Heartburn Health Article

Causes

Heartburn is caused by:

• a relaxed LES that does not close properly
• over-production of stomach acid
• increased stomach pressure
• a damaged esophagus with increased acid sensitivity

Many factors can contribute to LES malfunction:

• irregular eating, skipping meals
• smoking
• caffeine
• stress
• some medications, including diazepam (Valium), meperidine (Demerol), theophylline, morphine, prostaglandins, calcium channel blockers, nitrate heart medications, progesterone, and anticholinergic and adrenergic drugs (drugs that limit nerve reactions)
• paralysis and scleroderma (an autoimmune disease that hardens body organs)
• large meals that distend the stomach and prevent the LES from closing
• alcohol, which lowers the pressure on the LES, allowing it to relax and open. Alcohol also may irritate the esophageal lining
• weakening LES and loss of LES muscle tone with increasing age

Hiatal hernias are common among pregnant women, smokers, the obese, and those over age 50. The hiatus is an opening in the diaphragm (the large muscle that separates the chest cavity and the abdomen) through which the esophagus connects to the stomach. If the hiatus loses its tautness and shape, the stomach may protrude through, forming a pocket just below the LES where stomach acid can be trapped. These hiatal hernias can cause the LES to relax and open. Hiatal hernias may result in frequent and severe heartburn and GERD.

Various factors can increase stomach pressure, causing gastroesophageal reflux:

• obesity
• lying down within one or two hours of eating
• tight clothing
• Pregnancy, which causes the enlarged uterus to displace the stomach, delaying the removal of stomach contents

Eating too fast, chewing insufficiently, and smoking all increase stomach acid production. Smoking also dries up saliva that protects the esophagus from acid.

Many foods are known to contribute to heartburn:

• greasy, fried, or fatty foods
• spicy foods
• black pepper
• such acidic foods as tomatoes, pickles, and vinegar
• chocolate
• coffee with or without caffeine
• Peppermint or other mints

Symptoms

Heartburn itself is a symptom of gastroesophageal reflux and GERD. Heartburn sufferers may salivate excessively or regurgitate stomach contents into their mouths, leaving a sour or bitter taste.

Other symptoms of GERD include:

• difficult or painful swallowing
• sore throat
• hoarseness, laryngitis, wheezing, coughing
• pneumonia
• gingivitis, bad breath
• earache