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Beat back the flames of heartburn

You knew it from those country songs: Sometimes feeling like your heart is on fire is not a good thing.

Heartburn, or acid indigestion, actually has nothing to do with your heart. The most common symptom is burning chest pain that begins behind your breastbone and moves upward to the neck and throat. It may feel like food is backing up into the mouth, leaving a bitter taste.

What it is

The muscle that connects the esophagus with the stomach, called the lower esophageal sphincter (LES), acts as a valve to stop food and stomach acids from flowing back up the esophagus. But if the LES is weakened, stomach acids back up and cause the unpleasant sensations of heartburn.

Causes

According to the National Institute of Diabetes and Digestive and Kidney Diseases, causes of heartburn can include:

  • Gastroesophageal reflux disease (GERD). GERD is a chronic condition caused by the routine backup of stomach contents into the esophagus.
  • Hiatal hernia. A hiatal hernia is caused when a small hole forms in the diaphragm—the muscle that separates the stomach from the chest. When this happens the stomach can move up into the chest. Many people have hiatal hernias without symptoms. However, it is a common cause of heartburn.
  • Weight. Being overweight can contribute to both a weakening of the LES and hiatal hernia.
  • Pregnancy. Many pregnant women experience occasional heartburn. Pregnancy increases the risk of heartburn because the uterus expands, pushing against the stomach, and because of a generally slowed digestive system.
  • Food triggers. Some foods and drinks may weaken the LES and cause heartburn. Common triggers are chocolate, peppermint, fried or fatty foods, coffee, and alcoholic beverages. Smoking also relaxes the LES.

Simple solutions

Most people with heartburn can find relief by changing their lifestyle and diet. Your doctor can work with you to develop a plan that may include:

  • Losing weight. This is no easy task, but many overweight people find relief from heartburn when they slim down.
  • Decreasing meal portions. Eating too much may cause a too-full stomach to expand and push food backward into the esophagus. Decreasing the size of your meals can also decrease heartburn symptoms.
  • Avoiding trigger foods. Some foods and beverages can irritate the esophagus or weaken the LES—fried or fatty foods, citrus fruits and juices, tomato products, peppermint, chocolate, alcohol, coffee, and pepper commonly cause or aggravate heartburn.
  • Quitting smoking. Not only will heartburn symptoms abate, your overall health and life expectancy will improve.
  • Not eating before bed. Avoid lying down at least three hours after eating. It can cause stomach contents to back up past a weakened LES.
  • Elevating the head of your bed. Safely raise the bed 6 to 8 inches using blocks under the bedposts.
  • Taking antacids. As a short-term fix, antacids work well for many people. If your problems persist, check with your doctor. Other medications are available, and long-term use of antacids may cause side effects. If you are pregnant, don't take any medication without consulting your doctor.

As uncomfortable as it is, heartburn is seldom life-threatening. If your symptoms persist, there are a number of treatments that can help you feel better.

A small number of people who don't respond to lifestyle changes or medications may need surgery.

Reviewed 3/4/2024

Sources

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