Heartburn (Pyrosis): Causes

Pathogenesis (development of disease)

The following pathophysiologic mechanisms may contribute to heartburn (pyrosis):

  • Aggressive gastric juice
  • Impaired self-cleaning powers of the esophagus (food pipe).
  • Insufficiency (weakness) lower esophageal sphincter (lower sphincter of the esophagus) (about 20% of cases are due to anatomical and functional changes).
  • Delayed gastric emptying
  • Change in the anatomical location of the junction between the esophagus and the stomach, for example, due to axial hiatal hernia (hiatal hernia or sliding hernia) or due to a so-called brachyesophagus (congenital shortness of the esophagus). In brachyesophagus, the abdominal part of the esophagus as well as parts of the gastric dome are located in the thoracic cavity (chest cavity) instead of the abdomen (abdominal cavity).
  • Muscular insufficiency (weakness) of the diaphragm legs.

In functional heartburn, there is neither gastroesophageal reflux (pathologically increased reflux of acidic gastric contents into the esophagus) as a cause nor histopathological (fine tissue) evidence of esophageal motility disorder (muscular dysfunction of the esophagus).

Etiology (causes)

Behavioral causes

  • Diet
    • Malnutrition:
      • Large, high-fat meals
      • Drinks rich in sugar such as cocoa or too much sweets (especially chocolate).
      • Hot spices
    • Fruit juices (eg citrus juices / orange juice) with a lot of fruit acids.
    • Peppermint tea and peppermint lozenges (mint).
    • Eating too hastily
    • Last food intake late in the evening before bedtime
  • Pleasure food consumption
    • Alcohol – Frequent consumption
    • Coffee – Frequent consumption
    • Tobacco (smoking) – Frequent use
  • Psycho-social situation
    • Stress
  • Overweight (BMI ≥ 25; obesity).

Disease-related causes

Cardiovascular system (I00-I99)

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Diffuse esophageal spasm – neuromuscular dysfunction of esophageal muscles with intermittent retrosternal (located behind the sternum) pain.
  • Functional dyspepsia (irritable stomach)
  • Hiatal hernia (hiatal hernia)
  • Hypercontractile esophagus (nutcracker esophagus) – motility disorder (movement disorder) of the esophagus characterized by high pressure amplitudes in the lower esophagus.
  • Gastric ulcer (stomach ulcer)
  • Esophagitis (inflammation of the esophagus):
    • Eosinophilic esophagitis (EoE; young men with allergic diathesis; leading symptoms: Dysphagia (dysphagia), bolus obstruction (“occlusion by a bite” – usually meat bites), and chest pain [children, adolescents, adults]Note: At least six esophageal biopsies should be obtained from different heights for diagnosis.
    • Infectious esophagitis (most common form: thrush esophagitis; furthermore, viral (herpes simplex type 1 (rarely type 2): cytomegalovirus, HIV (in the context of acute HIV syndrome 2-3 weeks after infection), bacterial (tuberculosis, Mycobacterium avium, streptococci, lactobacilli) and parasitic (Pneumocystis, cryptosporidia, Leishmania)).
    • Physicochemical esophagitis; esp. acid and alkali burns and radiation therapy.
    • “Tablet esophagitis”; most common triggers are antibiotics (esp. doxycycline), bisphosphonates, non-steroidal anti-inflammatory drugs (NSAIDs) and potassium chloride.
    • Systemic diseases that may be associated with esophagitis (eg, collagenoses, Crohn’s disease, pemphigus)
  • Esophageal achalasia – dysfunction of the lower esophageal sphincter (esophageal muscles), with the inability to relax; it is a neurodegenerative disease in which nerve cells of the myenteric plexus die. In the final stage of the disease, the contractility of the esophageal muscles is irreversibly damaged, with the result that food particles are no longer transported into the stomach and lead to pulmonary dysfunction by passing into the trachea (windpipe). Up to 50% of patients suffer from pulmonary (“lung-related”) functional impairment as a result of chronic microaspiration (ingestion of small amounts of material e.g.B. food debris into the lungs). Typical symptoms of achalasia are: Dysphagia (dysphagia), regurgitation (regurgitation of food), cough, gastroesophageal reflux (reflux of stomach acid into the esophagus), dyspnea (shortness of breath), chest pain (chest pain), and weight loss; as secondary achalasia, it is usually the result of neoplasia (malignant neoplasm), e.g., cardiac carcinoma (cancer of the entrance of the stomach).
  • Esophageal diverticulum – protrusions of mucosa through the muscular layer of the esophagus.
  • Esophageal ulcers – ulcers in the esophageal wall.
  • Ulcus ventriculi (stomach ulcer)

Neoplasms – tumor diseases (C00-D48)

  • Gastric carcinoma (stomach cancer)
  • Esophageal carcinoma (cancer of the esophagus)

Other causes

  • Pregnancy

Medication