn is a chicken-and-egg situation: having regular acid reflux is stressful, disrupting sleep and daily life, but stress and having high cortisol levels can also cause acid reflux.

5. Hormone fluctuations

Changes in hormone levels can lead to heartburn for some, especially those going through the symptoms of perimenopause. Fluctuating levels of oestrogen can change the amount of acid in the stomach, but can also lead to loss of tone to the "valve" at the bottom of the oesophagus, which prevents stomach acid from backflow. Menopause can also slow digestion, causing food to remain in the stomach for longer, which can increase the risk of reflux.

6. Medicine side effects

Some medications will have side effects that cause heartburn, such as anti-inflammatory painkillers, including Ibuprofen, especially if you take them often or over a long period.

7. Stomach ulcers

Heartburn and acid reflux can be caused by a stomach ulcer – a sore that develops on your stomach lining. Often, bacterial infections or long-standing use of Ibuprofen or Aspirin cause these.

8. Hernia

A hiatus hernia is where part of the stomach pushes through the diaphragm, and this can contribute to heartburn, It can be what causes heartburn but it's less common than dietary triggers.

These can be common in people over 50 and occur when part of the stomach pushes through your diaphragm and up towards your chest. Medicines and lifestyle changes, such as losing weight, can usually ease the symptoms of a hiatus hernia but in some cases surgery may be required.

Treatment of heartburn

Over-the-counter medicines: Over-the-counter antacid medicines such as Gaviscon or Relcer can be taken after meals and before bed. They create a protective layer over your stomach acid so it can’t rise through your food pipe.

Gaviscon can be taken in tablet or liquid form and should start to work quickly and will last for around four hours. You can take it up to four times a day but might experience side effects like wind and bloating.

Chew gum: Proper saliva production can keep your stomach acid where it belongs and chewing gum helps to create more saliva acid, so this can be a useful short-term solution.

Elevate your head: Elevating the head of your bed by 15-20 cm (6-8 inches) can maintain gravity and prevent night-time symptoms.

Sit up straighter: It might sound like a small thing but "poor" posture – sitting slouched in your chair for hours at a time as many of us do – can be one of the causes of heartburn. Sitting up straighter can alleviate pressure on the stomach, which may be pushing acid into the oesophagus.

Eat smaller meals: If you are eating large meals before bed then perhaps switch to eating earlier and smaller portions in the evenings.

Prescribed medicines: Long-term acid reflux can cause damage to your esophagus which is why doctors may recommend you take a medicine called a proton pump inhibitor (PPI), for example omeprazole. It is available on prescription or you can buy 20mg tablets from pharmacies and supermarkets and it comes in tablet, liquid or capsule form.

The terms "heartburn" and "acid reflux" are used interchangeably – but they are actually slightly different things. Acid reflux is the action – the stomach contents rising back into the oesophagus – while heartburn is the feeling of this happening – the burning, painful, uncomfortable sensation after meals or when you're lying down.

If you're experiencing heartburn caused by acid reflux, you may also have bad breath, a hoarse voice, feel bloated or nauseous, or you might also have hiccups.

Contact Dr Maxwell on 3631807 or 7575411