One of the most common symptoms I see in my practice is heartburn.
What Is Heartburn?
Many people describe heartburn as a burning sensation in the upper abdomen or middle of the chest. Others describe a sour, acidic, or bitter taste in their mouth.
Heartburn occurs when the valve between the stomach and the esophagus (food pipe), called the lower esophageal sphincter (LES), does not close properly. When this happens, stomach acid can travel upward into the esophagus, causing irritation and a burning sensation.
Heartburn can present differently from person to person. Examples include:
- A young child with occasional vomiting
- A stressed teenager who feels nauseated whenever they eat
- A woman experiencing chest discomfort
- A man who complains of abdominal bloating
However, the most common symptom remains a burning sensation in the upper abdomen or middle of the chest.
Many people experience heartburn from time to time, and it is often not a serious condition. However, frequent heartburn or heartburn associated with certain warning signs may indicate a more significant medical problem.
Let’s first understand how the stomach works.
Function of the Stomach
The stomach is a muscular pouch that receives the food we eat. It produces acids and enzymes that help digest food so nutrients can be absorbed through the gastrointestinal tract and used to nourish our bodies.
While the stomach is doing its job, the lower esophageal sphincter (LES) remains closed, keeping stomach contents where they belong.
What Causes Heartburn?
The simple answer is: acid.
The more complete answer is: many different factors can contribute to heartburn.
Let’s explore some of the common causes.
Main Cause: LES
When the lower esophageal sphincter (LES) does not close properly, stomach contents, including acid, can travel upward into the esophagus. This causes the familiar burning sensation known as heartburn.
Some people may also develop a sore throat if acid reaches the throat.
Imagine pouring vinegar onto a cut or a sensitive area inside your mouth. It would burn. Stomach acid can have a similar irritating effect on tissues that are not designed to tolerate acid exposure.
Anything that causes the LES to not close properly will cause heartburn. Let’s further explore.
Dietary Cause
Certain foods and beverages are known to trigger heartburn, particularly foods that are acidic, spicy, fatty, or highly processed.
Common examples include:
- Tomato products, including tomato sauce
- Pizza
- Coffee
- Spicy foods like Hot sauce
- Alcohol
- Chocolate
- Fried foods
- Peppermint
Not everyone has the same triggers, so it can be helpful to pay attention to which foods worsen your symptoms.
Positional Cause
Lying down soon after eating is a common cause of heartburn.
It generally takes about three hours for the stomach to empty much of its contents. When you lie flat immediately after a meal, gravity is no longer helping to keep stomach contents in place.
Think of a bottle filled with liquid. When it is standing upright, the liquid stays at the bottom. When the bottle is turned sideways, the liquid spreads out. The same principle applies to the stomach.
The stomach has a protective lining designed to tolerate acid. The esophagus and throat do not. As a result, acid can cause chest burning, throat irritation, chronic cough, or a sour taste in the mouth.
Waiting at least three hours after eating before lying down can help reduce heartburn symptoms.
Anatomical Cause
People with a hiatal hernia have a higher risk of developing heartburn.
A hiatal hernia occurs when part of the stomach moves upward through the diaphragm into the chest cavity. This change in anatomy can make it easier for stomach acid to reflux into the esophagus.
Pregnancy also causes heartburn due to anatomical as well as hormonal reasons.
Infectious Cause
A bacterial infection called Helicobacter pylori can contribute to stomach inflammation and heartburn like symptoms. Treatment for Helicobacter pylori infection typically involves a combination of antibiotics and acid-reducing medications.
Lifestyle Cause
Several lifestyle factors can increase the risk of heartburn, including:
- Tobacco use
- Excessive alcohol consumption
- Large meals
- Irregular eating habits
- Late-night eating
- Excess body weight
- Tight clothing around the abdomen
Emotional and Mental Health Cause
Stress, stress, and more stress!
Stress can affect the digestive system in many ways. It may increase sensitivity to stomach discomfort, contribute to unhealthy eating habits, and disrupt normal digestion.
Medication Cause
Certain medications can contribute to heartburn, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin
- Some diabetes and weight-loss medications known as GLP-1 receptor agonists
- Osteoporosis medications called bisphosphonates
- Certain blood pressure medications
- Supplements like iron
- Some antibiotics like doxycycline
For this reason, your doctor may recommend you to take certain medications with food.
Autoimmune Cause
Certain autoimmune conditions can contribute to heartburn symptoms, including:
- Eosinophilic esophagitis
- Systemic sclerosis (scleroderma)
- Sjögren’s syndrome
- Lupus
These conditions often require specialized testing and evaluation by specialists.
Should I Be Worried About Heartburn?
Occasional heartburn is common. Over-the-counter antacids such as Tums or Famotidine may provide temporary relief. It is also helpful to identify potential triggers. For example, you may notice that drinking coffee on an empty stomach time to time causes heartburn and you may eat food before you drink your coffee to avoid getting a heartburn.
However, frequent heartburn should NOT be ignored.
Regular heartburn symptoms may indicate a condition called gastroesophageal reflux disease (GERD). Over time, GERD can lead to complications such as:
- Esophagitis (inflammation of the esophagus)
- Ulcers
- Narrowing of the esophagus
- Barrett’s esophagus (a precancerous condition)
- Esophageal cancer
If you experience heartburn regularly, it is important to see your doctor for further evaluation.
The cause may be relatively simple, such as dietary habits, stress, or excess weight. It may also be related to an infection, medication side effect, hiatal hernia, or another medical condition that requires treatment.
Alarm Symptoms
Seek medical attention promptly if you experience:
- Difficulty swallowing
- Food getting stuck when swallowing
- Unintentional weight loss
- Black or tarry stools
- Vomiting blood
- Persistent chest pain
- Ongoing sore throat or hoarseness
Your primary care physician may refer you to a gastroenterologist for additional testing if needed.
A Holistic Approach to Heartburn
Treatment for heartburn can involve lifestyle changes, medications, and sometimes surgery, depending on the underlying cause.
In my practice, I often find that patients have multiple contributing factors.
It may be:
- A busy professional who drinks coffee on an empty stomach, eats fast food for lunch, and has late dinners.
- A teenager experiencing significant academic stress and poor appetite.
- A grieving spouse who has increased alcohol consumption after losing a loved one.
- A family facing food insecurity and limited access to healthy food choices.
- An older adult with chronic pain who is less active, gains weight, and develops reflux symptoms.
Heartburn is often not caused by just one thing.
That is why I encourage patients to look at themselves as a whole person—not just a stomach, an esophagus, or a symptom.
Questions to Consider
Are you experiencing heartburn?
What factors in your life might be contributing to it?
Would you consider looking at your health through a holistic lens and explore the challenges and opportunities affecting your well-being?
Would you consider partnering with your doctor to identify the root causes and create a treatment plan that works for you?
Sometimes the path to feeling better begins with asking the right questions.
Final Thought
Heartburn happens. Treat the cause. Get help when appropriate. And be healthy!
