Heartburn (Pyrosis)

Heartburn is the reflux of stomach contents into the esophagus. Heartburn can be harmless, but in the long run, it can also be pathological and indicate reflux disease or cause esophagitis. Read more about the symptoms, causes, therapy, and prevention of heartburn.

Most people are familiar with heartburn (pyrosis) or acid regurgitation (ructus). As a rule, it is uncomfortable – but it also quickly passes and is harmless. Recurring or regular heartburn, on the other hand, should be examined by a doctor. Either the constant reflux of gastric acid into the esophagus is due to the disease and indicates a reflux disease or it injures the esophagus and causes esophagitis (esophagitis). With a few exceptions, heartburn can be treated very well with medication and a change in diet or behavior.

A typical symptom of heartburn is a burning pain in the center of the chest (above the stomach area) that can radiate to the throat, throat, or even face. This often happens after meals (due to overcrowding or acidification of the stomach) or when bending over and changing positions.

Occasionally, stomach acid or digested food gets into the oral cavity with the acidic burping. This leads to an unpleasant burning sensation in the throat and a sour or bitter taste in the mouth. This can cause nausea and, rarely, vomiting.

Heartburn is often accompanied by an unpleasant, sour-smelling bad breath. Heartburn or the pain associated with heartburn are sometimes also perceived as heart pain. In English, heartburn is therefore also called heartburn.

Heartburn Complications

Recurring heartburn puts stress on the esophagus. The result can be inflammation of the esophagus. In turn, esophagitis could increase the risk of esophageal cancer.

Causes

Heartburn is caused by acidic stomach contents flowing back into the esophagus (acid regurgitation). The causes of stomach contents getting back into the esophagus can be very different.

Typically, very large meals trigger heartburn once we’ve eaten enough to fill the stomach. Then a slight pressure – for example by moving – is enough to let the stomach contents get into the esophagus.

As the pregnancy progresses, the child puts pressure on the stomach and can cause stomach contents to enter the esophagus. Heartburn can also indicate conditions such as stomach ulcers, duodenal ulcers, or stomach cancer.

Cause Reflux Disease

Heartburn is the main symptom of acid reflux disease. This is a malfunction of the lower esophageal muscle (lower esophageal sphincter) that separates the esophagus from the stomach. As a result, the weakened sphincter muscle can get stomach contents easily into the esophagus.

Heartburn

Other Causes Of Heartburn

The excessive production of stomach acid and the resulting heartburn can have a variety of other causes:

    • excessive consumption of alcohol, coffee, or cigarettes
    • Obesity
    • nervous stomach
    • Diaphragmatic hernia
    • Use of certain medications such as pain relievers and anti-rheumatic drugs (e.g. acetylsalicylic acid, diclofenac, and ibuprofen), cortisone, and chemotherapy drugs
    • Stress or other psychological stress.

Cause In The Duodenum

In the case of heartburn with bitter and bilious belching, the cause is often in the duodenum. Often the intestine is overactive (so-called motility disorder) or the gastric sphincter (also called gastric gatekeeper or pylorus) does not close properly.

Investigation

The main focus of diagnosing heartburn is finding the cause of the backflow of stomach contents into the esophagus. A frequently used examination method for this is the esophagus and gastroscopy. You will find detailed information on this under gastroscopy.

Treatment

Inhibiting gastric acid production with medication is usually the essential element of medical treatment for heartburn. Different groups of drugs are used.

    • Antacids are drugs with aluminum or magnesium salts such as aluminum hydroxide or magnesium hydroxide. Other active ingredients are Algedrat, Magaldrat or Simeticon. These drugs bind excess stomach acid for heartburn and also relieve the symptoms of inflammation of the stomach lining (gastritis) or a stomach ulcer. The chewable tablets or sachets of suspension are chewed or swallowed approximately one hour after eating and before going to bed. Sometimes it takes 2 chewable tablets or sachets for the heartburn to go away. Suspensions work faster than chewable tablets because the milky solution quickly lines the stomach lining and protects it from acid. Antacids are also useful during pregnancy.
    • H2 blockers are another group of heartburn medication. So-called H2-receptor blockers such as cimetidine, famotidine and ranitidine inhibit the production of stomach acid. For some time now, various H2-receptor blockers have been available in pharmacies without a prescription.
    • Proton pump inhibitors, such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole, are another group of drugs that can be used to treat heartburn. For example, the proton pump inhibitors omeprazole, pantoprazole, or esomeprazole are now freely available (see also below: gastric acid blockers involve risks)
    • Prokinetics such as metoclopramide accelerate the intestinal transit and the further transport of food in the intestine. As a result, less acidic food pulp can get into the esophagus.

Recall Of Drugs Containing Ranitidine

Numerous drugs with the active ingredient ranitidine may no longer be used for the time being since September 2019. A current list of the drugs concerned can be found here: Recall ranitidine drugs due to nitrosamine contamination. Ranitidine belongs to the active substance group of H2 antihistamines and is also mainly used in the following clinical pictures:

    • Anaphylactic shock
    • gastritis
    • Diaphragmatic hernia

The European Medicines Agency ordered the EU-wide recall because impurities had been detected at a manufacturer of the active ingredient in India (Saraca Laboratories Limited). According to the Federal Institute for Drugs and Medical Devices (BfArM), this is N-nitrosodimethylamine (NDMA). These nitrosamines are thought to be potentially carcinogenic.

In 2018, NDMA contaminants had already caused numerous recalls for another group of active ingredients, the sartans. The Central Laboratory of German Pharmacists has now examined 38 preparations and declared them not to be contaminated.

Heartburn Surgery

In rare cases, surgery is needed to get rid of heartburn. Reasons for an operation can be, for example, stomach and duodenal ulcers, stomach cancer, or a rupture of the diaphragm.

Self-Help Against Heartburn

To help yourself with heartburn – assuming no other illnesses – you can usually use the above-mentioned over-the-counter medications or sodium hydrogen carbonate (such as baking soda and Bullrich’s salt). However, this only applies if the heartburn occurs occasionally and another disease is excluded as the cause. In the best-case scenario, discuss any medication with your doctor.

Chamomile, yarrow, or liquorice root in the form of teas or drops, like peppermint, caraway, anise or fennel tea, have a digestive and calming effect on the stomach.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report from the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

Connection Between Proton Pump Inhibitors And Allergies Is Possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.

Prevention

There are few meaningful studies on the effects of behavior change on heartburn. However, many experiences confirm that, for example, avoiding coffee, alcohol, and smoking relieves heartburn or prevents heartburn from developing in the first place. If you have a tendency to heartburn, you should also take note of the following tips:

    • Avoid very spicy or citrus-acid foods and drinks
    • Avoid fatty foods and chocolate if possible
    • eat in an upright position
    • Keep evening meals as small as possible
    • Avoid being overweight
    • no overly tight clothing and constant sitting
    • Do not bend forward after meals
    • Increase the headboard of the bed if you have heartburn at night.