When we eat, food travels through the esophagus to the stomach. At the end of the esophagus is a valve that opens to allow food to pass and then closes so that stomach acid stays in the stomach. In heartburn, the acidic contents of the stomach flow back into the esophagus. The gastric valve can then insufficiently hold back the stomach contents. We call this gastroesophageal reflux. The esophagus is not protected from stomach acid, and this causes a burning sensation just behind or below the breastbone. This feeling can last from a few minutes to a few hours and is often worse after eating or when you lie down right after eating. Sometimes the feeling can also radiate to the neck or throat. It may be accompanied by a sour or bitter taste at the back of the throat.
Between 25 and 40 percent of the population sometimes suffers from heartburn. It is common during pregnancy and in people over 50. Occasional heartburn is not serious. When it occurs frequently, we speak of gastroesophageal reflux disease (GORD).
If the esophagus regularly comes into contact with stomach acid, inflammation of the esophagus wall (reflux esophagitis) can occur. With prolonged inflammation of the esophagus wall, the tissue in the esophagus can change. Then we speak of a Barrett’s esophagus. In this condition, the mucous membrane in the lower part of the esophagus is similar to the lining of the stomach. People with Barrett’s esophagus have an increased risk of esophageal cancer.
SYMPTOMS
• Painful, burning sensation behind the sternum
• Cramp in the sternum
• Burning sensation in the throat
• Chestpain
• Hoarseness, sore throat, cough
• Bitter, sour or salty taste at the back of the throat
• Difficulty swallowing and the feeling of having a lump in the throat
• Acid regurgitation (regurgitation) where stomach contents back up to the mouth
• Deteriorated teeth due to the acid that flows back into the oral cavity
The most common symptom of heartburn is the burning sensation behind the sternum. This is what most people with heartburn suffer from.
Heartburn mainly occurs after large meals, fatty foods, chocolate, coffee, alcohol, spicy food and acidic fruit juices. Bending, lying, lifting and wearing tight clothing can make the complaints worse.
CAUSES
There can be several reasons that cause the lower esophageal sphincter to malfunction. Causes of heartburn include:
• Stress
Psychological complaints such as anxiety, depression and stress can cause heartburn. Also, stress can encourage poor eating and drinking habits that negatively affect stomach acid production.
• Overweight
Being overweight makes the pressure in the abdomen greater than normal, making it easier for stomach acid to flow back.
• Nutrition
Fatty or spicy food, acidic fruit juices, carbon dioxide and coffee can cause heartburn. Eating too much or too quickly can also cause heartburn.
• Smoking and alcohol
Nicotine and alcohol cause the sphincter to relax. This allows stomach acid to flow back into the esophagus.
• Old age
People over 50 are more likely to suffer from heartburn, because as we age, the production of stomach acid decreases. The sphincter can also slacken and therefore close less well.
• Diaphragm rupture
In a diaphragmatic rupture (hiatus hernia), the opening between the chest and abdominal cavity through which the esophagus runs is somewhat wider than normal. This prevents the sphincter between the esophagus and stomach from closing properly.
• Use of certain medicines
Painkillers such as aspirin and ibuprofen attack the mucous membranes, causing the stomach lining to become overstimulated and react by producing extra stomach acid.
• Infection with the bacterium Helicobacter pylori
Helicobacter pylori is a bacterium that is resistant to stomach acid and can live in the mucous membrane of the stomach wall. Many people carry the bacteria without being bothered by it, but infection with Helicobacter pylori can cause bloating, heartburn, belching and nausea, among other things. Sometimes the bacterium causes inflammation of the stomach lining (gastritis).
• Heartburn pregnant
Heartburn is common during pregnancy. The pregnancy hormone progesterone ensures that the sphincter between the stomach and esophagus relaxes more easily, allowing the stomach contents to end up in the lower part of the esophagus. Later in pregnancy, heartburn can develop from the growing uterus. It then presses against the stomach, pushing the stomach acid up.
HEARTBURN DUE TO LACK OF STOMACH ACID
With heartburn, there is not always too much stomach acid, as is often thought. Heartburn is often caused by the body producing too little stomach acid. When food is not digested properly due to insufficient stomach acid and when the pancreas does not produce enough enzymes, the food remains and it starts to rot at the top of the stomach. This leads to heartburn and reflux.
With a shortage of stomach acid you quickly feel full and the food is not digested properly. The stool often contains undigested remains of food. In case of a shortage of stomach acid, it is therefore advisable to take digestive enzymes and the enzyme betaine HCL to increase stomach acid. Gastric acid inhibitors are often incorrectly prescribed, which can lead to, among other things, a deficiency of vitamin B12. This is due to the limited absorption due to too little stomach acid. In addition, the protein-splitting enzyme pepsin produced by the stomach can do its job less well when the stomach acid level decrease.
NUTRITIONAL ADVICE
Getting rid of heartburn quickly is sometimes difficult, but there are tricks that help against heartburn. These nutritional tips can help:
• Eat enzyme-rich foods such as fresh, steamed organic vegetables
• Do not eat too fatty or too spicy food
• Avoid citrus fruits if heartburn is caused by excess stomach acid. If the cause of heartburn is precisely a deficiency of stomach acid, it helps to drink a glass of water with lemon juice half an hour before a meal. This increases stomach acid production.
• Drink less coffee, carbonated drinks and acidic fruit juices
• Do not drink anything from half an hour before and during the meal. Fluid dilutes stomach acid.
• Use celtic sea salt with meals or make sole. Sodium chloride binds acids.
• Drink aloe vera juice
In addition, the following nutritional advice can help reduce the condition:
• 400-800 grams of fresh vegetables per day
• Red meat in moderation, maximum once a week
• Vary every day by swapping lean meats with vegetarian meals
• Full-fat dairy products in moderation
• About 25 grams (a handful) of nuts and seeds per day for the healthy, unsaturated fatty acids
• Avoid refined sugars and sweeteners in moderation
• Avoid soft drinks and refined fruit juices
• Preferably avoid alcohol
HEARTBURN TIPS
• Do not eat too large portions, eat slowly and chew well
• Do not eat right before going to sleep. When you lie down, the acid flows more easily into the esophagus
• Make sure your head is a little higher while sleeping
• Make sure you get enough exercise (at least half an hour a day)
• Make sure you have enough relaxation
ORTHO HEALTH FOUNDATION references: Yago, M. R., Frymoyer, A. R., Smelick, G. S., Frassetto, L. A., Budha, N. R., Dresser, M. J., … & Benet, L. Z. (2013). Gastric reacidification with betaine HCl in healthy volunteers with rabeprazole-induced hypochlorhydria. Molecular pharmaceutics, 10(11), 4032-4037.