Heartburn

Digestive Disease Myths Slideshow

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

• Overview of Heartburn
• Heartburn Causes
• Heartburn Symptoms
• Heartburn Diagnosis
• Heartburn Treatment
• Heartburn Summary

Overview of Heartburn

The esophagus is a tube that connects the mouth to the stomach. It is made of muscles that work to push food toward the stomach in rhythmic waves. Once in the stomach, food is prevented from refluxing (moving back into the esophagus), by a special area of circular muscle located at the junction of the esophagus and stomach, called the lower esophageal sphincter (LES). A pressure difference across the diaphragm, the flat muscle that separates the chest from the abdomen, also tends to keep stomach contents in the stomach.

The stomach combines food, acids, and enzymes together to begin digestion. There are special protective cells that line the stomach to prevent the acid from causing inflammation. The esophagus does not have this same protection; if stomach products reflux back into the esophagus, they can cause inflammation to the lining.

Heartburn Causes

Heartburn is actually a symptom of GERD, and is caused by acid refluxing back into the esophagus. Risk factors include those that increase the production of acid in the stomach, as well as structural problems that allow acid reflux into the esophagus.

• Some common foods we eat, drink, and over-the-counter and prescription medications stimulate increased stomach acid secretion setting the stage for heartburn. Examples of these irritants include:
   
  • alcohol,
    
    
  • caffeine,
    
    
  • aspirin (Bayer, etc.),
    
    
  • other anti-inflammatory medications like ibuprofen (Motrin, Advil, Nuprin, etc.).
    
    
  • carbonated beverages,
    
    
  • acidic juices (grapefruit, orange, pineapple)
    
    
  • acidic foods (tomatoes, grapefruit, and oranges), and
    
    
  • chocolate.
  
  
  
• Smoking and the consumption of high-fat content foods tend to affect LES function, causing it to relax and allow acid to reflux into the esophagus.
  
  
• A hiatal hernia, in which a portion of the stomach lies in the chest instead of the abdomen, can affect the way the LES works and is a risk factor for reflux. Hiatal hernias by themselves cause no symptoms. It is only when the LES fails that heartburn occurs.
  
  
• Pregnancy can cause increased pressure in the abdomen which can affect LES function and predispose to reflux.
  
  
• Obesity may also cause increased pressure in the abdomen, and thus reflux in the same way.
  
  
• Primary diseases of the esophagus can also present with heartburn as a symptom. These include, among others, scleroderma and sarcoidosis.