Heartburn: Causes, symptoms, diagnosis, treatments & remedies

Heather Campbell
 min read

Heartburn refers to the excessive flow of acidic stomach contents back into the esophagus. The medical term for this is acid reflux.

Heartburn: Causes, symptoms, diagnosis, treatments & remediesAlmost everyone suffers from heartburn or belching at one time or another, for example, after a heavy meal. In itself, this can do no harm.

As a general rule, heartburn in itself is harmless. However, a doctor’s visit is warranted if heartburn occurs regularly, because if acidic stomach contents flows back regularly it can damage the esophagus. This can lead to Barrett’s esophagus, a potentially lethal condition if left untreated.

Do you regularly suffer from acid regurgitation? If so, be sure to read on for some interesting insights and tips to ease the pain and burden!

Heartburn: Introduction

Once we swallow food, it enters the esophagus. The esophagus is a tube that runs from the pharynx to the stomach.

The wall of the esophagus contains muscles that transport food to the stomach. At the junction of the esophagus to the stomach is a sphincter.

This sphincter opens when food passes from the esophagus to the stomach. Then it closes again. This prevents food and gastric juice from the stomach from flowing back into the esophagus.

Food is mixed with gastric juice in the stomach. Stomach juice contains, among other things, hydrochloric acid. The stomach itself has a thick mucous membrane that protects the stomach lining from this acid.

On the other hand, the esophagus does not have this protective layer. In other words, if stomach contents enter the esophagus, the esophagus can be damaged by the acidic gastric juice.

This can eventually lead to esophagitis or Barrett’s esophagus.

Barrett’s esophagus

People in whom the esophagus is overexposed (chronically) to refluxing stomach acid for years may develop a Barrett’s esophagus.

This is a permanent change in the tissue in the esophagus. People with a Barrett’s esophagus have a slightly increased risk of esophageal cancer.

However, most people with chronic heartburn symptoms do not get a Barrett’s esophagus. It is not yet known why some people develop Barrett’s esophagus, and others do not.

Causes of heartburn

There are several causes for acidic stomach contents flowing back into the esophagus too often and we’ve listed the most common causes here:

A fracture of the diaphragm

The diaphragm is a flat muscle that separates the chest and abdominal cavities. There is a small opening in the diaphragm through which the esophagus runs to the stomach.

If this opening in the diaphragm is too wide, the top of the stomach may begin to protrude slightly above the diaphragm. We call this a rupture of the diaphragm.

In such a situation, acidic stomach contents flow back more easily into the esophagus.

Too much pressure on the abdomen

Due to excess weight or constipation, or pregnancy, there is less space in the abdominal cavity, so the pressure in the abdomen is greater than normal.

The increased pressure allows acidic stomach contents to flow back into the esophagus more easily.

Eating a huge meal can also cause the stomach to become too full, and acidic stomach contents flow more easily back into the esophagus.

A lazy stomach

With a lazy stomach, food stays in the stomach longer than normal. This increases the likelihood that the acidic stomach contents will flow back into the esophagus.

A lazy stomach is a condition also called delayed gastric emptying. A lazy stomach occurs, for example, in people with diabetes.

Tip: For more info on delayed gastric emptying, also known as gastroparesis, check out our other article Gastroparesis dietary guidelines: Foods to eat and foods to avoid

Age

Age can cause the sphincter to weaken a bit and not close as well.

Acidic stomach contents then flow more quickly back into the esophagus.

Smoking and alcohol

Nicotine and alcohol can cause the sphincter to slacken.

It closes the stomach less tightly, and the acidic stomach contents then flow more quickly back into the esophagus.

Nutrition

Consumption of certain foods, such as peppermint, coffee, strong tea, chocolate, sharp spices, carbonated beverages, and acidic fruit juice, can cause the sphincter to slacken.

It then closes the stomach less tightly, and the acidic stomach contents flow more quickly back into the esophagus.

How do I recognize heartburn?

Reflux complaints and symptoms of heartburn

The symptoms of heartburn vary from person to person. Many people suffer from acid regurgitation. They then taste the acid in their mouth from time to time, which is horrible.

But you can suffer from heartburn even without tasting acid.

People often have symptoms, especially at night when lying in bed or bending over. This has to do with the position of the stomach and esophagus.

In addition, symptoms often occur after meals or when there is extra pressure on the abdomen, for example, when overweight, obese, pressing hard on the toilet, sneezing, or coughing.

Common symptoms associated with heartburn are as follows:

  • Bad teeth. If stomach acid flows back into the oral cavity, it can affect the teeth.
  • Irritated throat, hoarseness, and cough. This occurs when acidic stomach contents regularly flow up into the pharynx (at the back of your mouth).
  • Swallowing symptoms and feeling like there is a lump in the throat.
  • Burping and suffering from annoying belching. A burp involves some stomach acid entering the mouth. Really an annoying and painful feeling. Moreover, it also gives a nasty aftertaste.
  • The pain may radiate to the neck, back, and between the shoulder blades.
  • A painful, burning sensation behind the sternum, just above the stomach. Some people feel this as a pressing, squeezing pain that is quite often mistaken for heart disease.

When to go to the family doctor?

If you suffer from heartburn for an extended period, it is wise to see your doctor. Don’t let it go.

Diagnosis of heartburn

Often, the family doctor can diagnose heartburn based on your symptoms and a physical examination.

Sometimes additional examination is necessary, for example, if the symptoms do not diminish with dietary advice, adapted rules of living, and medication. Or if the symptoms disappear at first but come back later.

Examination of the stomach

A viewing examination of the inside of the esophagus and stomach is called a gastroscopy and is done with a particular viewing instrument called the gastroscope.

This is a flexible tube with a tiny camera and a light on it. The doctor inserts the tube through your mouth into your esophagus and looks to see if the esophagus is damaged or inflamed. It can also detect a rupture in the diaphragm.

24-hour acidity measurement

A 24-hour acidity measurement is an examination in which the acidity in the esophagus is measured for 24 hours and is also called the pH value.

The doctor inserts a thin tube into the esophagus through the nose. At the end of this tube is a measuring device.

This examination is done mainly when no abnormalities are seen inside the esophagus and doubt remains about the cause of the symptoms.

Treatment of heartburn

Treatment depends on the severity of the symptoms. Sometimes the doctor will give you dietary advice and lifestyle rules that can reduce symptoms, such as:

Dietary recommendations and rules of life

Usually, you will first receive dietary recommendations and lifestyle changes that may reduce symptoms. Fortunately, this works sufficiently for many people.

Medications

Sometimes the doctor also prescribes medication. These medications are usually for a period of four to six weeks. During that time, your symptoms will often lessen or disappear.

If this is not the case for you, you sometimes have to take the medication a little longer or be prescribed a higher dose of the same medicine. If necessary, the doctor may decide to change medicine.

There are several types of medications that the doctor can prescribe for heartburn.

Medications can help reduce symptoms of heartburn.

Did you know that the step-up method is used to find the right medication for heartburn? More on that below.

In addition, it is also essential to gradually phase out such antacids after a certain time.

Step-up method

The step-up method involves starting with an antacid drug with the mildest effect.

If that doesn’t help, you can start taking an increasingly heavy drug, always in consultation with your treating physician.

You start with a stomach acid binder or a mucosal protector. These are mild varieties that bind and neutralize stomach acid. Use these for up to 2 weeks.

If the symptoms persist, you switch to an antacid. Use this remedy for 2 to 4 weeks. Antacids cause less stomach acid to be produced.

More and more is known about the side effects of antacids.

For example, long-term use can lead to intestinal infections, increased risk of bone fractures, chronic kidney damage, or vitamin and/or mineral deficiencies, such as vitamin B12 and magnesium.

Therefore, it is crucial not to use these drugs for too long, but after a maximum of 8 weeks, try to stop gradually.

It is advisable to always take the remedies in consultation with your (family) physician. In time, ask again if you can stop taking these drugs. And how best to phase them out.

Phasing out method of antacids

Cutting back on antacids is best done gradually. Phasing out its use makes it less likely that the stomach symptoms will return.

An example of the phase-out method:

  • Take half of what you usually take and do this for a week.
  • The following week, take half again.
  • After this week, you then stop taking antacids.

It is preferable to refrain from taking the medicine daily, as this can actually cause more stomach upset. And this makes stopping more difficult.

These medications affect symptoms in different ways:

Medications that apply a protective layer

These drugs apply a protective layer to the inside of the esophagus and stomach. These are therefore more resistant to the aggressive gastric juice.

To bind stomach acid

These drugs make stomach acid less acidic by binding the acid. However, these antacids only work for a short time.

To inhibit or block stomach acid production

These medications make the gastric juice much less acidic for an extended period. They are therefore also called antacids. So there is still gastric juice, but it is less or not even acidic anymore.

Within this group of medications, a distinction can be made between medications that inhibit stomach acid production and those that block stomach acid production.

To aid function of esophageal and stomach muscles

These medications do nothing to help the sphincter not close properly. Thus, gastric juice can still flow back into the esophagus.

But because the gastric juice is no longer acidic, it can no longer cause problems. It also allows any damage to the esophagus to heal appropriately.

The use of these medications can cause side effects. Therefore, use these medications only in consultation with your doctor.

Anti-reflux surgery

If medications combined with dietary recommendations and lifestyle rules do not help sufficiently to reduce symptoms, your doctor may suggest surgery. This operation is also called anti-reflux surgery.

In this keyhole surgery, the upper part of the stomach is looped around the lower part of the esophagus. The stomach is then unable to rise through the diaphragm.

Your doctor can tell you more about this surgery which does come with its own set of risks.

Tips and advice for heartburn

People with heartburn can basically eat and drink anything. What causes symptoms in one person does not cause problems in another.

Therefore, it is wise to find out which foods are causing you symptoms. For example, a dietitian may be able to help you with this.

General tips and dietary advice to reduce the symptoms of heartburn:

  • Raise your head in bed by placing something under it or raising the pillows a bit, for example. That way, your head is a little higher than the rest of your body. The acidic stomach contents then do not flow back into the esophagus as easily and reduce the amount of acidic gastric juice in your esophagus and mouth.
  • Alcohol (such as champagne and cava), peppermint, coffee, strong tea, chocolate, sharp spices, carbonated drinks, and acidic citrus fruit juice such as lemon, grapefruit, tangerine, and orange often cause heartburn. Avoid.
  • Maintain a healthy weight. In overweight people, the pressure in the abdomen is more significant than average. This allows the acidic stomach contents to flow back into the esophagus more easily. Lose weight gradually, and a dietitian can help you do this.
  • Do you also suffer from constipation? With constipation, the pressure in the abdominal cavity is greater. Therefore gastric juice flows more easily back into the esophagus. You can prevent or reduce constipation by eating a healthy, high-fiber diet, drinking at least 0.4 to 0.5 liquid gallons of fluid, and exercising regularly.
  • Bend over as little as possible. The acidic stomach contents flow more easily back into the esophagus when bending over. Try to go down through your knees and keep a straight back if you have to bend over.
  • It is wise to stop eating at least three hours before going to sleep. Try not to eat too late in the evening, and do not lie down on your bed or couch immediately after eating. If you lie down with a full stomach, the acidic stomach contents can flow more easily back into the esophagus.
  • Eating a high-fiber, varied diet helps prevent stomach upset.
  • Do not wear tight clothing. In fact, tight clothing can put too much pressure on the stomach. As a result, acidic stomach contents flow more easily back into the esophagus.
  • Don’t smoke. Nicotine slackens the sphincter between the esophagus and stomach, making it easier for acidic stomach contents to flow back into the esophagus.
  • Heavy meals and fatty foods often cause heartburn. Try to avoid heavy dining, eat lightly instead, and spread out throughout the day. If your stomach is very full or you eat very fatty food, it will quickly lead to symptoms. A large, heavy meal stays in the stomach much longer. The acidic stomach contents then flow more easily back into the esophagus.

Heartburn FAQs

I suffer from heartburn. When should I contact my family doctor?

Everyone suffers from acid regurgitation from time to time. Suffering from burps a few times won’t hurt.

But if it occurs regularly, contact your doctor. If acidic stomach contents flow back too often and this is not treated, the esophagus can be damaged so do something about it and find out the cause.

If the symptoms persist or worsen for more than 2 weeks, see your doctor. Same if it happens several times a day.

It is also important to contact your doctor if you can no longer sleep well due to the symptoms.

I suffer from reflux symptoms, can it hurt?

Almost everyone suffers from heartburn or belching at some point, such as after a heavy meal. That in itself can do no harm.

But if you suffer from reflux on a regular basis, it can be very annoying. If the reflux symptoms last for a very long time and are not treated, esophagitis, for example, can develop.

People in whom the esophagus is exposed to stomach acid for years (chronically) may develop Barrett’s esophagus.

Fortunately, not all people with reflux symptoms develop a Barrett esophagus (an estimated +/- 10-20% of people with reflux symptoms eventually develop a Barrett’s esophagus).

If you suffer from heartburn for an extended period, it is wise to see your doctor.

I have Barrett’s esophagus, should I be concerned?

If you have Barrett’s esophagus, there is no need to be frantic, however, you must have regular contact with the doctor.

Your doctor will perform regular examinations on you to see how your esophagus is doing.

If the doctor discovers any peculiarities, the doctor will look for troubled cells or, for example, an early form of esophageal cancer.

Early detection is crucial to facilitate monitoring, and esophageal cancer can be prevented or detected early.

Good news: Of all Americans who suffer from a Barrett’s esophagus, less than 5% eventually develop esophageal cancer.

Heartburn: Conclusion

Although heartburn is simply an occasional irritation for many, it is good to know that if you are burping excessively, or experiencing heartburn regularly, you should consult a doctor without delay.

More often than not, a simple nutritional adjustment will be enough, but it’s better to be safe than sorry.

About Heather Campbell

As a dietitian, my field of specialization is science-based nutritional advice but more importantly, it is my goal to share capturing and inspiring stories, examples and solutions which can help plus-size individuals overcome their specific difficulties. Read More