Triggers of heartburn: what’s burning you?

Heartburn or acid reflux is the sensation of burning and pain in your chest that is often accompanied by a bitter taste. Oesophagus, the tube that connects your stomach and throat, gets irritated by stomach acid backing up, leading to burning discomfort in the area under your breastbone or upper abdomen. The condition draws its name from the region that it affects, which makes the sensation feel like your “heart is burning”.

Heartburn may occur more frequently after a large meal, while lying down, or bending. The specific factors that trigger heartburn can vary from person to person as well. Though heartburn symptoms are fairly common and can be managed at home, if they occur too frequently and interfere with you being able to swallow easily, there may be an underlying medical condition causing it.

The common symptoms of heartburn are:

• A bitter or strong, acidic taste in the mouth.

• A sensation of burning in the chest. It may usually occur after eating and at night.

• The discomfort increases upon lying down or bending.

What causes heartburn?

Heartburn typically occurs due to contents of the stomach backing up the oesophagus. This involves a problem with a valve called the lower oesophageal sphincter (LOS). The LOS is located where the oesophagus meets the stomach. The function of the LOS is to keep stomach acids and the contents contained to the stomach with the help of gravity and your natural upright posture. It opens to let food into the stomach or to allow gases out when you burp.

Sometimes, the LOS can open too frequently or not close tightly enough, allowing the stomach acid to back up into the oesophagus and leading to heartburn. The cause or factors that trigger this problem can be related to eating habits, lifestyle, diet, or even exercise. Let’s examine these factors in detail.

Heartburn triggers: diet

Certain kinds of food and drinks that can trigger heartburn in people who are susceptible to the condition:

• High-fat foods. They sit longer in the stomach longer and are the most common trigger for heartburn.

• Spicy foods such as red and green chillies, various kinds of peppers, garlic, and raw onions.

• Alcohol, red wine in particular.

• Carbonated drinks like flavoured sodas and colas.

• Caffeinated drinks such as coffee, tea, and energy/ sports drinks.

• Chocolate and other sweets.

• Citrus fruits such as lemon, grapefruit, and orange.

• Products made from citrus fruits such as juices and concentrates.

• Peppermint

Heartburn triggers: lifestyle

Lifestyle choices or health conditions can exacerbate heartburn as well:

• Smoking

• Sustained mental stress and anxiety.

• Conditions that put pressure on the stomach, such as obesity, pregnancy, and constipation.

• Overeating, resulting in too much food in your stomach.

• Lying down or sleeping too soon after meals. It is advisable to sleep after 2 hours of eating. This allows the food to pass from the stomach into the intestines and not back up into the oesophagus.

• Consumption of NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin and ibuprofen, some types of blood pressure medication, and heart disease medicines such as nitrates and calcium channel blockers.

Heartburn triggers: exercise

Abdominal pressure due to exertion or body positions involved in certain exercises can cause heartburn:

• Exercise positions that involve bending over can increase pressure on the abdominal area and cause stomach acids to be pushed back into the oesophagus.

• Exercises that exert pressure on the abdomen, such as leg crunches, crunches, and other ab workouts.

• Positions and yoga moves such as headstands and the downward dog that can reverse the natural flow of stomach acids.

• High-impact exercises and sports, such as running, football, basketball, and aerobics, which jar your body and slosh stomach contents upwards if you suffer from a weak LOS.

• Exercising on a full stomach or before the food has not left the stomach and travelled down to the intestines.

When should you see your doctor for heartburn?

Heartburn that lasts for more than 2 weeks and does not respond effectively to medication can indicate an underlying medical issue. Heartburn can be a symptom for digestive conditions such as GERD (gastroesophageal reflux disease) or ulcers, which are sores in the stomach or oesophageal lining.

Consult your doctor if you develop the following issues with heartburn:

• Difficulty or pain while swallowing.

• Difficulty in breathing or shortness of breath.

• Pain that spreads outwards from your back to your shoulder.

• Sweating during discomfort in the chest.

• Dark tarry stools with or without blood.

• Dizziness or lightheadedness.

Preventions and treatment

Heartburn prevention mostly involves avoiding the triggers discussed above. The lifestyle or diet changes should suffice in most cases to alleviate a tendency to develop heartburn. Your doctor may also prescribe you medication to treat occasional instances of heartburn, such as antacids, H2 receptor antagonists to reduce the production of stomach acids, and proton pump inhibitors to block stomach acid production. You can also maintain a log of heartburn instances to track your heartburn triggers and decide appropriate portion sizes for yourself.

However, if these measures do not improve your symptoms and the condition persists, your gastroenterologist will have to conduct a few tests to diagnose your condition accurately for a timely intervention.

These include:

• An endoscopy to check for ulcers or signs of irritation in your stomach lining or the oesophagus.

• An x-ray of the abdominal region.

• A ph-test to determine the acid levels in your oesophagus.

Identifying and understanding what triggers your heartburns can go a long way in managing and avoiding the discomfort of heartburn. Occasional episodes of heartburn are easily managed at home and little cause of concern, but chronic heartburn can limit your food choices and interrupt daily activities and sleep. Keeping a record of when and what you eat can help your doctor diagnose your symptoms better to identify the root cause of the heartburn. If you are facing issues with heartburn too frequently and it is beginning to affect your daily activities, you are advised to consult the gastroenterologists at the Department of Gastroenterology and Hepatology at Sagar Hospitals.