Heartburn: Causes, Symptoms, and Treatments

Understanding Heartburn: A Clinical Perspective

Heartburn! A familiar sensation for many, with symptoms of burning chest, often after eating. A common outpatient presentation is a patient who is looking for a solution to this reflux of stomach acid that he or she experiences from time to time.

In this article, we will explore what heartburn is, why you might have it, what to look out for, how to treat it, and how to prevent it.

What is Heartburn?

What is Heartburn? Heartburn is a burning sensation in your chest that sometimes spreads to your neck and throat. Despite its name, Heartburn has nothing to do with your heart. Heartburn occurs when acid in your stomach backs up into the tube that carries food from your mouth to your stomach, a tube known as the oesophagus. The backward flow of acid irritates the lining of your oesophagus.

Heartburn is a symptom of acid reflux (also known as gastro-oesophageal reflux), which occurs when stomach acid washes back up into your oesophagus. Reflux is defined by a return of contents (in this case, acid and other stomach secretions) that normally goes in just one direction – out of the stomach into the intestines, in this case. If your reflux problem occurs more than twice a week, it can become a more chronic and nuisance condition called gastroesophageal reflux disease (GORD).

Incidence:

According to a study by Ntagirabiri et al. (2020), the prevalence of gastroesophageal reflux disease (GERD) in Africa ranges from 10% to 20%, with variations among different countries. However, specific data on GERD incidence in South Africa is limited.

A study by Van der Merwe and Van Rensburg (2011) conducted in the Western Cape, South Africa, found that 23.9% of the study participants experienced reflux symptoms at least once a week, suggesting a relatively high prevalence of GERD in that region.

Another study by Nwokediuko (2012) reported that the prevalence of GERD in Africa is generally lower compared to Western countries, but it is increasing due to factors such as obesity, smoking, and changes in diet and lifestyle.

While these studies provide some insight into the prevalence of GERD in South Africa, they are limited in scope and may not represent the entire country. More comprehensive and up-to-date research is needed to determine the current incidence of GERD in South Africa.

What does heartburn feel like?

• A burning sensation in your chest, usually after eating
• Chest pain, especially when lying down or bending over
• A bitter or sour taste in your mouth
• Difficulty swallowing
• A feeling that food is "sticking" in your throat (throat symptoms)
• Chronic cough or hoarseness (throat symptoms)
• It can happen alone or with ingestion that is felt like bloating and burping

What causes heartburn?

Several factors can contribute to heartburn, including:

Foods that cause heartburn: Some foods relax the valve between the oesophagus and stomach, causing stomach acid to come back into the oesophagus. Which foods have this effect varies from person to person, but often include spicy, fatty or acidic foods, as well as chocolate, coffee and alcohol.

Lifestyle factors: Being overweight, smoking, wearing tight clothing, and eating large meals or lying down right after eating can all contribute to heartburn.

Medical conditions: Hiatal hernia, pregnancy, and a few connective tissue disorders can predispose you to getting heartburn.

Medication: Heartburn is a common side-effect of nonsteroidal anti-inflammatory drugs (commonly known as NSAIDs), aspirin and various medications used to treat hypertension (high blood pressure) because these drugs irritate the oesophagus or relax the LES.

Heartburn Diagnosis

 If you have chronic heartburn symptoms, you should see a doctor. Your physician may propose tests to confirm the diagnosis and rule out other potential conditions such as:

• Endoscopy: a thin, flexible tubing with a light and camera is passed down your throat into the oesophagus and stomach to examine your stomach.
• Oesophageal pH monitoring: This test measures the acid levels in your stomach that leak into your oesophagus for 24 to 48 hours.
• Oesophageal manometry: This test measures the coordinated muscle contractions of your oesophagus when you swallow.

How to Treat Heartburn?

The type of heartburn treatment you need depends on how serious your symptoms are and how often they occur. Treatment options include:

• Lifestyle changes: Avoiding trigger foods and eating smaller meals, along with losing weight if needed and staying upright after eating, can decrease the risk of heartburn.
• Over-the-counter: Antacids neutralise stomach acid; anti reflux or H2 blockers and PPIs reduce acid production.
• Prescription medications: Stronger versions of H2 blockers and PPIs are available by prescription.
• Surgery: In severe cases, surgery (fundoplication) to reinforce the LES may be necessary.

Living with Heartburn

 Changing your lifestyle can also help you to live with and manage heartburn:

• Diet changes: Keep a food diary so you can begin to avoid your trigger foods. A good diet is high in fruits, vegetables, lean proteins and whole grains. Make sure you plan meals that include smaller portions, and remember to try not to eat more than you need. Go slow – literally. Eat slowly, and be sure to chew food thoroughly.
• Stress management: Stress can promote production of acid. Perform relaxation exercises such as deep breathing, meditation or yoga. Doing something you take pleasure in on a consistent basis such as going to the gym will help lower your stress level.
• Sleep postures: Raise the head of your bed 6-8 inches or sleep with a wedge pillow to prevent stomach acid backing up into your esophagus while you sleep. Wait three hours after eating before going to bed to allow enough time for your stomach to empty before lying down.

Complications of Untreated Heartburn

Complications of Untreated Heartburn If left untreated, chronic heartburn can lead to serious complications:

• Esophagitis: Inflammation of the oesophagus, which can cause bleeding, ulcers, and difficulty swallowing.
• Barrett’s oesophagus: Precancerous changes in the oesophageal lining due to chronic acid exposure.
• Oesophageal cancer Although it’s a less-common complication, long-term exposure to stomach acid can lead to the development of esophageal cancer.

How to Prevent Heartburn?

To prevent heartburn and attain heartburn relief, try these tips:

• Maintain a healthy weight

• Avoid smoking and excessive alcohol consumption

• Eat smaller, more frequent meals

• Wait at least 3 hours after eating before lying down

• Wear loose-fitting clothing

Symptoms similar to heartburn can indicate other conditions:

Angina: Chest pain caused by poor blood circulation in the heart.

Gallstones: Digestive problems that may lead to abdominal pain, nausea and vomiting.

 If you are wondering whether or not your symptoms are heartburn or not, definitely schedule an appointment with your doctor.

FAQ

Q: Is heartburn the same as acid reflux and GERD?

A: Heartburn is the symptom of acid reflux, which is either occasional or chronic, depending on the frequency of repeat occasions (labelled GERD, for gastro-oesophageal reflux disease, and diagnosed when it recurs more than twice a week with troublesome symptoms).

Q: Is heartburn a symptom of a heart attack?

A: While the pain of heartburn may mimic that of a heart attack, heartburn is not a symptom of a heart attack. However, severe chest pain or pressure, especially if accompanied by shortness of breath, can be a sign of a heart attack, so call 999 or 084 124 if you’re experiencing any such symptoms.

Q: Is it dangerous for my wife to have heartburn now that she’s pregnant?

A: Mild heartburn is part of being pregnant. It frequently occurs due to the effects of the pregnancy hormones and because the growing baby pushes up on the tummy and stomach so the acid can back up into the oesophagus. Although this heartburn is uncomfortable, it is usually not dangerous. However, you should always ask your obstetrician about which treatments to use during pregnancy, since some medications cannot be taken during pregnancy.

Q: How can I prevent heartburn at night?

A: The best way to prevent heartburn at night is to eat smaller meals, avoid spicy or acidic foods, and avoid eating within 3 hours of going to bed. Elevating the head of your bed while you sleep can also help.

Q: When should I see my doctor about heartburn?

A: See your doctor if your heartburn is severe, frequent (more than twice a week or when troublesome symptoms occur), or unresponsive to lifestyle changes and over-the-counter medications, as untreated heartburn can lead to more serious complications.

Is my heartburn related to stress?

A: Heartburn in itself is not a direct result of stress, but it can definitely complicate its symptoms. Stress triggers such things as increased muscle tension and increased production of acid in the stomach, which can heighten heartburn symptoms. Stress in general can complicate heartburn, but by using relaxation techniques, exercises, and counselling, stress can easily be reduced, which in turn will reduce the frequency and severity of heartburn episodes.

Is there anything - natural remedies, for example - that you can do that will help with heartburn?

Answer: Yes, some people respond better to natural remedies than with medicine. So... Natural remedies are:

• Chewing gum to stimulate saliva production, which can neutralize stomach acid

• Drinking ginger tea or taking ginger supplements to soothe the digestive tract

• Consuming aloe vera juice to reduce inflammation and heal the esophagus

• Chewing liquorice root extract, which could serve as a protective shield for the stomach lining But, of course, you should consult your physician before trying any alternative remedies because natural treatments can counteract medications or have unwarranted side effects.

Q: I’ve heard it’s common for heartburn to flare up when you travel. How can I stay in control of symptoms while on the road?

A: Falling out of your regular routine and eating habits is a common culprit when it comes to heartburn symptoms, so when you’re on the go, consider these tips:

• Avoid trigger foods, especially when eating out or trying new cuisines
• Eat smaller, more frequent meals to avoid overeating
• Stay hydrated by drinking plenty of water
• Wear loose, comfortable clothing during travel
• Try to stick to a regular sleep pattern and use a wedge pillow if possible If your heartburn symptoms persist or worsen during your travels, get medical help.

Pack heartburn medications with their prescription in your carry-on luggage.

 Key takeaways

1. Heartburn is a common condition that can negatively impact the quality of life when inadequately treated.
2. The most common causes of heartburn are eating large meals, eating too late at night, stress, smoking, drinking alcohol, eating spicy or acidic foods, and taking certain medications, such as anti-inflammatory drugs.
3. Symptoms of heartburn can vary but include a burning feeling in your lower chest, difficulty swallowing, and regurgitation of stomach contents.
4. Treatments for heartburn include lifestyle changes such as avoiding trigger foods and quitting smoking, as well as over-the-counter remedies
5. If lifestyle modifications and over-the-counter treatments aren't helpful, schedule an appointment with a gastroenterologist to relieve your pain and prevent complications with tailored treatment.

References:

1. Ntagirabiri, R., Mumana, A., & Baransaka, E. (2020). Epidemiology of Gastroesophageal Reflux Disease in Africa: A Systematic Review and Meta-Analysis. Journal of Gastroenterology and Hepatology Research, 9(2), 3118-3124.
2. Van der Merwe, L. J., & Van Rensburg, C. J. (2011). Gastroesophageal reflux disease in our population - The tip of the iceberg? South African Journal of Surgery, 49(4), 172-175.
3. Nwokediuko, S. C. (2012). Current trends in the management of gastroesophageal reflux disease: A review. ISRN Gastroenterology, 2012, 391631.Alyami, S. and Alzahrani, Y.A., 2022. Gastroesophageal Reflux Disease: Diagnosis and Management Approach, Literature Review. World Journal of Environmental Biosciences, 11(1), p.10.51847.
4. Maret-Ouda, J., Markar, S.R. and Lagergren, J., 2020. Gastroesophageal Reflux Disease: A Review. JAMA, 324(24), p.10.1001/JAMA.2020.21360.
5. Fox, M. and Gyawali, C.P., 2023. Dietary factors involved in GERD management. Best Practice & Research Clinical Gastroenterology, 62-63, p.10.1016/j.bpg.2023.101826.