Heartburn: Introduction

Many people experience heartburn or indigestion at some stage in their lives. In most cases, heartburn will not be serious. Dr Joe Kosterich explains what happens in heartburn, the different forms of heartburn, tests that can be used to diagnose it, and ways it can be managed.

Most people will experience some indigestion or heartburn at some stage through their life. When you think about it, most people – at least in the developed world – are eating three meals a day, and heartburn or indigestion is something that is likely to come on after meals.

So what are we actually talking about? When food goes into the stomach, the stomach naturally produces acid. It’s supposed to do that, and that helps to break down the food to aid the absorption. If the acid stays in the stomach, that’s fine – the stomach lining is designed to cope with it and manage it. If some of that acid escapes up into the oesophagus or gullet, the oesophagus is not actually designed to cope with that, and the acid will burn the lining of the oesophagus. That is what we experience as heartburn.

The area where you feel it is near to where your heart is, because the oesophagus runs behind the heart, and hence people get a feeling of burning in the area where their heart is.

There are different forms of heartburn. For most people, if they get it as a little bit of a once-off – or perhaps you’ve eaten a little bit too much chilli-type food, or maybe the Indian food you had last night disagreed with you – it’s fairly easy to manage. There are some things you can buy over the counter, some antacids and some other medications that can be used. These will generally settle it down, and there’s not a lot else that you need to do.

For people getting it more frequently, or perhaps through the night or at times that are not directly related to meals, and it doesn’t settle down after no more than two weeks of use of some medication you can get from the chemist, that’s the time to be going to see your doctor.

Pains in the chest can have lots of different causes. Sometimes people think they have heartburn, but they may actually be brewing some problems with the lungs, heart or some of the other structures in the chest. This is going to be the exception, but it goes to say that if symptoms are persisting, you should go along and see your doctor and get it checked out.

There are some other tests that can be done for people who are getting heartburn that’s getting a little bit more serious and perhaps going for a longer period of time. There is a test called a gastroscope, where under sedation a tube is passed down the oesophagus to look into both the oesophagus and stomach. These procedures are done by a gastroenterologist.

For those who have had a gastroscope, it may show that you have some reflux which is, of course, acid going from the stomach up into the oesophagus, and for some people it may show what is called a hiatus hernia.

Despite being a little bit painful and uncomfortable, heartburn or reflux is not a serious condition in the vast majority of cases.

There are some simple things that you can do yourself. First and foremost, most people will find that certain foods or certain things they do tend to bring it on. While there is no specific reflux or heartburn diet to follow because it is specific to the individuals, if you find that every time you eat chillies you get some heartburn then you may want to go easy on them, or at least know what’s coming up next and be prepared. For a lot of people, alcohol will contribute to heartburn. If people have had too much to drink, apart from all the other issues with that, it may also cause some heartburn, so go easy on the alcohol.

Something that will contribute to and sometimes worsen reflux and heartburn is if you are overweight. That means that one of the simple things you can do that’s going to help reflux is to eat smaller meals and eat a little bit less – that will help you with your weight loss program and will also help your heartburn and reflux.

For some people, if they do get reflux at night time, then sleeping on a second pillow can assist with that, and some people even go to the extent of putting half a brick under the head of the bed so the bed is on a slight tilt. That does help some people, though some people find it equally annoying – it really just depends.

Prevention, where possible, is always better than cure. For a lot of people, just trying to avoid the foods or drinking too much alcohol that may contribute to reflux and heartburn. Simple treatments that you can get over the counter are quite okay in the first instance, and there are a range of different things you can use. However, if it is ongoing – certainly beyond the two-week stage – then it’s worth going along and having a check with your doctor. There may be just a continuation of some medication to use, or there might be some other recommendations made. So simple things first, then go and see your doctor if the symptoms do persist.

More information

For more information on acid reflux and heartburn and related investigations, treatments and supportive care, see Acid Reflux and Heartburn.