Heartburn: Treatment and Causes

Brief overview

What is heartburn? Reflux of stomach acid into the oesophagus and possibly even into the mouth. Typical symptoms include acid regurgitation and burning pain behind the breastbone. If heartburn occurs more frequently, it is referred to as reflux disease (gastroesophageal reflux disease, GERD).
Causes: Weakness or dysfunction of the sphincter muscle at the entrance to the stomach, sumptuous meals, alcohol, coffee, smoking, citrus fruits, certain medications, pregnancy, stress, various illnesses such as a hiatal hernia or gastritis
Diagnosis: Doctor-patient consultation (medical history), physical examination, possibly further examinations such as endoscopy of the oesophagus and stomach, long-term acid measurement (pH-metry) – possibly combined with so-called impedance measurement (as pH-metry-MII), pressure measurement (manometry) in the oesophagus
Treatment: Home remedies for mild, occasional heartburn (baking soda, starchy foods, nuts, etc.). Medication for persistent or recurrent heartburn or reflux disease. Possible surgical intervention for reflux disease.
Prevention: Reduce excess weight; avoid stimulants and foods that promote heartburn (alcohol, nicotine, coffee, spicy foods, fatty and fried foods, etc.); reduce stress through exercise and relaxation techniques

The signs of heartburn can be deduced from the name: “boiling” stomach contents rise into the oesophagus (reflux) and cause burning pain. The typical symptoms occur particularly after fatty, rich food and alcohol:

Belching, especially of acid and chyme
Burning pain behind the breastbone
feeling of pressure in the upper abdomen

In some people, the reflux of stomach acid is also noticeable through hoarseness in the morning, throat clearing or coughing. This is because the rising gastric juice irritates the vocal cords and the mucous membrane of the throat.

If the stomach contents rise up into the mouth, this not only causes an unpleasant taste in the mouth. In the long term, it can also attack the tooth enamel.

If heartburn only occurs occasionally, it is usually harmless. Frequent reflux, however, can be a sign of reflux disease. In this case, the lower oesophageal sphincter is usually slack, making it very easy for stomach acid to rise upwards. Poor eating and lifestyle habits often exacerbate reflux.

Consequences of frequent heartburn

Another possible consequence of repeated heartburn caused by reflux disease is Barrett’s oesophagus: the cells in the lower third of the oesophagus are abnormally altered. Barrett’s oesophagus is a precancerous condition: It can develop into a malignant esophageal tumor (esophageal cancer = esophageal carcinoma). This risk exists if the sensitive mucous membrane of the oesophagus is repeatedly exposed to aggressive stomach acid over many years.

Heartburn: Treatment

Anyone who only occasionally suffers from painful reflux of gastric juice can help themselves with home remedies. If this is not enough or if the heartburn occurs more frequently, you should see a doctor and have the cause investigated.

Heartburn: Home remedies

Occasional heartburn can often be remedied with home remedies:

If you suffer from heartburn, eat starchy foods such as dry white bread, rusks, potatoes or bananas: they can quickly bind excess stomach acid and thus relieve heartburn.
Chewing nuts is said to neutralize stomach acid.
A spoonful of mustard after a meal is said to prevent the development of reflux due to the mustard oils it contains.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.

Heartburn: Medication

What helps against heartburn when home remedies fail or the symptoms occur more frequently? The answer: medication from the pharmacy. Some of them are available over the counter and some require a prescription. The following groups of active ingredients are mainly used to treat heartburn or reflux disease.

Proton pump inhibitors (PPI): These are the most important drugs for heartburn and reflux disease. PPIs prevent the formation of an enzyme that opens channels in the acid-producing cells in the gastric mucosa for the outflow of stomach acid. This means that the medication inhibits the release of stomach acid. Low doses and limited quantities of gastric acid inhibitors are available over the counter. Higher doses of proton pump inhibitors, on the other hand, require a prescription. Examples of this group of active ingredients are omeprazole and pantoprazole.

Representatives of this group of active ingredients, such as cimetidine or famotidine, are available from pharmacies on prescription.

The previously non-prescription H2 antihistamine ranitidine is no longer approved in the EU until January 2, 2023. According to the Committee for Medicinal Products for Human Use of the European Medicines Agency (EMA), small amounts of a carcinogenic substance may be present in ranitidine-containing medicines. This is currently being investigated. If you have any further questions about this, please contact your doctor or pharmacist.

Antacids: These are alkaline salts that bind and neutralize stomach acid already formed in the stomach (e.g. magnesium hydroxide). They used to be used more frequently to treat heartburn, but are now only used relatively rarely. However, you can try the over-the-counter acid binders if you only have occasional mild heartburn or the above-mentioned medications do not help. However, there are no good studies to prove that they are effective against reflux disease.

Your doctor or pharmacist will tell you how and in what dosage the individual heartburn remedies should be taken. Follow these recommendations to avoid side effects as far as possible!

Heartburn: Operation

During anti-reflux surgery (fundoplication), the surgeon places the upper part of the stomach around the lower end of the oesophagus and fixes it with a suture. This strengthens the sphincter muscle at the entrance to the stomach and thus prevents reflux and heartburn. The procedure is usually performed as part of a laparoscopy.

Surgery or medication – which is better?

There are not yet enough studies to be able to assess whether anti-reflux surgery helps better against heartburn and reflux disease than treatment with medication. In the short term – i.e. in the first year after the operation – the operation appears to perform better: According to studies, patients who have had surgery feel less restricted by heartburn during this time than patients who are treated with medication. Whether anti-reflux surgery also delivers better results in the long term still needs to be investigated in more detail.

Heartburn: Prevention

Most people are only plagued by heartburn after a particularly sumptuous meal, extensive alcohol consumption or stress. In fact, an unhealthy lifestyle is the most common cause of heartburn – and therefore a particularly promising treatment approach:

Chocolate, coffee, carbonated drinks, citrus fruits, spicy foods, fatty foods and fried foods also stimulate the production of stomach acid. Test whether your heartburn improves if you cut out one or more of these foods or at least only consume them in small quantities.
If you suffer from heartburn, especially at night, you should avoid a hearty dinner. Instead, prefer light food as your last meal of the day.
An early dinner can also help against heartburn at night – some sufferers do not eat anything for at least three hours before going to bed. It is also often useful to elevate the upper body with a pillow. This makes it more difficult for stomach acid to rise into the oesophagus. Sometimes it also helps to turn onto the left side of the body when lying down with heartburn – the entrance to the stomach is then at the top, which makes it more difficult for stomach contents to flow back.
Relaxation techniques and exercise are good ways to relieve inner tension and reduce the stress that triggers reflux.
If you are overweight, there is additional pressure on the stomach, which can easily force gastric juice into the oesophagus. Anyone who weighs too many kilos should therefore lose weight with a healthy, low-calorie diet and plenty of exercise. Heartburn often improves as a result.

Heartburn or reflux disease is often caused by a dysfunction of the sphincter muscle between the oesophagus and stomach. Normally, the so-called lower oesophageal sphincter ensures that the stomach contents cannot rise into the oesophagus. Why it sometimes does not function properly often remains unclear. However, various factors can promote reflux. These include alcohol and nicotine, for example: they have a relaxing effect on the muscles – the sphincter muscle between the oesophagus and stomach also relaxes under the influence of beer, cigarettes and the like. The two stimulants also increase the production of stomach acid. Both mechanisms promote the occurrence of heartburn.

Rich, fatty meals, chocolate, coffee, hot drinks and citrus fruit juices can also contribute to reflux. This also applies to some medications such as

Anticholinergics (used in the treatment of asthma, dementia and irritable bladder, among others)
Calcium channel blockers (e.g. for cardiac arrhythmia, coronary heart disease, high blood pressure)
some antidepressants
bisphosphonates such as alendronic acid (against osteoporosis)

Pregnant women also experience an increase in abdominal pressure. This is why heartburn is also common during pregnancy.

In addition, various illnesses can cause reflux. These include, for example

Diaphragmatic hernia (hiatal hernia): Normally, the esophagus passes through the diaphragm just before the stomach. In the case of a hiatal hernia, however, the diaphragm has a hole. Part of the stomach pushes up through this hole and becomes somewhat constricted. This allows stomach contents to be pushed up into the esophagus.
Esophagitis: Esophagitis can be caused by swallowed foreign bodies (damage to the mucous membrane in the esophagus) or pathogens such as bacteria. The affected, irritated mucous membrane can make itself felt with heartburn. Please note: oesophagitis can also be the result of reflux.
Irritable stomach (“functional dyspepsia”): The term refers to various upper abdominal complaints for which no organic cause can be found. In addition to acid regurgitation and heartburn, possible symptoms include pain, a feeling of pressure and fullness in the upper abdomen, nausea and vomiting as well as loss of appetite.
Protrusions of the oesophageal wall: These so-called oesophageal diverticula can cause belching and heartburn, among other things.
Achalasia: This is a rare disease in which the contractility of the muscles in the esophageal wall is weakened. The function of the sphincter muscle at the entrance to the stomach is also impaired. This impairs the transportation of food into the stomach, which manifests itself in belching and heartburn, among other things.
Diabetes: In the case of advanced diabetes, the nerve control of the oesophagus can be affected. This disorder also means that the transportation of chyme no longer functions properly.

A heart attack sometimes manifests itself with symptoms that are similar to heartburn. Pre-existing heart conditions should therefore always be taken into account when clarifying the symptoms.

Heartburn: When do you need to see a doctor?

Fatty, rich food that is heavy on the stomach and a digestive schnapps on top – this is an “irritating” program for the stomach that often leads to heartburn. As long as the symptoms only occur occasionally and disappear spontaneously, they are considered harmless.

Heartburn: What does the doctor do?

To get to the bottom of heartburn, the doctor first has a detailed discussion with the patient. This allows him or her to take a medical history (anamnesis). During the consultation, the doctor will ask, among other things, how long the heartburn has been present, how often it occurs and whether it gets worse when lying down, for example. He will also ask about any other complaints and known pre-existing conditions and whether the patient is taking any medication.

The medical history interview is followed by a general physical examination.

If the doctor suspects reflux disease in adult patients based on the medical history and there are no alarm symptoms (such as frequent vomiting, anaemia, etc.), a trial treatment with proton pump inhibitors (PPI test) may be useful: The patient takes PPI for about two weeks. If the symptoms improve as a result, this indicates reflux disease. Treatment with PPI is then continued.

Further examinations are normally only necessary in the following cases:

The PPI test cannot noticeably alleviate the symptoms.
The patient shows symptoms that could indicate esophageal cancer or a narrowed esophagus.
There are indications of another cause for the symptoms.

Heartburn in children also usually requires further investigation.

Endoscopy of the oesophagus and stomach: The doctor pushes a tube-shaped instrument (endoscope) through the mouth into the oesophagus and further into the stomach. A light source and a small video camera are located at the front end. This allows the doctor to examine the mucous membrane of the oesophagus and stomach in detail (for example, to check for inflamed, reddened areas, constrictions or ulcers). Instruments can also be inserted via the endoscope, for example to take tissue samples (biopsies) for precise analysis.

24-hour pH metry: In this procedure, a fine probe is inserted into the patient’s oesophagus via the nose and placed just before the entrance to the stomach. It remains in this position for 24 hours and continuously measures the acidity level in the lower oesophagus during this time. This allows acid reflux from the stomach to be detected.
24-hour pH-Metry-MII: This variant of the 24-hour pH-Metry described above can be used to detect not only the reflux of acidic stomach contents, but also that of non-acidic stomach contents. Occasionally, this can also lead to symptoms of illness. Incidentally, the abbreviation MII stands for “multichannel intraluminal impedance measurement”.

Frequently asked questions about heartburn

What helps against heartburn?

You can eliminate heartburn by losing weight and reducing stress. Avoid smoking, drinking alcohol and eating spicy or fatty foods. Meals shortly before going to bed are also unfavorable. Medication can also help: Antacids (e.g. algedrate) neutralize stomach acid, proton pump inhibitors (e.g. pantoprazole, omeprazole) reduce it.

What can you eat with heartburn?

Bananas, potatoes, oatmeal, ginger, almonds, wholemeal bread or pasta are suitable foods for heartburn. Spicy, fatty and acidic foods, on the other hand, often make the symptoms worse. Suitable drinks include skimmed milk, aloe vera juice, camomile tea and, above all, still water.

What is heartburn?

Heartburn is a burning sensation in the chest that often occurs behind the breastbone. It is caused by stomach acid entering the oesophagus. In severe cases, the burning sensation extends up to the throat.

What does heartburn feel like?

Many patients experience heartburn as a burning, stinging and unpleasant sensation in the chest area. If the heartburn is severe, the gastric juice and burning sensation will rise up into the throat. Those affected often have a sour, bitter taste in their mouth.

Which tea helps with heartburn?

Where does heartburn come from?

Heartburn occurs when stomach acid flows back into the oesophagus and irritates it. This usually happens when the sphincter muscle between the stomach and oesophagus does not close properly. Triggers include stress, severe obesity, pregnancy or acidic foods.

What home remedies help against heartburn?

Helpful home remedies for heartburn include bananas, almonds or oatmeal. Water, milk, camomile tea or aloe vera juice can also alleviate the symptoms. Another well-known household remedy is baking soda dissolved in a glass of water: it neutralizes stomach acid. However, this also produces the gas carbon dioxide, which bloats the stomach and may make the symptoms worse.

What should you drink for heartburn?

Drinking still water or herbal teas helps with heartburn. You should avoid caffeinated, alcoholic, acidic or carbonated drinks: They may make the heartburn worse. To avoid putting too much strain on your stomach, it is best to drink slowly and in small sips.