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Heartburn is an unpleasant burning sensation just behind the breastbone. Because the area from which the pain radiates is near the heart, people frequently mistake heartburn for a true cardiac problem. In fact, however, the burning sensation originates in the esophagus and is generally caused by a backflow of digestive juices that are normally kept in the stomach by the gastroesophageal sphincter, which is located at the level of the diaphragm, the muscle that separates the chest cavity from the abdominal cavity.
Heartburn usually begins about an hour after eating and disappears in another few hours. Most of the time, it is simply a result of overindulgence in food and drink. Occasionally, however, it is caused by stress and, in a few people, it may be a symptom of cancer or another serious disorder.
The worst cases of heartburn do, in fact, mimic heart attacks. Severe episodes often cause intense pain, difficulty breathing, and palpitations.
Causes of heartburn
Anxiety
A certain amount of anxiety is normal and even beneficial in daily life. Overwhelming anxiety in response to life's normal stresses, however, often becomes incapacitating. Some anxious people swallow air, which can lead to heartburn, as can cigarette smoking and poor eating habits, which are common responses to anxiety.
Esophageal spasm
In this condition, the normal muscle contractions that propel food and liquids through the esophagus fail to coordinate properly, resulting in painful spasms. Besides heartburn, there may be difficulty swallowing, and the lining of the esophagus may become inflamed, adding to symptoms.
A hiatus hernia allows stomach acids to flow into the esophagus, producing heartburn.
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Esophagus cancer
Early symptoms of a tumor in the esophagus include difficulty swallowing and a feeling of pressure or fullness beneath the breastbone, sometimes accompanied by heartburn. The heartburn may be no more than a momentary burning as food is swallowed, or it may persist.
Gastritis
Acute gastritis sometimes leads to a chronic inflammation of the stomach lining that may persist for weeks, months, or even years. In both acute and chronic forms, the mucous lining of the stomach becomes inflamed, most often as the result of too much alcohol, spicy food, coffee, or certain drugs such as aspirin. In addition to heartburn, symptoms include burning pain or pressure in the pit of the stomach, loss of appetite, nausea, and vomiting.
Heartburn
Classic heartburn is brought on by overeating, consuming spicy foods, smoking, and drinking alcohol, as well as by conditions such as pregnancy that place stress on the esophageal sphincter, the muscle that relaxes to allow food to pass into the stomach. Reclining too soon after a large meal can also bring on heartburn in susceptible people. Uncomfortable as it is, heartburn is harmless and self-help measures generally can control it.
Hiatus hernia
In this condition, an abnormal opening or area of weakness develops in the diaphragm, allowing a portion of the stomach to protrude into the esophagus. This protrusion or hernia allows stomach acid to flow into the esophagus, causing irritation. Heartburn is one of the earliest symptoms and is often accompanied by excessive belching.
Indigestion
Also known as dyspepsia, indigestion is characterized by an overproduction of stomach acid, which leads to heartburn, gas, abdominal distress, nausea, and occasionally
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vomiting. It can be brought on by overeating, hasty eating, heavy smoking, emotional upset, or overconsumption of alcohol, coffee, or tea. Indigestion that cannot be relieved by antacids may be due to a more serious condition.
Stomach cancer
Indigestion and abdominal discomfort are the most common and earliest symptoms of stomach cancer. Loss of appetite, a bloated feeling after eating, and mild stomach pain follow, along with heartburn, weight loss, and fatigue. Symptoms may then progress to include mild nausea and periodic bouts of vomiting.
Stress
Although some stress is unavoidable, it is well known that excessive stress, or an inability to cope with normal stress, can affect a person's health. Emotional upsets can trigger excess production of stomach acid and interfere with good eating habits. In such instances, heartburn and indigestion are common symptoms of the stress overload.
Advice about heartburn
- Many people bring on heartburn by unconsciously swallowing air. To prevent this, eat slowly and breathe out before swallowing. Avoid gulping liquids and chewing gum.
- Regular exercise, adequate sleep, and a balanced diet help reduce stress. Structured relaxation techniques such as yoga and meditation are often beneficial. Anyone who suffers from severe anxiety should consider consulting a mental health professional for appropriate therapy.
- Know the warning signals of a heart attack, including intense chest pain radiating to the left arm or shoulder; pallor and clamminess; nausea; and a feeling of dread or anxiety. If these symptoms develop, call an ambulance immediately.
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