Heartburn, characterized by a burning pain in your chest, is a common discomfort experienced by many. It occurs when stomach acid flows back up into the esophagus, a process known as acid reflux. While occasional heartburn is usually not a cause for concern, frequent heartburn could be a symptom of gastroesophageal reflux disease (GERD). Understanding What Causes Heartburn is the first step towards managing and preventing it.
Common Symptoms of Heartburn
Recognizing the symptoms of heartburn is crucial for timely management. The primary indicators include:
- Burning sensation in the chest: This is the hallmark symptom, often felt behind the breastbone and can radiate up to the throat.
- Sour taste in the mouth: Stomach acid refluxing into the mouth can leave an unpleasant sour or bitter taste.
Other associated symptoms might include:
- Persistent cough or hiccups
- Hoarseness of voice
- Bad breath
- Bloating and nausea
These symptoms often worsen after meals, particularly when lying down or bending over, due to increased pressure on the stomach and facilitating acid reflux.
Unpacking What Causes Heartburn: Key Factors
Heartburn is a multifaceted issue, and pinpointing what causes heartburn often involves considering a range of dietary, lifestyle, and medical factors. While sometimes there isn’t a clear single cause, several factors are known to trigger or exacerbate heartburn:
Dietary Triggers
Certain foods and beverages are notorious for provoking heartburn. These include:
- Coffee: Caffeine and acidity in coffee can relax the lower esophageal sphincter (LES), allowing stomach acid to escape.
- Tomatoes and Tomato-based products: Highly acidic foods like tomatoes, tomato sauce, and ketchup can increase stomach acid levels.
- Alcohol: Alcohol can irritate the stomach lining and relax the LES, increasing acid reflux.
- Chocolate: Chocolate contains caffeine and theobromine, which can relax the LES. It’s also high in fat.
- Fatty Foods: High-fat meals take longer to digest, increasing stomach pressure and the likelihood of acid reflux.
- Spicy Foods: Spicy foods can irritate the esophagus and stomach lining, contributing to heartburn.
Lifestyle Factors
Beyond diet, lifestyle choices significantly influence heartburn occurrence:
- Being Overweight or Obese: Excess weight puts pressure on the abdomen, forcing stomach contents and acid into the esophagus.
- Smoking: Smoking weakens the LES and reduces saliva production, which helps neutralize stomach acid.
- Pregnancy: Hormonal changes during pregnancy, particularly increased progesterone, relax the LES. The growing uterus also adds pressure to the stomach.
- Stress and Anxiety: Psychological stress can disrupt normal digestive function and increase acid production.
Medical Conditions and Medications
In some cases, heartburn is linked to underlying medical conditions or medication use:
- Hiatus Hernia: This condition occurs when part of the stomach protrudes through the diaphragm into the chest cavity, weakening the barrier between the stomach and esophagus.
- Stomach Ulcer: Open sores in the stomach lining can increase acid production and lead to heartburn.
- Bacterial Infection: Helicobacter pylori (H. pylori) infection in the stomach can cause gastritis and increase acid reflux.
- Certain Medications: Some medications, like anti-inflammatory painkillers such as ibuprofen, can irritate the stomach lining and contribute to heartburn. Hormone replacement therapy and certain osteoporosis drugs can also be triggers.
Self-Help Strategies for Heartburn Relief
For many, managing heartburn involves simple lifestyle adjustments. These strategies can significantly reduce the frequency and severity of symptoms:
Recommended Actions
- Eat Smaller, More Frequent Meals: Large meals distend the stomach, increasing pressure. Smaller, more frequent meals can ease digestion and reduce acid reflux.
- Weight Management: Losing weight if overweight can reduce abdominal pressure and alleviate heartburn.
- Stress Reduction Techniques: Practicing relaxation techniques such as yoga, meditation, or deep breathing exercises can help manage stress-related heartburn.
- Elevate the Head of Your Bed: Raising the head of your bed by 10-20cm using blocks or books can help gravity keep stomach acid down during sleep. Avoid using extra pillows, which can increase abdominal pressure.
Actions to Avoid
- Identify and Avoid Trigger Foods and Drinks: Keep a food diary to pinpoint specific foods that trigger your heartburn and limit or eliminate them.
- Avoid Late-Night Eating: Eating close to bedtime allows less time for digestion and increases the likelihood of nighttime heartburn. Aim to finish eating 3-4 hours before lying down.
- Loose Clothing: Tight clothing around the waist can compress the stomach and worsen heartburn.
- Quit Smoking: Smoking cessation is crucial for overall health and can significantly improve heartburn symptoms.
- Limit Alcohol Consumption: Reduce or eliminate alcohol intake to minimize its irritating effects on the stomach and LES.
- Consult Doctor Before Stopping Medications: Do not discontinue any prescribed medications without consulting your doctor, even if you suspect they are contributing to heartburn.
When to Seek Professional Help
While lifestyle changes and over-the-counter remedies can manage occasional heartburn, persistent or severe symptoms warrant medical advice.
Pharmacist Assistance
For infrequent heartburn, a pharmacist can recommend over-the-counter medications like antacids or alginates. These provide short-term relief by neutralizing stomach acid or creating a barrier to prevent reflux. It’s best to take these medications with or shortly after meals for optimal effect. However, they are not intended for long-term regular use. Pharmacists can also advise pregnant women on safe medication options for heartburn.
When to Consult a Doctor (GP)
It’s important to see a GP if:
- Lifestyle changes and pharmacist-recommended medicines are ineffective.
- Heartburn occurs most days.
- You experience additional symptoms such as difficulty swallowing (food getting stuck), frequent vomiting, or unexplained weight loss.
A GP can investigate further, rule out serious underlying conditions, and prescribe stronger treatments. Seek urgent medical advice if your symptoms worsen suddenly by contacting your GP, NHS 111 online, or calling 111.
Medical Treatments for Heartburn and Acid Reflux
If heartburn is persistent or severe, a doctor may prescribe stronger medications.
Proton Pump Inhibitors (PPIs)
PPIs are a common prescription for acid reflux. They work by reducing the amount of acid produced in the stomach. Common PPIs include omeprazole, lansoprazole, and pantoprazole. Treatment typically lasts for 4 to 8 weeks, but long-term prescriptions may be necessary for recurring symptoms.
H2 Receptor Antagonists
If PPIs are not effective, H2 receptor antagonists like famotidine may be considered. These medications also reduce stomach acid production, although they may be less potent than PPIs.
Further Investigations and Treatments
For severe cases unresponsive to medication, or when complications are suspected, a specialist referral may be necessary. Further tests might include a gastroscopy to visualize the esophagus and stomach. Tests for H. pylori infection may also be conducted, and if positive, treated with antibiotics and PPIs. In rare cases, surgery to strengthen the LES or repair a hiatus hernia might be considered.
Understanding what causes heartburn is key to effectively managing this common condition. By recognizing triggers, adopting appropriate lifestyle modifications, and seeking timely medical advice when needed, individuals can find relief and improve their quality of life.
Page last reviewed: 20 November 2023
Next review due: 20 November 2026
