Heartburn

Heartburn can have several different causes, including the foods you eat or a more serious underlying medical condition like hiatal hernia or esophagitis. Understanding the causes of heartburn can help you identify what kind of treatment you need and why you're experiencing your symptoms.

This article discusses the symptoms and causes of heartburn. It also covers how treatments may help to treat gastroesophageal reflux disease (GERD).

Symptoms of Heartburn

While heartburn will have many symptoms, depending on its causes, some of the more common symptoms include:

• Intense burning sensation in the chest
• Chest pain while laying down or bending over
• Sour or acidic taste in the mouth
• Pain or difficulty when swallowing

While heartburn is generally related to lifestyle factors, such as food, it can also indicate a more serious medical condition, such as esophageal cancer. If your symptoms persist or intensify, contact your healthcare provider.

Some of the mechanisms that can contribute to heartburn include:

• Direct irritation of the esophagus
• Weakness of the lower esophageal sphincter (LES)
• Motility disorders of the digestive tract that result in delayed gastric emptying
• Hiatal hernia

Often, more than one of these factors contributes to bouts of heartburn.

Understanding Heartburn

Knowing how your digestive system functions can help you better understand heartburn. Your digestive tract starts with your mouth, where food is chewed and mixed with saliva, starting the process of digestion. From here, food travels to the esophagus. This muscular tube makes tiny contractions, called peristalsis, to move the food to the stomach.

The esophagus and stomach are connected by a band of muscle fibers called the lower esophageal sphincter (LES). Normally, the LES works like a valve, opening to allow food to pass into the stomach and closing to keep food and digestive juices from flowing back into the esophagus. But if the sphincter relaxes when it shouldn't, or becomes weak, stomach acid can flow backward into the esophagus causing the burning sensation known as heartburn.

Causes of Heartburn

The underlying mechanisms that can cause heartburn can also lead to the development of gastroesophageal reflux disease (GERD) if heartburn is frequent enough. GERD has multiple stages, from mild to precancerous, and it's possible to experience flare-ups many times per week.

Some of the most common causes of heartburn include:

Esophageal Irritation

Some types of food, drink, smoking, and medications can directly irritate the lining of the esophagus and cause heartburn. In the case of medications, it may help to stay upright for at least 20 to 30 minutes after taking the medication and to take the pill with a full glass of water. You may also want to speak with your healthcare provider about making changes to your diet in order to support esophageal health.

Lower Esophageal Sphincter (LES) Dysfunction

If the lower esophageal sphincter is weak or loses tone, it will not close completely after food passes into the stomach. Stomach acid can then back up into the esophagus. Certain foods and beverages, alcohol, drugs, and nervous system factors can weaken LES and impair its function.

Motility Disorders (Slow Stomach Emptying)

In normal digestion, food is moved through the digestive tract by rhythmic contractions called peristalsis. When someone has a digestive motility disorder, these contractions are abnormal. This abnormality can be due to one of two causes—a problem within the muscle itself, or a problem with the nerves or hormones that control the muscle's contractions.

When the muscles in the stomach do not contract normally, the stomach does not empty into the small intestine as fast as it normally would. The combination of more food left in the stomach plus increased pressure in the stomach due to the delayed emptying increases the risk for stomach acid to leak back up into the esophagus.

Hiatal Hernia

Hiatal hernia is often found in patients with GERD. A hiatal hernia occurs when the upper part of the stomach is pushed upward into the chest through an opening in the diaphragm. This may occur due to a weakening in the diaphragm or because of increased abdominal pressure. This opening is called the esophageal hiatus or diaphragmatic hiatus. It is believed that a hiatal hernia can weaken the LES and cause reflux.

Pressure on the Abdomen

Excessive pressure on the abdomen can put pressure on the LES, allowing stomach acid to enter the esophagus or even the mouth. Pregnant women and overweight people are especially prone to heartburn for this reason.

Other Medical Conditions

Other medical conditions that may contribute to GERD include asthma and diabetes.

Genetic Factors

Studies have suggested there is an inherited risk for GERD. This could be because of inherited muscular or structural problems in the esophagus or stomach. Genetic factors may also be an important aspect in a patient's susceptibility to Barrett's esophagus, a precancerous condition caused by severe GERD.

Lifestyle Risk Factors

Some people have a naturally weak LES that is unable to withstand normal pressure from the contents of the stomach. But other factors also can contribute to this weakening and lead to heartburn episodes.

Alcohol

Alcohol relaxes the LES, allowing the reflux of stomach contents into the esophagus. It also increases the production of stomach acid and makes your esophagus more sensitive to stomach acid. Drinking alcohol can also lead to making less healthy food choices and eating foods you know can trigger your heartburn.

Smoking Tobacco

The chemicals in cigarette smoke weaken the LES as they pass from the lungs into the blood. Cigarette smoking slows the production of saliva, which is one of your body's defenses against damage to the esophagus. Smokers also produce fewer acid-neutralizing chemicals in saliva, called bicarbonates. Also, smoking stimulates the production of stomach acid and changes stomach acid by promoting the movement of bile salts from the intestine into the stomach. Digestion is slowed while you are smoking and the stomach takes longer to empty.

Foods

People differ as to which foods trigger heartburn. These are the most common:

• Coffee, tea, and other caffeinated drinks: Caffeine can relax the (LES), allowing stomach contents to reflux into the esophagus. Caffeinated beverages may also stimulate acid production.
• Chocolate: Chocolate contains concentrations of theobromine, a compound that occurs naturally in many plants such as cocoa, tea, and coffee plants. This relaxes the esophageal sphincter muscle, letting stomach acid squirt up into the esophagus.
• Fried, greasy, or fatty foods: These foods tend to slow down digestion and keep food in your stomach longer. This can result in increased pressure in the stomach, which in turn puts more pressure on a weakened LES. All of this allows reflux of what's in your stomach.
• Peppermint is often a heartburn trigger.
• Tomatoes and tomato-based products: Any foods that contain tomatoes stimulate stomach acid production.
• Spicy foods and black pepper stimulate stomach acid production.
• Citrus fruits and juices: Oranges, lemons, limes, and other citrus fruits stimulate stomach acid production.

Eating Habits

How you eat can also trigger heartburn episodes:

• Large meals: A full stomach can put extra pressure on the LES, which will increase the chance that some of this food will reflux into the esophagus.
• Eating two to three hours prior to bedtime: Lying down with a full stomach can cause stomach contents to press harder against the LES. This increases the chances of refluxed food.

Abdominal Pressure

Excess weight can put pressure on the abdomen that can trigger heartburn, in which case your healthcare provider may recommend weight loss. Even wearing tight-fitting clothes can cause pressure in the abdomen. This forces food up against the LES and causes it to reflux into the esophagus. Tight-fitting belts and slenderizing undergarments are two common culprits. You can also feel increased symptoms when you lie down or have a full stomach.

Some people find certain types of exercise trigger heartburn. High-impact exercises that involve jumping, as well as exercises such as crunches that place pressure on the abdomen, are the most likely to be triggers.

What Medications Can Cause Heartburn?

Nearly any medication may cause heartburn; however, some render patients more vulnerable than others. Medications can cause heartburn in multiple ways. If the medication you're taking is causing you heartburn, you may want to talk to your healthcare provider about possible remedies.

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Medications that have been known to cause heartburn include:

• Antianxiety medications, such as Valium (diazepam), may not only relax your mood but your LES as well.
• Some antibiotics, such as tetracycline, can directly irritate the esophagus.
• Anticholinergics such as Compazine (prochlorperazine) and Phenergan (promethazine) can relax the LES.
• Aspirin. For some people unable to tolerate aspirin due to heartburn, enteric-coated aspirin may be an option. Never stop aspirin before talking with your healthcare provider.
• Bisphosphonates such as Fosamax (alendronate), Actonel (risedronate), and Boniva (ibandronate) can cause heartburn by directly irritating the esophagus. If your medication is causing heartburn, there are options for preparations that are given as an injection which is less likely to cause this symptom.
• Calcium channel blockers for high blood pressure, such as Procardia (nifedipine), and Cardizem (diltiazem) can result in a weakening of the LES and also slow gastric emptying. Thankfully, there are many different classes of blood pressure medications available, and switching to another class may be helpful if your symptoms persist.
• Asthma medications such as Proventil (albuterol) and theophylline
• Chemotherapy drugs
• Corticosteroids (steroids) such as Deltasone (prednisone) and Medrol (methylprednisolone) can cause heartburn as well as other significant digestive concerns.
• Hormone replacement therapy (HRT), which is a combination of estrogen and progesterone
• Narcotics can cause heartburn by delaying gastric emptying.
• NSAIDs (nonsteroidal anti-inflammatory drugs) such as Advil (ibuprofen) and Aleve (naproxen) can increase acidity in the stomach by inhibiting prostaglandins. Options for pain control such as Tylenol (acetaminophen) or even narcotic medications may be needed when NSAIDS cause significant heartburn or digestive tract upset. In some cases, making sure to take NSAIDs on a full stomach can be helpful.
• Tricyclic antidepressants, such as Tofranil (imipramine), Sinequan (doxepin), Norpramin (desipramine), and Pamelor (nortriptyline) slow gastric emptying. Many of the newer anti-depressants are less likely to cause this symptom.
• Potassium can cause heartburn by directly irritating the esophagus.
• Iron supplements can directly irritate the stomach. Some people find relief by taking these supplements with food or by using them early in the day.
• Vitamin C

How to Treat Heartburn

There are multiple ways you can treat or manage your heartburn to decrease symptoms and maximize your quality of life. For heartburn that indicates a more serious condition, please work with your healthcare provider to undergo the appropriate test and treatment plans. Some of the more common ways to treat heartburn include:

Prescription and Over-the-Counter (OTC) Medications

Depending on the frequency and severity of your heartburn, your healthcare provider may recommend prescription or OTC antacids, such as:

• Prilosec (omeprazole)
• Prevacid (lansoprazole)
• Nexium (esomeprazole)

Common OTC medications include sodium bicarbonate, antacids (Rolaids, Tums, Mylanta), Prilosec OTC, and Nexium 24HR (esomeprazole).

Diet and Lifestyle Changes

• Limiting or avoiding spicy or acidic foods
• Stopping eating or snacking three hours before bedtime
• Eating smaller and more frequent meals
• Limiting alcohol consumption

When to Call Your Healthcare Provider

Consider making an appointment with your healthcare provider if you:

• Experience intense heartburn two or more times per week.
• Have trouble sleeping due to heartburn.
• Experience nausea and severe stomach cramps.
• Have trouble swallowing.
• Taste an unusual taste (bitter, sour, acidic) during heartburn.
• Have trouble breathing.
• Experience no relief with OTC or medications.

A Word From Verywell Health

Heartburn can emerge from a variety of causes, some of which are more serious than others. It's important to know the causes of your heartburn so you can develop a treatment plan, reduce frequency and severity, and maximize your quality of life. Even though heartburn is common, it's not inevitable and it shouldn't be ignored. If you think you're heartburn may be linked to a more serious medical condition, work with your care provider to identify the causes and create a plan for treatment.