Understanding Heartburn and Its Impact
Heartburn, the burning sensation caused by acid reflux, is a common issue that affects up to one in four people in the UK. It can be extremely uncomfortable and significantly impact an individual's quality of life. Dr Ajay Verma, a consultant gastroenterologist and physician, emphasizes that while heartburn is often dismissed due to its prevalence, it should not be taken lightly. “In most cases, there is a reasonable explanation for why you’re experiencing it, and it’s not something to panic about,” he says.
Causes of Reflux
The oesophagus is designed to allow food and drink to pass easily into the stomach while preventing them from coming back up. The diaphragm, a large muscle at the base of the lungs, plays a crucial role in this process. “The oesophagus goes through a small opening in the diaphragm to reach the stomach,” explains Dr Verma. “As well as aiding in breathing, the diaphragm acts like a valve, closing the bottom of the oesophagus. It opens when you eat or drink and then closes immediately.”
However, certain factors can cause this valve to become less effective. Common triggers include red wine, spicy foods, chocolate, and caffeine, which can relax the diaphragm junction. Smoking also contributes to this relaxation, as does the consumption of onions and tomatoes. Additionally, increased abdominal pressure from weight gain, pregnancy, or chronic coughing can heighten the risk of reflux by pushing part of the stomach through the gap in the diaphragm, known as a hiatus hernia.
Occupational factors can also play a role. Jobs that involve frequent bending or kneeling may gradually shift the stomach upward over time. Moreover, the timing of meals is significant. Eating late or in excess can increase the likelihood of heartburn, as the body produces more stomach acid during meals. Lying down after eating allows gravity to work against the stomach, making it easier for acid to travel up the oesophagus.
When to Seek Medical Attention
There are several symptoms that indicate when heartburn might be more serious. These include:
- A worsening of heartburn over time
- Medication no longer providing relief
- A feeling that food is stuck at chest level
- Persistent nausea and vomiting
- Unexplained weight loss alongside heartburn
These signs could suggest the development of Gastro-Oesophageal Reflux Disease (GORD), which can range from mild to severe. If left untreated, GORD can lead to inflammation and even scar tissue. “Constant acid exposure can result in cancerous changes,” warns Dr Verma. Therefore, it is essential to consult a GP if these symptoms persist.
Managing Heartburn
In most cases, heartburn and reflux can be managed through lifestyle changes and over-the-counter medications. Avoiding dietary triggers such as coffee and chocolate, especially in the evening, and ensuring the last meal is at least four hours before bedtime can help prevent symptoms. Addressing issues that exert pressure on the abdomen, such as constipation or excess weight, can also make a significant difference.
Over-the-counter treatments come in various forms. Chalky substances can neutralize acid, while alginates like Gaviscon create a protective layer over the stomach contents. Proton Pump Inhibitors (PPIs) reduce the amount of acid produced by the stomach.
Sometimes, heartburn is unavoidable. “If you are going to eat something that triggers your symptoms, understand that you will have to accept the consequences,” says Dr Verma. However, managing the condition effectively can minimize discomfort.
For those currently experiencing reflux, strategies such as drinking water to neutralize acid or sleeping propped up with a pillow can provide relief. Lying on the left side is also recommended, as it helps keep the acid deeper in the stomach and away from the oesophagus.