Heartburn

Heartburn: An Overview

Although its name may suggest otherwise, heartburn has no direct connection to the heart. Instead, it refers to a painful or burning sensation in the chest, often linked to a digestive condition known as reflux. This discomfort is usually felt after eating and tends to worsen when bending over or lying down. It is estimated that around 20% of the population experiences frequent episodes of heartburn or reflux.

What Causes Heartburn?

The oesophagus, which is the tube that carries food from your mouth to your stomach, is surrounded by a muscle band at its lower end called the oesophageal sphincter. Under normal circumstances, when you swallow, this muscle relaxes to allow food and liquid to pass through and then tightens to prevent anything from coming back up. However, if this sphincter becomes weak or relaxes at the wrong time, stomach acid can flow back into the oesophagus, a condition referred to as gastro-oesophageal reflux disease (GERD) or simply reflux. It is this acid that causes the burning sensation associated with heartburn. In some cases, heartburn may also signal the presence of a hiatal hernia. This condition occurs when a portion of the stomach pushes through the diaphragm, the thin muscle separating the chest from the abdomen. Pregnancy can also be a contributing factor. The elevated levels of the hormone progesterone during pregnancy may cause the oesophageal sphincter to relax, which can allow stomach contents to flow back into the oesophagus, triggering heartburn.

Heartburn Symptoms

Heartburn often leads to various symptoms, which can vary in severity. If you experience frequent or intense symptoms, it may indicate a more serious issue such as gastroesophageal reflux disease (GERD). Symptoms of Heartburn:

• Burning sensation in the chest, often after eating
• Sour or bitter taste in the mouth due to acid regurgitation
• Chronic cough or hoarseness
• Sore throat
• Bloating or a feeling of fullness
• Difficulty swallowing
• Pain in the chest or a sensation that food is stuck
• Pain radiating to the shoulder, neck, or arms in severe cases
• Nausea or shortness of breath in more intense episodes

Risk Factors for Heartburn

The likelihood of experiencing heartburn increases under certain conditions, including:

• Age: Research indicates that about 25% of individuals over the age of 75 take medication for heartburn.
• Smoking: This habit can contribute to the development of heartburn.
• Overweight: Excess weight can increase the risk of experiencing heartburn.
• Pregnancy: The hormonal changes during pregnancy may increase the chances of heartburn.
• Family History: A genetic predisposition, such as a family history of acid reflux or GERD, can raise your risk.
• Exercise: Exercising too soon after eating can trigger heartburn.
• Large Meals: Consuming large portions of food may contribute to heartburn.
• Certain Medications: Some medications and supplements may irritate the lining of your oesophagus or worsen acid reflux. These include antibiotics, iron supplements, painkillers, narcotics, antidepressants, and sedatives.

There are also specific foods that are known to trigger heartburn, such as:

• Spicy foods
• Fatty or fried foods
• Onions
• Citrus fruits
• Tomatoes or tomato-based products
• Peppermint
• Chocolate
• Alcohol
• Caffeine
• Carbonated drinks

Can Heartburn Be Prevented?

In many cases, heartburn can be alleviated or even eliminated by making a few lifestyle adjustments. These include:

• Quitting smoking
• Achieving and maintaining a healthy weight
• Avoiding lying down immediately after eating
• Eating smaller meals
• Steering clear of foods that trigger heartburn

In more severe cases, prescription medications or even surgery may be required to fully address heartburn.

Heartburn Treatment

If you’re seeking relief from heartburn symptoms, you may consider using over-the-counter (OTC) medications. These can provide varying degrees of relief depending on your symptoms and needs:

• Antacids/Alginates: Antacids work quickly to neutralize stomach acid, providing immediate relief. Alginates, on the other hand, form a protective barrier when they react with stomach acid, preventing stomach contents from flowing back into the oesophagus. However, both antacids and alginates can affect the absorption of other medications, so it’s important to consult your doctor or pharmacist before using them.
• H2-antagonists/H2 blockers: These medications reduce the production of stomach acid. While they take longer to work than antacids, they offer longer-lasting relief.
• Proton Pump Inhibitors (PPIs): PPIs are designed to reduce acid production in the stomach, providing a more significant reduction in acid levels over time.

When using OTC medications for heartburn, it’s a good idea to talk to your pharmacist about which medication or combination of medications is best for your specific condition and how often you should use them. In cases where OTC medications don’t effectively relieve heartburn, prescription medications may be necessary. In rare instances, surgery might be needed to tighten the oesophageal sphincter to prevent heartburn, but this is typically reserved for individuals who do not respond to medication.

When to Seek Medical Help

If you experience heartburn twice a week or more, or if your symptoms are severe and not relieved by OTC treatments, it’s important to see your doctor. Heartburn can sometimes accompany other medical conditions such as ulcers or gastro-oesophageal reflux disease (GERD). If you experience heartburn along with any of the following symptoms, seek medical attention immediately:

• Difficulty or pain when swallowing
• Dark or bloody stools

Though heartburn is not typically linked to heart attacks, some of its symptoms can be similar. If you experience any of the following signs, call 000 as it could be a medical emergency:

• Chest pressure, tightness, pain, or a squeezing sensation
• Pain radiating to the shoulder, neck, or arms
• Irregular heartbeat
• Sweaty or clammy skin
• Sudden dizziness, lightheadedness, or weakness
• Nausea, indigestion, vomiting, or abdominal pain
• Shortness of breath