Heartburn (acid reflux) - causes, treatment, prevention

Heartburn, also referred to as acid reflux, is a painful burning sensation in the chest. It is a symptom of a digestive system problem. Lifestyle changes and over-the-counter medications are used to treat and prevent heartburn.

General information

Heartburn is a form of upper abdominal / chest pain.  It is important that you take steps to ensure that any discomfort you are experiencing is in fact heartburn, and not another health condition. Medical assistance should be sought urgently if you experience severe chest pain, especially if accompanied by symptoms of shortness of breath, arm pain, dizziness, and/or cold sweats. These symptoms may indicate a more serious medical condition such as a heart attack . Occasional heartburn occurs in most people and does not require a visit to the doctor. However, heartburn that is frequent (more than twice a week) or persists despite the use of over-the-counter medications may indicate a more serious form of heartburn, gastro-oesophageal reflux disease (GERD), for which you should visit your doctor. 

Causes

Heartburn is caused by stomach acid travelling back up your oesophagus (acid reflux). The oesophagus is the tube that carries food from your mouth to your stomach. It has a circular band of muscle (the oesophageal sphincter) at its lower end where the oesophagus opens to the stomach. The sphincter closes after food has entered the stomach to prevent the contents of the stomach travelling back up the oesophagus. However, if the sphincter becomes weak and does not close fully, or relaxes at the wrong moment, stomach acid can flow back up the oesophagus and irritate the lining of the oesophagus. 

Some types of food aggravate heartburn, including: 

• alcohol, which relaxes the oesophageal sphincter
• coffee and chocolate
• orange juice and other acidic juices
• acidic foods, such as tomatoes, oranges, and grapefruits
• fatty or fried foods
• black pepper, mustard, and spicy foods.

Foods that can cause heartburn vary for different people. A weekly food journal may be useful in identifying what types of food trigger your heartburn. By keeping a daily record of what you eat, the time that you eat, and any activities that made your symptoms worse you should be able to correlate specific foods with episodes of heartburn. 

Heartburn is common in pregnancy because the oesophageal sphincter is weakened during pregnancy and the pregnancy places increasing pressure on the stomach, all of which promote the reflux of acid from the stomach. Heartburn associated with pregnancy usually resolves after delivery of the baby. 

Signs and symptoms

A burning pain in the chest, which usually occurs after eating and sometimes at night, is the most obvious symptom of heartburn. This may be accompanied by a sour taste in the back of the throat and/or a feeling of food being stuck in the throat.   The symptoms are often worse when lying down or bending over. 

Diagnosis

Taking your medical history and a physical examination is often all that your doctor requires to make a diagnosis of heartburn.  To determine how severe your heartburn is or to determine if there is any damage to your oesophagus, your doctor may conduct tests. 

These tests may include endoscopy, which involves using an endoscope (a thin flexible tube with a camera and light at one end) to examine the lining of your oesophagus; or pH monitoring, which involves using an acid monitor (a thin tube or catheter with a sensor at one end) to measure acidity levels in your oesophagus. 

Treatment

Treating heartburn is important because over time acid reflux can damage your oesophagus.   Many over-the-counter and prescription medications are available to relieve the symptoms of heartburn. They can be grouped into three major categories: 

• medications that neutralize stomach acids: Known as antacids, these medications provide quick relief by reducing the amount of stomach acid but do not help to heal existing damage to your oesophagus or prevent future episodes of heartburn. Antacid brands include Mylanta, Eno, Quick Eze and Gaviscon. 
• medications that reduce the production of stomach acid: Known as H2-receptor blockers, e.g. ranitidine and cimetidine, these drugs are slower acting than antacids but provide longer term symptom relief. 
• medications that block stomach acid production and help to heal the oesophagus: Known as proton-pump inhibitors, e.g. omeprazole and lansoprazole, these drugs block the production of acid in the stomach allowing time for the damaged oesophagus to heal. 

Surgery that aims to strengthen the oesophageal sphincter may be an option if lifestyle changes and medications have not helped. 

Prevention

The following lifestyle changes can help you to avoid heartburn: 

• lose weight/maintain a healthy weight – excess weight places pressure on the stomach causing stomach acid to back up into the oesophagus 
• quit smoking – smoking impairs the normal functioning of the oesophageal sphincter
• diet control – avoid foods that trigger your heartburn and reduce the amount of food you eat
• avoid lying down after a meal – wait at least three hours after eating before lying down or going to bed
• raise the head of your bed by placing blocks under the feet at the head of your bed or insert a wedge between your mattress and the bed’s base so that your body is elevated from the waist up.
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•  Digestive system conditions