Definition Heartburn

In heartburn (reflux disease) there is excessive reflux of acidic stomach contents (gastric acid) into the esophagus. The persistent chemical irritation caused by stomach acid causes an inflammation of the mucous membrane of the esophagus (reflux esophagitis).


reflux esophagitis, reflux disease, reflux, gastroesophageal disease


In gastroenterological practice (gastrointestinal diseases) heartburn is the most common clinical picture. 6-20% of the population suffer from reflux disease (heartburn). 10% of patients with heartburn develop reflux esophagitis over time. Of these patients with reflux esophagitis, 10% develop a severe esophageal ulcer (berett-ulcer)10% of the ulcers develop an esophageal tumor (esophageal carcinoma).

Cause of heartburn

Heartburn is a common symptom. In some people it is chronic – i.e. recurring – and in others it occurs only rarely. Heartburn is caused by stomach acid running from the stomach back into the esophagus.

This occurs either through an excess of gastric acid due to overproduction or through an insufficient closure of the lower esophageal muscle which normally seals the esophagus to the stomach. Typical triggers for heartburn are alcohol and nicotine abuse, intake of fatty, spicy, very sweet meals, excessive coffee consumption, overweight and stress. These stimulate the production of gastric acid, more gastric acid is produced than is actually necessary and the excess acid flows back into the esophagus.

The stomach – unlike the esophagus – is designed to come into regular contact with the acid, as the mucous membrane has a different structure than that of the esophagus. This means that when stomach acid enters the esophagus, this leads to a significant irritation of the mucous membrane. If this happens more often, an inflammation of the mucous membrane of the esophagus occurs, which is called reflux esophagitis.

Stress is a common cause of heartburn. The exact connections are unclear. So far, two correlations have been observed in studies: on the one hand, stress causes the lower sphincter muscle of the esophagus to relax.

This opens the way for stomach acid to enter the throat. On the other hand, stress leads to increased production of gastric acid. The neuronal connections (i.e. based on the nerve tracts) have not yet been conclusively clarified.

However, it is increasingly coming into focus that the vegetative (autonomous) nervous system, which controls the digestive system, has probably been severely underestimated in all previous medical considerations. A similar mechanism in stress-induced diarrhea has been known for a long time, but there is no scientific justification for it. If stress can be identified as a trigger in a patient, a therapeutic approach can be considered here.

The affected person, together with his or her family doctor, a psychotherapist or physiotherapist, can identify and reduce stress triggers in order to find relief. If this does not result in freedom from symptoms, physical (somatic) causes should again be considered. Changes in position such as bending over and lying down often lead to an aggravation of the heartburn, because more pressure is then exerted by the abdominal contents on the lower sphincter muscle of the esophagus.

If such body positions are taken during sports, they also aggravate the heartburn. Strong abdominal breathing or tense abdominal muscles also cause increased pressure. At the same time, repeated up and down movements cause the gastric juice to “slosh” to the upper part of the stomach, which can also trigger heartburn if the sphincter muscles are insufficient.

In order to avoid this, two to three hours after eating and possible heartburn, sporting activities in the form mentioned above should be avoided, and gentler movements should be resorted to (walking, cycling). Alcohol consumption can worsen the symptoms of gastritis, firstly because it contains many simple sugars that stimulate the production of gastric acid and secondly because it is a drink with an acidic pH. It therefore potentiates the acidic environment of the stomach.

Especially high-proof, spicy alcoholic drinks (schnapps) should therefore be avoided. Coffee is an acidic drink, which, like alcohol, usually makes heartburn worse.This can be remedied by adding a dash of milk to the coffee and preferably no sugar. However, if symptoms such as heartburn and nausea occur immediately after coffee consumption, this food should be avoided completely until the symptoms have improved permanently. A more stomach-friendly alternative would be black or green tea with low-fat milk.