Causes of Heartburn (Acid Reflux)

Heartburn is characterized by a painful burning sensation that originates from the chest and spreads toward the throat. The main cause of heartburn is back flow of stomach acid into the esophagus (food pipe), leading to irritation in the unprotected esophagus. It is a very common symptom of the gastro esophageal reflux disease. It mainly occurs after taking meals, in the evening, or while lying down, and can last for several hours.

Acid reflux, heartburn and gerd infographic with medical illustration: stomach acid moving up into the esophagus causing acid reflux symptoms. Image Credit: elenabsl / Shutterstock

Due to physical and hormonal changes in the body, heartburn is very common during pregnancy. Usually, heartburn does not have any serious consequence; however, frequent occurrence can damage the esophageal lining.

Common symptoms of heartburn include burning sensation in the chest or throat, bitter or acidic taste in the mouth, difficulty in swallowing, pressure in the chest, bloating, etc. In most cases, heartburn does not need any special diagnosis.

Symptoms are easily recognizable. Generally, all these symptoms can be treated or avoided with over-the-counter drugs or just by changing the food habit and lifestyle. However, in cases of uncertainty or confusion about the symptoms, diagnostic tests that are usually considered by the physicians include X-ray or endoscopy to check the stomach and esophagus; pH test to check the acid in the esophagus; and esophageal motility testing to measure esophageal movement and pressure.   

Image Credit: sasha2109 / Shutterstock

Although a painful sensation in the chest is common in heartburn cases, an emergency medical attention is necessary if the pain is severe and persists for a long time. A severe chest pain may be a symptom of heart attack. Therefore, it is important to consult a physician if heartburn comes with following symptoms:

• Episodes of heartburn occur more than twice a week
• Symptoms persist even after taking medicines
• Difficulty in swallowing
• Frequent nausea or vomiting
• Loss of appetite
• Weight loss

Causes of Heartburn

In most cases, the main culprit for heartburn is acid reflux. When the valve, also known as sphincter muscle, at the entrance to the stomach becomes weak and does not close properly, gastric/stomach acid flows reverse from the stomach into the esophagus. This is called an acid reflux. Gastric acid agitates the esophagus and induces heartburn.

Heartburn can also occur when part of the stomach pushes up through the diaphragm, a condition known as hiatal hernia. Some food items, such as fried foods, high-fat foods, and dairy products, can relax the sphincter muscle and induce heartburn.

In addition, spicy foods, alcohol, coffee, and caffeinated drinks can induce excessive acid secretion in the stomach and increases the change of heartburn.

Certain medications, such as pain killers, muscle relaxants, sedatives, and high blood pressure medicines, are known to trigger acid reflux; thus, cause heartburn.

In some cases, obesity, overweight, pregnancy, and stressful conditions can also cause heartburn. Certain things that aggravate heartburn include smoking, carbonated drinks, citrus fruits, chocolate and peppermints, onion, etc. Lying down just after having food can also worsen the situation.  

Treatment of heartburn mainly depends on over-the-counter drugs, such as antacids, histamine H2 receptor blockers, and proton pump inhibitors. All these medications aim at neutralizing or reducing stomach acid.