heartburn

and Martina Feichter, medical editor and biologist Updated on

Hanna Rutkowski is a freelance writer for the medical team.

More about the experts

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Heartburn occurs when stomach acid rises into the esophagus and irritates the mucous membrane here - for example after consuming large meals. If this only happens occasionally, there is usually no need to worry. If the burning pain and the feeling of pressure behind the breastbone occur more frequently, the reflux disease may be behind. Read more here: How does heartburn occur? What to do about heartburn When do you have to see a doctor?

Brief overview

What is heartburn? Backflow (reflux) of stomach acid into the esophagus and possibly even into the mouth. Typical signs include acidic belching and burning pain behind the breastbone. If heartburn occurs more often, it is referred to as reflux disease (gastroesophageal reflux disease, GERD).
Causes: weakness or dysfunction of the sphincter muscle at the stomach entrance, lavish meals, alcohol, coffee, smoking, citrus fruits, certain medications, pregnancy, stress, various diseases such as diaphragmatic hernia or gastric mucosal inflammation
Diagnosis: Doctor-patient conversation (anamnesis), physical examination, possibly further examinations such as mirroring (endoscopy) of the esophagus and stomach, long-term acid measurement (pH-metry) - possibly combined with the so-called impedance measurement (as pH-metry- MII), pressure measurement (manometry) in the esophagus
Treatment: Home remedies for mild, occasional heartburn (baking soda, starchy foods, nuts, etc.). Medication for persistent or repeated heartburn or reflux disease. Possibly surgical intervention for reflux disease.
Prevention: reduce excess weight; Refrain from luxury foods and foods that promote heartburn (alcohol, nicotine, coffee, spicy foods, fatty and fried foods, etc.); reduce stress through sport and relaxation techniques

Heartburn: description

The signs of heartburn can already be deduced from the name: "Boiling" stomach contents rise up into the esophagus (reflux) and cause burning pain. The typical symptoms occur especially after fatty, rich food and alcohol:

Belching, especially from acid and porridge
burning pain behind the breastbone
Sensation of pressure in the upper abdomen

In some people, gastric acid reflux also manifests itself as morning hoarseness, throat clearing, or coughing. Reason: The rising gastric juice irritates the vocal cords and the pharynx.

If the stomach contents rise up into the mouth, this not only causes an unpleasant taste in the mouth. In the long run, it can also attack tooth enamel.

If heartburn occurs only occasionally, it is usually harmless. However, frequent reflux can be a sign of reflux disease. In most cases, the lower esophageal sphincter is relaxed so that the stomach acid can rise very easily. The wrong eating and lifestyle habits often make the reflux even worse.

Consequences of frequent heartburn

The reflux disease can develop into what is known as reflux esophagitis: The mucous membrane of the esophagus (esophagus) becomes inflamed due to repeated contact with the rising stomach acid. Without treatment, a bleeding ulcer can develop. In addition, the inflammatory processes can lead to scar-like constrictions (strictures) of the esophagus. These constrictions prevent the porridge from being transported into the stomach. This can be noticeable in swallowing problems.

Another possible consequence of repeated heartburn in reflux disease is what is known as Barrett's esophagus: The cells in the lower third of the esophagus are abnormally changed. The beret esophagus is one of the precancerous stages: it can develop into a malignant esophageal tumor (esophageal cancer = esophageal carcinoma). This danger arises when the sensitive mucous membrane of the esophagus is repeatedly exposed to aggressive gastric acid for years.

Heartburn: Treatment

Those who only occasionally suffer from painful gastric juice reflux can make do with home remedies. If that is not enough or if heartburn occurs more often, you should see a doctor and have the cause clarified.

Heartburn: home remedies

Occasional heartburn can often be remedied with home remedies:

If you have heartburn, eat starchy foods such as dry white bread, rusks, potatoes or bananas: They can quickly bind excess stomach acid and so relieve heartburn.
Chewing nuts is said to neutralize stomach acid.
A spoonful of mustard after a meal is said to prevent reflux from developing due to the mustard oils it contains.
An old home remedy for heartburn is baking soda, which is found in baking soda, for example. It reacts chemically with the hydrochloric acid of the stomach. This creates water and the gas carbon dioxide (CO2). However, the latter can increase the pressure in the abdomen and thus indirectly promote acid reflux again.

Heartburn: medication

What helps against heartburn when home remedies fail or the symptoms occur more frequently? The answer: drugs from the pharmacy. Some of them are over-the-counter and some require a prescription. The following groups of active ingredients are mainly used to treat heartburn or reflux disease.

>> Proton pump inhibitors (PPIs): They are the most important remedies for heartburn and reflux disease. PPIs prevent the formation of an enzyme that opens channels on the acid-producing cells in the gastric mucosa for the gastric acid to flow out. So that means: The drugs inhibit the release of gastric acid. The stomach protection agents are freely available in small doses and in limited numbers. In contrast, higher doses of proton pump inhibitors require a prescription. Representatives of this group of active ingredients are, for example, omeprazole and pantoprazole.

>> H2 antihistamines (H2 blockers): They inhibit the action of the messenger substance histamine by occupying its binding sites (receptors) in the stomach. Actually, histamine stimulates the release of gastric acid by docking onto its receptors. However, if H2 blockers are already attached to the histamine receptors, the messenger substance cannot develop its effect - the amount of acid in the stomach drops. This can relieve heartburn and acid-related stomach upsets.

Representatives of this group of active ingredients such as cimetidine or famotidine are available from pharmacies on prescription.

The previously over-the-counter H2 antihistamine ranitidine will no longer be approved in the EU until January 2, 2023. According to the Committee for Medicinal Products for Human Use of the European Medicines Agency (EMA), medicinal products containing ranitidine are said to contain small amounts of a carcinogenic substance. This is currently being investigated. If you have any further questions about this, ask your doctor or pharmacist.

>> Antacids: These are basic salts that bind and neutralize gastric acid already formed in the stomach (e.g. magnesium hydroxide). In the past they were used more often for heartburn, but today they are used relatively rarely. You can try the over-the-counter acid binders if you only have occasional mild heartburn or if the above medication does not help. However, its effectiveness in reflux disease has not been proven by good studies.

Your doctor or pharmacist can tell you how and in what dosage the individual heartburn remedies should be taken. Follow these recommendations to avoid side effects as much as possible!

Heartburn: surgery

In certain cases, surgery can be used to treat heartburn or reflux disease. This can be the case, for example, if the heartburn medication does not work or is not tolerated or the symptoms are very severe.

In anti-reflux surgery (fundoplication), the surgeon wraps the upper part of the stomach around the lower end of the esophagus and secures it with a suture. This strengthens the sphincter muscle at the stomach entrance and prevents reflux and heartburn. The procedure is usually carried out as part of a laparoscopy.

Surgery or medication - which is better?

There are still not enough studies to be able to assess whether anti-reflux surgery is better for heartburn and reflux disease than treatment with medication. In the short term - that is, in the first year after the procedure - the procedure seems to do better: According to studies, people who have been operated on feel less restricted by heartburn during this time than patients who are treated with medication. Whether the anti-reflux operation also delivers better results in the long term needs to be investigated more closely.

Heartburn: prevention

Most people are only plagued by heartburn after a particularly large meal, heavy alcohol consumption, or stress. In fact, an unhealthy lifestyle is the most common cause of heartburn - and therefore a particularly promising treatment approach:

Avoid nicotine and alcohol. These stimulants promote heartburn through several mechanisms. Among other things, they stimulate the release of gastric acid and have a relaxing effect on the muscles - including the sphincter at the entrance to the stomach.
Chocolate, coffee, carbonated drinks, citrus fruits, spicy foods, fat and fried foods also stimulate the production of gastric acid.Test whether your heartburn improves if you omit one or the other (or several) or at least only consume them in small amounts.
If you suffer from heartburn, especially at night, you should avoid a large dinner. Instead, prefer light fare as the last meal of the day.
An early evening meal can also help against heartburn at night - some sufferers therefore do not eat anything for at least three hours before going to bed. Raising the upper body with pillows is often a good idea. This makes it difficult for stomach acid to ascend up the esophagus. Sometimes it also helps to turn over on the left side of the body while lying down if you have heartburn - the entrance to the stomach is then on top, which makes it difficult for stomach contents to flow back.
Relaxation techniques and exercise are well suited to releasing inner tension and reducing the reflux-triggering stress.
If you are overweight, there is additional pressure on the stomach, which makes it easy for gastric juice to be pressed into the esophagus. Anyone who weighs too many pounds should therefore lose weight with a healthy, low-calorie diet and plenty of exercise. Often the heartburn also improves.

Heartburn: causes and possible diseases

Heartburn or reflux disease often results from a dysfunction of the sphincter muscle between the esophagus and stomach. Normally, the so-called lower esophageal sphincter ensures that the stomach contents cannot rise up into the esophagus. Why it sometimes doesn't work properly is often unclear. However, various factors can promote reflux. These include, for example, alcohol and nicotine: They have a relaxing effect on the muscles - the sphincter between the esophagus and stomach also relaxes under the influence of beer, cigarettes, etc. In addition, the two luxury foods increase the production of gastric acid. Both mechanisms favor the occurrence of heartburn.

Large, fatty meals, chocolate, coffee, hot drinks, and citrus juices can also contribute to reflux. This also applies to some medications such as:

Anticholinergics (used in the therapy of asthma, dementia and irritable bladder, among others)
Calcium channel blockers (e.g. for cardiac arrhythmias, coronary heart disease, high blood pressure)
some antidepressants
Bisphosphonates such as alendronic acid (for osteoporosis)

Some people also report that stress, anger or a certain posture (such as prevention) favor reflux in them. People who are very overweight are also particularly prone to heartburn: their body mass and an increased amount of fat in the abdomen increase the pressure in the stomach. It can easily happen that stomach contents are "pressed" up into the esophagus.

An increase in pressure in the abdomen also occurs in pregnant women. This is why heartburn is also common during pregnancy.

In addition, various diseases can cause reflux. These include, for example:

Diaphragmatic hernia (hiatal hernia): Usually the esophagus passes through the diaphragm just before the stomach. In the case of a diaphragmatic hernia, however, the diaphragm has a hole. Part of the stomach pushes up through this hole and becomes somewhat constricted. This allows stomach contents to be pushed up into the esophagus.
Esophagitis: Esophagitis can be triggered, among other things, by swallowed foreign bodies (damage to the mucous membrane in the esophagus) or pathogens such as bacteria. The damaged, irritated mucous membrane can make itself felt with heartburn. Warning: esophagitis can also be the result of reflux.
Irritable stomach ("functional dyspepsia"): The term describes various upper abdominal complaints for which no organic cause can be found. In addition to acid regurgitation and heartburn, possible complaints include pain, pressure and fullness in the upper abdomen, nausea and vomiting, and loss of appetite.
Inflammation of the stomach lining: gastritis can be caused by the bacterium Helicobacter pylori. Irritants such as nicotine, coffee and alcohol as well as stress are also possible causes of gastric mucosal inflammation. Common symptoms are epigastric pain, nausea, heartburn, belching, bloating, and poor appetite.
Protuberances in the esophageal wall: These so-called esophageal diverticula can cause belching and heartburn, among other things.
Achalasia: This is a rare condition in which the muscles in the wall of the esophagus become less able to contract. The function of the sphincter muscle at the stomach entrance is also disturbed. The transport of food to the stomach is thus impaired, which manifests itself among other things in belching and heartburn.
Diabetes: In advanced diabetes, the nerve control of the esophagus can be affected. Even with this malfunction, the porridge transport no longer works properly.

A heart attack sometimes presents with symptoms similar to heartburn. Pre-existing heart diseases should therefore always be taken into account when clarifying the complaints.

Heartburn: when do you need to see a doctor?

Greasy, luscious food that is heavy on the stomach, and on top of it a digestive schnapps - this is an "irritating" program for the stomach that often leads to heartburn. As long as the symptoms only occur occasionally and spontaneously disappear again, they are considered harmless.

If the acidic contents of the stomach bump into you frequently, you may have a reflux disease behind your heartburn. In addition to frequent heartburn, symptoms of this disease are often a dry cough, morning clearing of the throat, voiced voice, hoarseness and a bad taste in the mouth. Such complaints should definitely be clarified by a doctor.

Heartburn: what does the doctor do?

To get to the bottom of heartburn, the doctor first has a detailed discussion with the patient. So he can collect his medical history (anamnesis). During the conversation, the doctor asks, among other things, how long the heartburn has existed, how often it occurs and whether it gets worse when lying down, for example. He also asks about any other complaints as well as known previous illnesses and whether the patient is taking any medication.

The anamnesis interview is followed by a general physical examination.

If the doctor suspects reflux disease in adult patients based on the medical history and there are no alarm symptoms (such as frequent vomiting, anemia, etc.), a trial treatment with proton pump inhibitors (PPI test) may be useful: The patient takes PPIs for about two weeks. If the symptoms improve as a result, this speaks in favor of reflux disease. Treatment with PPI will then continue.

Further examinations are normally only necessary in the following cases:

The PPI test cannot noticeably alleviate the symptoms.
The patient has symptoms that could indicate esophageal cancer or a narrowed esophagus.
There is evidence of another cause of the discomfort.

Heartburn in children usually also requires further investigation.

The following examinations can be:

Endoscopy of the esophagus and stomach: The doctor pushes a tubular instrument (endoscope) over the mouth into the esophagus and further into the stomach. At the front end there is a light source and a small video camera. This allows the doctor to examine the mucous membrane of the esophagus and stomach precisely (for example with regard to inflamed, reddened areas, constrictions or ulcers). In addition, instruments can be inserted via the endoscope, for example to take tissue samples (biopsies) for a precise analysis.

24-hour pH-metry: In this procedure, a fine probe is pushed through the nose into the patient's esophagus and placed just before the entrance to the stomach. It remains in place for 24 hours and during this time continuously measures the acidity in the lower esophagus. This is how you can detect acid reflux from the stomach.
24-hour pH-metry-MII: With this variant of the 24-hour-pH-metry described above, not only the reflux of acidic stomach contents, but also that of non-acidic stomach contents can be detected. Occasionally, this can also lead to symptoms of the disease. The abbreviation MII stands for "multichannel intraluminal impedance measurement".

Esophageal pressure measurement: In esophageal manometry, a fine probe with pressure sensors is inserted into the esophagus and then gradually withdrawn while the patient drinks water in small sips. In this way, the functionality of the esophageal muscles can be determined for each section. This examination is only recommended in certain cases, such as in patients with heartburn, difficulty swallowing, and pain behind the breastbone.

Tags: toadstool poison plants pregnancy stress