What Causes Chronic Heartburn?
Heartburn is a familiar experience for most people, even if it only occurs after eating a lot of spicy, fatty, acidic, or fried foods. Indeed, according to the American College of Gastroenterology, the burning feeling associated with heartburn affects an estimated 15 million Americans every day and 60 million Americans at least once a month. But for many people, heartburn isn’t just an occasional nuisance after indulging in hot wings; rather, it is an unpleasant, chronic condition that is also known as GERD.
GERD vs Heartburn vs Acid Reflux
When people talk about heartburn, they’re really referring to a specific condition called acid reflux. When someone has acid reflux, it means that digestive acids and other stomach contents have risen up into the esophagus and are causing inflammation. The presence of stomach acid on esophageal tissue results in the pain and discomfort we associate with heartburn. When acid reflux becomes recurrent and chronic (usually two or more times a week), it is recognized as gastroesophageal reflux disease, or GERD for short. In this sense, the terms “chronic heartburn” and “GERD” are essentially interchangeable.
What Causes GERD?
To understand the causes of heartburn and GERD, it’s helpful to know how it works. The primary “mechanism” of the underlying acid reflux is a problem with the ring of muscle between the esophagus and the stomach. This ring of muscle is called the lower esophageal sphincter (LES) and, under normal circumstances, relaxes to allow chewed food to pass from the esophagus to the stomach; then, it automatically closes to prevent anything in the stomach from backing up into the esophagus.
Blocking off the lower esophagus is important for smooth digestive function, largely because the process of peristalsis in the stomach involves aggressive churning that can cause the stomach contents to slosh around. In some situations and for some people, the LES sometimes either doesn’t close all the way or stays open longer than it should; this allows the corrosive acids of the stomach to irritate the esophageal lining. Over time, an abnormally functioning LES can lead to a variety of serious gastrointestinal conditions.
As noted earlier, many people associate heartburn with eating too much of a certain food or drinking too much alcohol. While these are some potential causes of acute acid reflux, the story is more complicated when thinking of chronic acid reflux/GERD. Below are some risk factors that can negatively affect the lower esophageal sphincter:
- Obesity: Obesity is a factor in many gastrointestinal conditions, but the impact on acid reflux seems to be primarily about the physical presence of excess weight. Weight carried around the midsection actually increases pressure on the entire abdominal cavity; this, in turn, can cause even more stomach acid to be pushed up into the esophagus.
- Pregnancy: Pregnant women are unfortunately more likely to get chronic heartburn for most of the pregnancy. Part of the reason for this is similar to obesity: the weight of the fetus puts pressure on the gastrointestinal system. Additionally, hormones secreted during pregnancy cause digestive motility to slow down and interfere with normal LES function.
- Smoking: In addition to the many other reasons smoking is unhealthy, it also has a negative impact on the digestive tract. The main concern is the fact that nicotine contained in tobacco relaxes the LES and impairs its function. Also, the smoke itself can contribute to heartburn by irritating the lining of the esophagus.
- Medication: Some medications that are prescribed for long-term conditions can also inadvertently cause or contribute to GERD. Examples include asthma medicines, tricyclic antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Hiatal Hernia: Though not as common as others, another possible cause of GERD is having a hiatal hernia. On the way from the mouth to the stomach, the esophagus passes through the diaphragm, a sheet of muscle that aids in respiration and keeps the upper abdominal cavity in order. In a hiatal hernia, part of the stomach pushes up through the small opening in the diaphragm; this can cause significant acid reflux as well as damage to the lower esophageal sphincter.
Symptoms of GERD
The most basic symptom of GERD is heartburn itself, the painful burning sensation that comes from the breastbone in the middle of the chest and can even radiate out toward the arms. But as heartburn becomes chronic and/or more severe, it can cause a variety of additional symptoms. One common example is regurgitation; in such cases, stomach contents back up the esophagus so far that acid or partially digested food can be tasted in the back of the throat. Other possible symptoms include:
- chest pain
- coughing or hoarseness
- difficulty swallowing or pain while swallowing
Complications of GERD
Heartburn that recurs often enough to become GERD is generally not a serious concern. For most people, it will be an uncomfortable annoyance for a while. If left untreated, though, GERD can eventually lead to a number of other more serious conditions:
- Esophagitis: This is the long-term effect of stomach acid on the epithelial lining of the esophagus. The irritation and inflammation can eventually cause painful and dangerous ulcers to form.
- Stricture: Another side effect of long-term stomach acid exposure is that the tissue can become scarred; over time, built-up scar tissue narrows the esophagus and can interfere with swallowing and digestion.
- Barrett’s Esophagus: About 10% of people with long-term GERD will develop Barrett’s esophagus, a condition where the actual cells of the esophagus begin to change as a result of repeated damage from acid reflux. While it doesn’t have any specific symptoms, it is primarily a concern because it increases the risk of cancer.
- Esophageal Cancer: Whether from Barrett’s esophagus or another underlying cause, sometimes long-term damage to the cells of the esophagus can lead to cancerous, abnormal growth.
Treatment for GERD and Heartburn
For many cases of GERD or even simple heartburn, the best treatment is simply avoiding the activities that lead to acid reflux; this might include limiting fatty or spicy foods, reducing alcohol consumption, and quitting smoking. Also, working to reduce abdominal fat can go a long way to preventing GERD. For those with medication-related acid reflux, talk to your doctor; they may be able to prescribe a different medication.
Even with lifestyle changes, however, other treatment methods are sometimes needed. Numerous over-the-counter medications are available that can relieve the symptoms of GERD, but you can also get prescription medication from a doctor if needed. Below are the main categories of GERD medication:
- Antacids: neutralize stomach acids and include Tums, Rolaids, Mylanta, and Maalox
- H-2 blockers: decrease stomach acid production and include Tagamet, Pepcid AC, and Zantac
- Proton pump inhibitors (PPIs): reduce stomach acid and heal damaged esophageal tissue and include Prilosec, Prevacid, and Nexium
- Baclofen: reduces relaxation of the lower esophageal sphincter
Contact a Gastroenterologist
Chronic heartburn in the form of GERD can really begin to affect someone’s quality of life, especially because for many people it affects their ability to sleep soundly at night. If you’ve been experiencing recurring heartburn and it doesn’t seem to be going away, it might be time to contact us at Cary Gastro to request an appointment. We are passionate about providing excellent digestive healthcare.