Most people recognise heartburn because they have occasionally experienced it, usually after a heavy or rich meal or an excess of alcohol. It is a burning discomfort felt behind the breast-bone; often seeming to rise up from the stomach to the throat.
Is heartburn a disease?
No. It is a discomfort that can be ignored or treated with simple indigestion medicines if it occurs occasionally. If it happens more frequently then further investigation may be advised.
Does heartburn have anything to do with the heart?
No, the name is misleading. Pain caused by heart disease is quite different from the burning in the chest called heartburn. The discomfort of heartburn actually arises in the gullet (oesophagus) which carries food from our mouth to the stomach.
What causes heartburn?
Heartburn occurs when digestive juices (containing add and chemical enzymes) rise into the gullet (oesophagus) from the stomach. This process is called reflux. If this happens a lot, the oesophagus becomes inflamed; this is called oesophagitis. There is a valve (sphincter) at the lower end of the oesophagus, where it joins the stomach, which normally prevents reflux. Sometimes the valve becomes weak or a normal valve is overcome by extra strain such as an overfilled stomach, or a lot of bending or lifting.
Why should the valve (sphincter) become weak?
We do not always understand the reason, but there are some known causes
- In pregnancy, the valve is weakened by hormones, so many women get heartburn late in pregnancy.
- Smoking, drinking coffee and eating fat or chocolate all weaken the valve temporarily, so if any of these things are done frequently it may lead to heartburn.
- Putting on weight, wearing tight clothing around the waist, and bending a lot, all put extra strain on the valve.
Can anything else cause heartburn?
Sometimes heartburn is a symptom of other diseases. A peptic ulcer (gastric or duodenal ulcer) sometimes causes heartburn, though usually there are other symptoms such as pain in the stomach. Some people with gallbladder disease have heartburn (though removing the gallbladder may not cure the heartburn). Occasionally, narrowing of the stomach outlet (pyloric stenosis) causes back-flow and leads to heartburn. One of the reasons for doing tests on patients with heartburn is to discover any of these possible causes.
What is a hiatus hernia?
If a portion of the stomach rises through the hole (hiatus) in the diaphragm through which the oesophagus (gullet) usually passes, it is called a hiatus hernia. A small hiatus hernia is often found in patients with frequent heartburn, hut by no means always Conversely, hiatus hernia can sometimes be seen on x-rays in people who have no heartburn. So, although patients with heartburn are often told that the diagnosis Is a hiatus hernia", the hernia is not the most important thing.
If I have a hiatus hernia, will it develop complications?
Almost certainly not. The sort of hiatus hernia associated with heartburn is not subject to strangulation and other complications which can affect hernias in the groin An uncommon sort of hiatus hernia may cause problems, but these are rare and do not usually cause heartburn. Most hiatus hernias never need surgical treatment.
Can medicines or drugs I take cause heartburn?
Many medications may irritate the gullet (oesophagus) if they do not pass through quickly into the stomach, so all tablets should be taken with a good gulp of water while sitting or standing upright. However, some drugs are particularly inclined to do this. Many of them are pain-relievers (including aspirin) taken for arthritis or back-ache. People prone to heartburn should be cautious about what they take.
Can the inflammation of the oesophagus interfere with swallowing?
Everything we swallow goes down the oesophagus into the stomach. if the oesophagus is inflamed (oesophagitis), swallowed material may hurt as it passes down. Hot dishes or alcoholic spirits are particularly likely to do this. Occasionally, large pieces of food, meat for example, may seem to stick for a moment. If such "sticking' happens at all frequently, it suggests that the inflammation is severe, and may have led to narrowing of the oesophagus (a stricture).
Can there be complications?
Heartburn due to reflux oesophagitis is not usually a serious disease, though if it is frequent or interferes with normal activities (such as eating, gardening, housework, sexual intercourse) then it should be investigated and treated. Complications are rare, the only important one being a stricture. This always needs investigation and may require special treatment
What treatment can be given?
The most important and helpful aspects of treatment are things that you can do for yourself.
- You must lose any excess weight; for many patients nothing else is necessary.
- If you are a smoker you must stop.
- Avoid large meals, and eating late at night. Do not eat fatty dishes or chocolate.
- Limit your coffee intake to 2 or 3 cups a day.
- Do not drink much alcohol. Avoid spirits and do not drink late at night.
- Do not bend or stoop if it can be avoided. For example, work with long handled tools rather than kneel to do gardening or housework.
If the symptoms are troublesome it may help to sleep with the head of the bed raised on bricks or blocks to reduce the likelihood of reflux occurring during the night.
What medicines can the doctor give me to help?
- Simple antacid medicines (liquid or tablets) will relieve many episodes of heartburn, and if taken regularly may be enough to control symptoms. When tablets are chewed they encourage salivation, which also helps to neutralise acid.
- Alginate compounds (liquid or tablets e.g. Gaviscon or Gastrocote) form a sticky material in the stomach to reduce the ease with which acid juice rises into the oesophagus.
- Acid reducing drugs ( eg; Cimetidine, Ranitidine, Lansoprazole or Omeprazole) reduce the volume and strength of acid produced by the stomach and thus make it less irritant and less likely to cause heartburn.
What you can do
- Lose any excess weight
- Stop smoking
- Avoid bending or stooping
- Raise the head of your bet
- Avoid large meals - particularly hot and spicy foods
- Avoid any foods that you notice cause heartburn
- Avoid fats and chocolates, cut down on alcohol
- Avoid pressure on the stomach - for example from tight clothes like corsets.