Heartburn begins with a bite

Take a bite of warm, gooey pepperoni pizza and your digestive system kicks into action. Acids tumble into the stomach, ready to break down your meal. In many people, a faulty valve lets these acids run amok, triggering a burning sensation in the chest. Heartburn is an extremely common symptom. The NHS cites studies showing that it affects between 10% and 20% of people. The following slides examine where heartburn starts and how it can be stopped.

Heartburn: An inside look

To understand what causes heartburn, let's trace the path of that pepperoni pizza. Once you swallow a bite,(chewed rather than whole shown here) it travels through the oesophagus to the stomach. A valve called the lower oesophageal sphincter opens to let the food in. Then it's supposed to close again to prevent stomach acids from sliding up into the oesophagus.

Heartburn: Faulty valve

In some people, the valve between the stomach and oesophagus doesn't work as well as it should. This allows acid to seep into the oesophagus (called acid reflux), where it can cause pain and irritation. Not everyone with acid reflux suffers from heartburn. Some people with 'heartburn' symptoms don't actually have acid reflux, but may, have some other condition causing this pain.

GORD symptoms

The hallmark of GORD (gastro–oesophageal reflux disease) is heartburn – a painful burning sensation in the middle of the chest. The pain typically strikes after meals and can last several hours. The discomfort may be worse after bending over or lying down. Other symptoms include a sour-tasting fluid in the back of the throat, difficulty swallowing or feeling that food is stuck in the chest or throat. A chronic cough or asthma attacks can also be caused by acid reflux.

Heartburn: Who's at risk?

Anyone can develop heartburn, but certain lifestyle factors affect how well the valve works, as well as the amount of acid produced by the stomach. People who are overweight, eat large meals, wear tight-fitting clothes or smoke tend to be the most vulnerable.

Diagnosing the cause of heartburn

A description of heartburn symptoms is usually all that's needed to diagnose acid reflux. However, if a trial of medicines to suppress stomach acids fail to relieve the symptoms of heartburn, your doctor may order tests, such as an endoscopy. This procedure uses a tiny camera (shown here) to look inside your oesophagus, stomach and beginning of the intestine to reveal any irritation or ulcers that might be forming.

Heartburn and GORD

Heartburn doesn't usually pose a serious threat to your health. However, complications can occur with severe, frequent and persistent acid reflux. GORD, is a chronic back-washing of acid into the oesophagus. Without treatment, it can cause inflammation, ulcers and changes in the lining of the oesophagus. Known as Barrett's oesophagus (shown here), these changes raise the risk of oesophageal cancer.

Night time heartburn: It can be dangerous

Waking with a sore throat, cough, or a bitter taste in your mouth? It could be night time acid reflux, and it could be dangerous. In addition to disturbing sleep, night time reflux increases the risk of oesophageal damage. That’s because lying down leaves stomach acid in the oesophagus longer. As we sleep we swallow less, and produce less acid-neutralising saliva, than when awake.

Managing heartburn at home

You may be able to manage mild heartburn with a few changes to your daily routine. Start by eating smaller meals. Finish dinner at least three to four hours before bedtime and avoid late-night snacks. (Having food in your stomach when you lie down can trigger acid reflux symptoms such as heartburn.)

Watch what you eat

Some foods are known to contribute to heartburn by bringing additional acid into the stomach or by relaxing the lower oesophageal sphincter. Stay away from food that gives you problems. Your symptoms may improve if you avoid foods you've identified as triggers. If you find spicy foods are a trigger, try milder versions rather than giving up your favourite foods altogether.

Watch what you drink

Certain drinks can also bring on heartburn. These include coffee, tea, fizzy drinks, alcohol, tomato juice and orange juice. However, unless these are causing you acid reflux symptoms, you don't have to avoid them. Water is the safest bet and may help dilute acid in the digestive tract.

Change your exercise routine

Exercise can increase abdominal pressure, increasing the risk of acid reflux. Some types of exercise increase the risk more than others by reversing the natural flow of digestion. Headstands and inverted yoga poses, such as downward dog, are good examples. Abdominal crunches can be a problem, because the motion may thrust stomach acids into the oesophagus.

Raise the head of your bed

If you experience night-time heartburn, try placing blocks under the legs of your bed to raise the head about 15cm (6 inches), or sleep with your upper body on a wedge pillow. This strategy uses gravity to keep stomach acids where they belong. (Avoid raising your head with piles of pillows. This bends your body in a way that can aggravate heartburn.) Reflux also occurs less frequently when lying on your left side rather than your right.

Wear loose-fitting clothes

Another way to ease heartburn is to take pressure off the abdomen. Lose excess weight and wear loose-fitting clothes and belts.

Heartburn during pregnancy

More than half of all pregnant women report symptoms of severe heartburn, especially during the second and third trimesters. Changing hormone levels and increased abdominal pressures during pregnancy increase the risk of acid reflux and heartburn. Mild symptoms should be treated with lifestyle changes, including eating several small meals a day instead of three large ones, avoiding foods identified as heartburn triggers, and not lying down after eating. However, if diet and lifestyle don't alleviate symptoms, pregnant women should seek medical advice before taking any medication.

Heartburn remedies: Antacids

For occasional heartburn, take something that works immediately, like an antacid. As the name suggests, an antacid neutralises stomach acid. This provides temporary relief from heartburn and is emptied from the stomach quickly. It's important to follow the directions carefully, because the overuse of antacids can cause serious side effects. And with more prolonged heartburn symptoms, antacids may not work.

Heartburn remedies: H2 blockers

Also available over the counter, H2 blockers work differently from antacids. Rather than attacking acids after they appear, these medicines prevent the production of stomach acid. More powerful doses are available in prescription form.

Prescription medication

If heartburn symptoms are more severe or recur more than a couple of times a week it’s time to seek medical advice. You may need prescription medicine. Proton pump inhibitors are a class of drugs that block the release of acid into the stomach. They are more effective at shutting down acid production than H2 blockers. Studies show they are effective at relieving chronic heartburn and can even heal inflammation in the oesophagus.

Heartburn surgery

Most people with heartburn find significant relief with lifestyle changes and medication. In rare cases, when drugs are unable to control the symptoms, surgery can help. The goal is to repair the faulty valve that lets acid slip into the oesophagus. Once this sphincter is able to shut tightly, acid will stay in the stomach and hearty meals will remain heartburn-free.

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