Acid Heartburn

What is Heartburn?

Heartburn occurs when the acid contents of the stomach pass backwards up into the food pipe (called the gullet or oesophagus). This is also known as stomach acid reflux.

Most people have stomach acid reflux at some point in their lives, either as heartburn or acid regurgitation.

What causes heartburn?

Heartburn typically occurs after eating a large meal or drinking a lot of alcohol. Some people get heartburn when they bend over or lie down.

The frequency of stomach acid reflux varies from one person to another. For most people, it happens very rarely. But weekly or daily incidents of heartburn or acid regurgitation may occur.

Is heartburn dangerous?

Heartburn is annoying and may have a detrimental effect on a person's wellbeing. Sometimes the tendency for heartburn may develop into a mucous membrane inflammation in the food pipe, also known as oesophagitis.

Occasionally, reflux oesophagitis may become complicated if scars cause a tightening or narrowing (sphincter) in the food pipe.

A gullet stricture can prevent swallowing. This is a serious condition, which requires immediate examination and treatment.

How does gastric acid end up in the food pipe?

At the lowest part of the food pipe there is a ring of muscle (sphincter) where it passes through a hole in the diaphragm.

The diaphragm

The diaphragm is a thin sheet of muscle dividing the lungs from the stomach.

The diaphragm holds the gullet sphincter in place and the system works as a one-way valve.

If the one-way valve does not function properly, acid from the stomach (gastric acid) will be able to pass up into the food pipe. This tendency increases if:

  • the stomach contains large amounts of food or fluids (especially if the food is fatty, the drink alcoholic)
  • there is something pressing on the stomach, eg such as occurs when people are overweight.

What increases the risk of heartburn?

There is often no known reason for increases in heartburn. But occasionally one of the factors below may contribute.

Other risks

  • Chocolate, peppermint, coffee and alcohol hamper sphincter function.
  • Tobacco hampers the function of the sphincter.
  • Constipation increases the chance of acid reflux.

This is the name for the condition where the upper part of the stomach has passed up through the hole in the diaphragm.

This means the muscle fibres of the sphincter can't press on the lower part of the food pipe. As a result, the lower part of the gullet is normally open, when it should be closed.

Obesity

In people who are overweight, the fat in their abdominal cavity exerts more pressure on the stomach.

This causes high pressure inside the stomach, and the contents of the stomach may then be pushed up into the food pipe.

Weight loss will reduce the chance of stomach acid reflux.

Pregnancy

The enlarged uterus (womb) presses on the stomach. This causes the same kind of high pressure inside the stomach as in people who are overweight.

The change that pregnancy brings to the balance of the hormones also leads to a general relaxation of the gullet sphincter.

Large meal portions

The risk of stomach acid reflux increases with more food in the stomach.

The risk will be greater after large (and especially fatty) meals, where the food is in the stomach for a long time before it passes on to the intestines.

If you avoid eating more than is necessary, the risk of stomach acid reflux is reduced.

Lying down

If you lie down, the chance of stomach acid reflux increases due to gravity.

You can avoid this to some extent by raising the head-end of your bed (see tips below).

What can I do to help myself?

  • If you are overweight, try to lose a few kilograms.
  • Avoid large fatty meals and try not to eat just before bedtime.
  • Try to cut down on coffee.
  • Avoid drinking too much alcohol.
  • Quit smoking or reduce your smoking habits
  • If suffering from nightly symptoms, try using an extra pillow or putting a couple of books under the legs at the head of the bed.
  • If heartburn or acid regurgitations are rare (less than five times a month) medicines bought from a chemist such as antacids can be used.

What medicines treat heartburn?

Antacids (such as Rennie and Gaviscon )

Since heartburn is caused by acid from the stomach, one of the simplest ways to relieve the discomfort is to neutralise the acid with an antacid.

Antacids usually contain a mixture of magnesium and aluminium salts, calcium carbonate or sodium bicarbonate.

Those containing high amounts of sodium may not be suitable for pregnant women or those on a sodium restricted diet, such as people with high blood pressure or heart disease.

Antacids are available as tablets that can be sucked or chewed and liquids. The choice is down to personal preference, but liquids may work faster and tablets may have a longer lasting effect.

Antacids can reduce the absorption of certain other medicines from the gut, so if you are taking any other medicines you should always check with your pharmacist before taking an antacid at the same time.

When should I consult my doctor?

If heartburn or acid regurgitation occurs often, or the symptoms are very annoying, consult your doctor. You should also consult a doctor if you:

  • have trouble swallowing
  • are middle-aged or older and have new symptoms
  • have suddenly lost a lot of weight.

Your doctor will decide whether a further examination or more effective medicine is needed.

Sources:

Page Created: 03 March 2011

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