What Causes Heartburn?
When we eat food, it stimulates the stomach to produce HCL to digest the food. The internal lining of the stomach is naturally protected from the harmful effects of acid. But the esophagus is not protected. The lower part of the esophagus has ring-like muscles called a lower esophageal sphincter (LES). It controls the direction of movement of food and avoids the backflow of food contents from the stomach. Sometimes due to some reasons, LES cannot close and loses its pressure. Thus, acid reflux is caused by involuntary backflow from the stomach to the esophagus which is also called acid regurgitation or gastroesophageal reflux. Acid reflux causes chest burning. In this article, you will learn what causes heartburn in acid reflux and what are the home remedies for acid reflux.
Acid reflux is a normal physiological process that occurs almost in every person. But it causes a problem when it starts occurring more frequently and damages the mucosal surface of the esophagus (esophagitis). If symptoms persist 2 times a week, then it would be called GERD (gastroesophageal reflux disease) which may initiate other problems like esophageal strictures, and Barrett’s esophagus.
This is a very common problem among US residents. About 1/3rd population of the US faced it while only 20% were admitted to hospital due to GERD as the primary cause.
Following are the symptoms of Acid reflux disease.
- Chest burn (commonly heartburn) in reality has nothing to do with the heart. Acid reflux vs heartburn is correlated.
- The sour or bitter liquid comes into the throat or mouth with food
- Chest pain radiates toward the back
- Difficulty in swallowing (Dysphagia)
- Atypical symptoms may arise from the throat, larynx, and lungs
- Bloating (Belly feels full and tight due to gas)
What are Causes of Acid Reflux?
GERD is a multifactorial disease. There may be many reasons in the context of what causes heartburn in acid reflux.
- Beverages and drinks cause bloating due to gas. When the stomach is filled with gas, it put pressure on already weak sphincter muscles
- Coffee with or without caffeine also decreases the sphincter pressure
- Citrus fruit (Orange, grapefruit, lemon, etc.) increases the acidity of the stomach
- Tomato-based products like tomato ketchup and sauces
- Chocolate (contains methyl xanthine) relaxes the Sphincter muscles
- Spicy and fried foods (relax the sphincter)
- Onions and garlic
- Avoid the cause for acid reflux would be considered a home remedy for acid reflux.
- In obesity, adipose tissues around the stomach put pressure on the weak sphincter muscles. Due to which chances of backflow increase.
- Smoking/tobacco reduces the pressure on sphincter muscles and decreases salivary bicarbonate secretions in the stomach.
- Vigorous exercise also increases the chances of acid reflux.
Treatment can be started depending upon the commonly found symptoms prior to testing. Complete testing is required if there is no response to initial therapy.
- Barium esophagram
It is an x-ray analysis in which barium is ingested before doing an X-ray scan. It is used to analyze esophagus in dysphagia (difficult swallowing)
In this test strength of the esophagus is measured by inserting a pressure-sensitive catheter into the esophagus. This catheter evaluates the pressure and strength of esophageal contractions and LES pressure.
- PH monitoring
Ph sensitive catheter is inserted into the stomach and connected with a device that recorded the 24 hours data of change in PH.
A camera catheter in front is inserted into the stomach and even the intestine through the esophagus to visualize damage.
Acid Reflux Treatments
In most cases, GERD patients are treated with a combination of medications along with lifestyle modifications. In very rare cases, surgical procedures are needed.
Home Remedy for Acid Reflux
Avoid foods that are the main risk factors for causing acid reflux. Lower sphincter muscles are weak in GERD patients, so gravity plays an important role. Avoid lying straight after having a meal and Elevate the head side of the bed to avoid backflow of food contents. Decrease the weight if you are obese. Avoid a lot of eating at once. Eat small meals 4-5 times a day.
Some patient simply feels better with lifestyle modifications but on the other hand, patients who have more symptoms, need medical treatment. Treatment can be divided into two categories. Some medicines suppress the acidity of the stomach and others increase gastric motility (prokinetic agents).
These are the medications that neutralize the acid in the stomach prior to eating. But antacids pass the stomach quickly and as a result, the stomach compensates for its acid requirement very sharply.
- H2 Blockers and Proton Pump Inhibitors (PPI)
Histamine blockers stop the histamine’s effect on acid production in the stomach by up to 70%. It helps to heal 50% of esophagitis. For example Omeprazole, Esomaperazole, lansoperazole etc.
These are the medicines that increase gastric motility and strengthen the peristaltic movement. It also increases the resting sphincter pressure. For examples metoclopramide and cisapride etc.
Surgical therapy is the patient’s personal preference to avoid chronic modification in lifestyle and medications. The most commonly used surgical therapy is Nissen fundoplication. In this treatment, the stomach is manipulated and wrapped to increase the lower sphincter pressure. Through this treatment 80-85% of patients get permanent relief from reflux.
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