Heartburn is a burning sensation behind the breastbone, starting in the pit of the stomach and moving up to the mouth, via the esophagus. Along with acid reflux, it is one of the main symptoms of gastroesophageal reflux disease (GERD).

What is it ?

The burning sensation that starts in the pit of the stomach and goes up to the mouth, via the esophagus, is called pyrosis. Along with regurgitation or acid reflux, heartburn is one of the characteristic symptoms of gastroesophageal reflux disease (GERD).

Heartburn is a very common symptom: About 30-45% of the population suffers from heartburn at least once a month, and 5-10% daily.

How to recognize the symptom

This burning sensation in the thorax occurs readily after a meal or in certain positions, leaning forward or even when lying down, especially at night. It may or may not be accompanied by acid reflux, sometimes even in the mouth.

Risk factors

Different factors are known to promote GERD and its main symptom, heartburn:

• certain foods can: spicy or fatty dishes, coffee, tea, sodas and soft drinks, sweets, foods that ferment (cabbage, onion, garlic, pulses, etc.);
• the presence of a hiatus hernia;
• overweight and obesity;
• pregnancy, due to the compression of the stomach by the uterus and the baby, but also to hormonal impregnation. With their relaxing action on the tissues, progesterone and relaxin cause relaxation of the cardia, a small muscle that closes the top of the stomach. Less tonic, it no longer plays its role of “anti-reflux valve”. These same hormones also cause relaxation of the stomach muscles with the consequence of slowing down digestion and gastric emptying;
• age, because after 50 years, the esophageal sphincter can lose tone;
• the stress ;
• certain medications: acetylsalicylic acid (aspirin) and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, osteoporosis medications, antibiotics, menopausal hormone therapy, certain sleeping pills, etc.

Heartburn occurs when acidic fluid in the stomach backs up into the esophagus, due to a failure of the natural anti-reflux mechanisms. It may be the small muscle called the lower esophageal sphincter (LES) which, for unknown reasons, does not play its role as an anti-reflux “valve” well. The sphincter opens at the wrong time and then allows gastric juices to rise from the stomach, causing burns.

The presence of a hiatus hernia can also lead to GERD.

L’oesophagite

Heartburn is, although very unpleasant, usually mild. However, if acid reflux is frequent, it can lead to esophagitis (inflammation of the esophagus) called peptic, that is to say linked to acidic gastric juices.

Esophagitis is the main complication of GERD. It can be diagnosed during an oesopastro-duodenal endoscopy (EOGD) with or without biopsies. Examination of the inner lining of the esophagus will then show erosions and ulcers.

In addition, certain signs should lead to consult:

• frequent coughing fits;
• acid reflux occurring during exertion or when lying down;
• dysphagia (a feeling of food being blocked when swallowing or as it passes through the esophagus;
• other digestive symptoms: nausea, vomiting;
• weight loss, anemia.

Different treatments exist for GERD and one of its symptoms, heartburn:

• anti-acid dressings locally neutralize the acidity of stomach contents. The specialties generally combine aluminum and magnesium salts. They are to be taken 1 hour after meals, at the height of gastric acid secretion. They are available without a prescription;
• alginates form a viscous gel on the surface of the stomach container. In the event of reflux, it is therefore this dressing that will first come into contact with the wall of the esophagus. They are to be taken immediately after the meal;
• gastric secretion inhibitors (histamine H2 receptor antagonists, H2 blockers) decrease the production of acid in the stomach by blocking the action of histamine. ;
• Proton pump inhibitors (PPIs) help decrease acid secretion in the stomach. 

In order to limit the occurrence of heartburn and GERD in general, certain hygiene and dietetic rules are recommended:

• lose weight in case of overweight or obesity, the latter being recognized as risk factors for GERD;
• stop smoking, for the same reasons;
• avoid lying down after a meal;
• elevate the head of the bed a few tens of centimeters or sleep with a few cushions behind your back;
• wear loose, comfortable clothing to avoid compressing the stomach;
• engaging in regular physical activity such as walking to stimulate digestion.

On the food side:

• split their meals into 3 small meals and 2 or 3 snacks;
• chew well;
• avoid foods that can promote GERD: hearty meals, fatty foods, spicy foods, coffee, tea, alcohol, soft drinks, etc;
• favor foods rich in antioxidants, such as very colorful vegetables. These antioxidants would indeed have a protective action on the lining of the esophagus;
• restore a good balance between omega 6 (pro-inflammatory) and omega 3 (anti-inflammatory), to claim inflammation.

Finally, it is important in the event of stress to find solutions to better manage it, because it acts as an aggravating factor of reflux. It indeed promotes the alteration of the permeability of the esophageal mucosa and therefore the entry of acid into the cells. In addition, it slows down gastric emptying.