Nearly everyone experiences heartburn at some point in their lives, with more than 40 percent of the U.S. population suffering heartburn pain at least once a month according to a Florida Hospital report. Furthermore, almost 95 percent of people link their causes of heartburn to a specific food, with a vast majority reporting symptoms at night rather than during the day. While there are common denominators and trends, what really causes heartburn?
What Is Heartburn?
Though often communicated as an ailment of its own, heartburn is actually a symptom of gastroesophageal reflux disease. Better known as acid reflux or GERD, gastroesophageal reflux disease is a condition in which stomach acid refluxes back into the esophagus after bypassing the lower esophageal sphincter (LES). The LES is a bundle of muscles at the low end of the esophagus, in which it meets the stomach, and prevents acid and stomach contents from traveling backwards. But with GERD and heartburn, the LES may relax and cause individuals to feel discomfort and pain as the potent acid enters the delicate lining of the esophagus.
Causes of Heartburn
Numerous and diverse risk factors and causes of heartburn include:
Foods and drinks can cause the LES sphincter to relax or increase stomach acid. Common examples include garlic and onion, peppermint, alcohol, caffeinated products such as coffee and chocolate, and acidic fruits and juices including tomatoes, lemons, and oranges. High-fat foods can similarly cause the LES to relax and allow acid to reflux back into the esophagus. Eating a large meal, especially right before bedtime, also increases the risk of heartburn.
Low levels of physical activity may increase the risk of heartburn. Conversely, exercise may actually induce heartburn if the LES muscle is weak or too relaxed.
Smoking can boost stomach acid and increase the risk of GERD symptoms. Nicotine in cigarettes is thought to relax the LES, while lessened salivation from frequent smoking can compromise the ability to neutralize stomach acid.
Many medications can trigger heartburn or exacerbate symptoms, including regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen. Blood pressure medications, sedatives, and other meds may relax the LES muscle and cause heartburn.
Excess weight may put pressure on the stomach and induce heartburn. Moderate amounts of weight gain may also develop or exacerbate GERD symptoms, with a study published in The New England Journal of Medicine implying even a 20-pound increase among normal-weight persons (moving from a BMI of 22 to 24 in the present study) doubles the risk of reflux.
Hormonal and physical changes during pregnancy may cause some women to experience heartburn, particularly during the second and third trimesters and if too much weight is gained.
• Hiatal Hernia
A hiatal hernia is a condition in which part of the stomach pushes into the chest cavity. While not all hiatal hernias trigger symptoms, they are often associated with heartburn and abdominal discomfort.
Treating and Managing Heartburn
Although occasional heartburn is normal from time-to-time, chronic exposure of stomach acid in the esophagus can increase the risk of tooth decay, esophagitis, Barrett’s esophagus, and esophageal cancer. To lessen such risks, management and treatment are primarily broken down into medications and lifestyle changes:
Especially if heartburn is severe, acid reflux is frequently treated with medications. Acid reflux medications come over-the-counter or via prescriptions, including antacids, histamine antagonists (H2 antagonists and H2 blockers) and proton pump inhibitors (PPIs). Antacids work by neutralizing stomach acid to reduce acid indigestion, heartburn, and an upset or a sour stomach and include the popular and commonly used Alka-Seltzer, Tums, and Pepto-Bismol. H2 antagonists and blockers and PPIs work by blocking and suppressing acid production in the stomach. Common H2 blockers include Axid, Pepcid, Tagamet, and Zantac and frequently used PPIs include Prilosec, Nexium, Protonix, and Aciphex. It is important to consult with your primary healthcare provider regarding medication use, as growing evidence suggests long-term use of PPIs may have concerning side effects.
• Lifestyle Changes
While medications have shown to be highly effectively and appropriate in many cases, lifestyle changes should be explored, considered, and implemented. Managing heartburn following a more holistic approach lessens the risk of acid reflux complications itself, along with lowering the likelihood of dangers of common acid reflux medications. Health and nutrition experts suggest trialing certain foods, eating smaller and more frequent meals, avoiding large meals before exercise, managing stress, quitting smoking and tobacco use, and losing weight or maintaining it.