What is heartburn and why does it occur?

What is heartburn and why does it occur? Is it the same as reflux? How do they differ?

Heartburn is characterized by an increase in the secretion of acid-peptic or hydrochloric acid by the cells of the stomach. It can be produced by many circumstances; among the most common causes are bad nutritional habits such as abusing foods that increase acid secretion such as excess fatty, processed, sugary, spicy, carbonated beverages and/or very large meals.

However, it is also related to many digestive and metabolic pathologies such as dyspepsia, helicobacter pylori infection, taking certain medications, gastritis, and ulcer disease, among others.

In patients with heartburn, the most common symptoms are burning and burning pain or discomfort in the upper abdomen. On many occasions, symptoms of abdominal discomfort due to early satiety, heaviness after meals, bloating and abdominal gas may be associated.

Reflux is another entity that can be related to heartburn. Nevertheless, they differ because in reflux there is a passage of acid gastric content, and sometimes not acid, from the stomach into the esophagus producing symptoms of heartburn or retrosternal burning upward that can reach the throat leaving a metallic or bitter taste in the mouth, these symptoms can cause mucosal lesions in the esophagus, oral cavity and oropharynx.

Reflux can be produced by structural abnormalities in the lower esophageal sphincter such as hiatal hernia or also by the effect of some foods on the relaxation of the lower esophageal sphincter such as very large meals, fats, processed foods... that favor the acid secretion to ascend towards the esophagus and produce the symptoms.

What percentage of people have heartburn and which people are more predisposed?

Heartburn is a very common symptom that can affect between 10 and 30% of the population, being more frequent in Western countries attributed to lifestyle and unhealthy and increasingly processed food. The incidence is increasing and probably most people have some symptom related to increased acidity throughout their lives.

As for people who are more predisposed to heartburn we would highlight patients who are overweight and/or obese, with poor nutritional habits, smokers, high alcohol consumption and taking medications such as NSAIDs, aspirin, iron, digoxin, theophylline, erythromycin, antihypertensive drugs such as calcium antagonists, the use of anticoagulants, antiplatelet drugs and some drugs used for the treatment of depression such as selective serotonin reuptake inhibitors.

The most common pathologies related to increased acidity are Helicobacter pylori infection, gastritis, gastroduodenal ulcer, NSAID gastropathies and other less frequent pathologies such as chronic pancreatitis, digestive tumors and some metabolic disorders.

Is there such a thing as chronic heartburn? What is it?

Yes, it is characterized by an increase in the secretion of hydrochloric acid by the cells of the stomach maintained or perpetuated in time for more than 1 to 3 months. If these symptoms are not adequately treated, they can alter the protective mechanisms of the gastrointestinal mucosa and cause digestive pathologies such as erosive gastritis and gastroduodenal ulcer. If, in addition, it is associated with chronic gastroesophageal reflux, it can be related to the appearance of pathologies such as Barrett's esophagus.

There are also chronic pathologies that produce persistent acid hypersecretion such as basal acid hypersecretion and some tumors such as gastrinomas in Zollinger-Ellison Syndrome.

For this reason, if digestive symptoms persist, we should consult a physician specialized in Digestive System.

What foods are not recommended for patients with acidity and why?

It is important to reduce those foods that increase acid secretion in the stomach, such as foods with high fat content, very sugary foods, high in carbohydrates, processed and spicy, as these foods can delay gastric emptying and increase the secretion of acid by the stomach. There are certain foods that can increase peptic acid secretion such as chocolate, mint, citrus fruits, canned tomatoes, caffeinated drinks, carbonated drinks and alcohol, so it would be advisable to reduce or even suppress them in periods where the patient has digestive symptoms related to an excess of acid secretion.

We should also take care of the culinary preparations, avoiding fried, battered, heavily sauced and seasoned foods. It would be advisable to use cooking techniques that contribute less fat to food, such as water, looking for recipes that use cooking or boiling, steaming, poaching, sautéing, grilling, baking and en papillote.

It is advisable to reduce the amount of food at each meal and to eat 5 meals a day. It is also advisable to eat slowly, chewing food very well.

What to do to avoid or improve acidity?

1. We must wait at least 2 hours after eating until we go to bed and sleep.

2. Avoid overweight and obesity.

3. Perform directed physical activity appropriate to each personal situation.

4. Reduce or suspend the consumption of alcohol and tobacco as they contain numerous stimulants of gastrointestinal secretion and motility.

5. As far as possible and after assessment by your doctor, avoid taking drugs that increase acid secretion such as NSAIDs, acetylsalicylic acid and benzodiazepines.

6. If symptoms occur at night, elevate the head of the bed, e.g., use wedges under the head of the bed, foam wedges or beds with elevating headboards. Elevating only the head with another pillow has no benefit. Sleeping on the left side may improve symptoms at night in some people.

7. In patients with persistent symptoms and/or who do not improve despite adopting the appropriate hygienic and dietary measures, they should be evaluated by a physician specializing in Digestive System.

Conclusions

Heartburn can cause problems with swallowing and belching, nausea or bloating. These symptoms can sometimes last up to 2 hours or more. In some people, heartburn symptoms may cause sleep problems, chronic coughing, asthma, wheezing, or choking episodes.

It is usually worse after eating or gets worse when lying down or bending over. It gets better when sitting or standing.

Almost everyone has problems with heartburn from time to time.

It occurs more often in adults than in children. Many women have heartburn every day when they are pregnant. This is because the growing uterus puts more and more upward pressure on the stomach.