The majority of us experience heartburn at some point in our lives. It is commonly presented as a burning sensation in the chest, which may sometimes be relieved by just swallowing saliva or water. The sensation can also be sharp or pressure-like, which should be differentiated from heart pain (angina) and heart problems by a doctor.
Causes of Heartburn Heartburn occurs when acidic content leaks back up from the stomach to the oesophagus (the tube which connects our mouth to our stomach). Unlike the stomach, the oesophagus does not have a special protective lining against acid. As a result, discomfort is experienced when the acid attacks the oesophagus walls.
Excessive pressure on the abdomen and stomach may induce stomach acid to flow back into the oesophagus, and this may be cause by reasons such as:
- Being overweight
- Tight Clothing
Certain triggering foods have also commonly been known to cause heartburn when consumed.
These foods are often high in acidity and include:
- Caffeinated drinks
- Carbonated drinks
- Citrus fruits
- Spicy food
- Fatty food
- Medication like painkillers (e.g. aspirin, ibuprofen or naproxen) and osteoporosis medicines (e.g. alendronate, risedronate)
Other common causes of heartburn include:
- Stress and anxiety
Over-the-counter antacids provide immediate temporary relief to the high acid content in the stomach. Interestingly, in the past, people used to chew on chalk (containing calcium carbonate) to ease heartburn, which is similar to the calcium-containing antacid preparations of today.
Antacids may also contain aluminium or magnesium salts as neutralising salts. In addition to those neutralising salts, some products may contain a foam barrier to prevent reflux. Do take note that calcium and aluminium may cause constipation, while magnesium may cause diarrhoea. Antacids should not be taken together with your other medications, unless as advised by your healthcare professionals.
H-2 Receptor Antagonists
If antacids do not relieve your heartburn, H-2 receptor antagonists (e.g. ranitidine, famotidine or cimetidine) or proton pump inhibitors (e.g. omeprazole, esomeprazole or lansoprazole) that reduce acid secretion may be recommended by your healthcare professionals. They are best taken before meals for maximum effect.
Lifestyle modifications such as maintaining a healthy body weight can reduce the occurrence of heartburn. Wearing loose-fitting clothes can also help to reduce abdominal pressure. If your heartburn is caused by stress and anxiety, try to relax by exercising, listening to soft music, or doing deep breathing exercises.
Heartburn patients should also avoid overeating and try to minimise the consumption of triggering foods. You should try smaller, more frequent meals instead. As heartburn can be worsened by bending or lying down, avoid lying down up to three hours after having a meal. If you suspect that you are taking medicine that causes heartburn, you should inform your pharmacist or doctor.
Smoking cessation is recommended for smokers who suffer from persistent heartburn. If quitting smoking is not an option, smokers should at least refrain from smoking immediately after meals.
Elevating the head of the bed (by at least six inches with a foam wedge) to prevent backflow is recommended for those who suffer from heartburn at night. Using a pillow (instead of a foam wedge) can be counterproductive as it may cause patients to bend at the waist, which would in turn increase the pressure on the stomach and the probability of gastric juice backflow.
If you suspect the cause of your heartburn to be pregnancy, check with your pharmacist or doctor on the suitable medication for heartburn during pregnancy.
When you should consult a doctor
Frequent heartburn that disrupts daily activities is considered to be gastroesophageal reflux disease (GERD) and can lead to more serious conditions such as oesophageal ulcers or cancer. Having frequent, persistent heartburn or alarming symptoms such as vomiting blood, dizziness, difficulty in swallowing, black stools or unintended weight loss should warrant a prompt consultation with a doctor.