Heartburn
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
- 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.
- alcohol,
- 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.
Next: Heartburn Symptoms
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