Heartburn, Acid Reflux, Indigestion: Three Imposters, and How to Deal with Them

That burning sensation low in your gut, gradually extending upward and outward. The hot acid that backs up into your oesophagus, scorching the lining of your throat, and the pain that feels like a hot brick stuck somewhere in your upper chest. These symptoms often occur after a stressful day or following a heavy meal.

Heartburn, acid reflux and indigestion. Let’s shed some light on the reasons why so many people suffer from one or the other, or possibly all three, and examine recommended ways of easing the pain, and better still, avoiding it.

Heartburn

When you eat and drink, food travels down your oesophagus, otherwise known as your gullet, into your stomach, where a ring of muscle called the oesophageal sphincter should ensure that the flow is one way only. Unfortunately, on occasions, this one-way system fails and whatever you have consumed is allowed to travel in the opposite direction back into your oesophagus.

Because the stomach produces acid to help digest your food, this is mixed with the food that is refluxing back into your oesophagus and whilst your stomach can resist the acid, your oesophagus can’t. This results in the fiery sensation known as heartburn. In a bad case, the oesophagus can become inflamed, and this condition is known as oesophagitis. In very severe cases ulcers can result from this inflammation.

What are the Main Causes of Heartburn?

Lifestyle

There are several lifestyle factors which can increase the risk of experiencing both reflux and heartburn. These include:

• Drinking too much alcohol
• Smoking
• A constantly stooped posture
• The action of continually bending forwards
• Carrying excess body weight

Medical Conditions

Certain conditions can pre-dispose you to suffering with heartburn. The main ones are:

• Hiatus hernia – when part of the stomach displaces upwards into your chest by pushing through a hole in the diaphragm muscle. This form of hernia rarely causes symptoms other than making reflux more likely. If the hernia is large, it can be corrected with surgery.
• Pregnancy – heartburn often occurs in the later stages of pregnancy. This is because as the baby gets larger it presses upwards against the stomach. Once the baby is born the symptoms usually disappear.

Foods That Cause Heartburn

Certain types of foods and drink cause heartburn for many people. The main triggers are:

• Pastry
• Cakes and rich desserts
• Dairy cream
• Fatty and processed meats
• Cheese
• Spicy foods such as curry
• Citrus fruit juices
• Alcohol
• Certain hot drinks, including coffee

Symptoms of Heartburn

Sometimes you may feel pain deep inside your chest and even in your back, and sometimes too the burning feeling will extend into your throat. Acid can burn in your throat when some of what you have eaten comes back up into your mouth. This causes a great deal of discomfort and soreness in the throat and can result in a choking sensation and spasms of coughing. Often this happens at night when you lie down to sleep.

In most cases this condition is a nuisance and a discomfort but has no sinister aspect. There are a very few instances where it may be more serious and could result in severe inflammation of the oesophagus. This may possibly result in complications such as bleeding and narrowing of the oesophagus, and these symptoms need medical attention.

You should make a visit to your GP if you have any of these symptoms:

• If food is becoming lodged in your oesophagus causing a blocking-up sensation.
• If heartburn is frequently causing you to be sick.
• When lifestyle changes are not making an improvement to the frequency of your heartburn.
• If taking over-the-counter heartburn medicines are having no beneficial effect.
• If your heartburn occurs on most days for a period of three weeks.
• When you have difficulty or pain swallowing food.

Acid Reflux

When this condition becomes more than an occasional event it is given the title of gastro-oesophageal reflux disease known as either GORD (English) or GERD (American, as the US spelling is esophageal). GORD occurs when stomach acid regularly backs up into the oesophagus which is the tube connecting your mouth and stomach. The acid causes irritation to the lining of your oesophagus.

During the process of swallowing food, your oesophageal sphincter relaxes to let food and drink flow into your stomach. During normal function it then tightens and closes to prevent digesting food and stomach acid back into the gullet. In cases where the sphincter becomes faulty and weak it may fail to relax and tighten as it should, so stomach acid can flow back into your oesophagus. When this happens regularly, the lining of your oesophagus becomes inflamed.

woman suffering with stomach pain

It’s very common to experience acid reflux occasionally, particularly after a heavy or rich meal, but when it happens often, that is when it can develop into GORD. The condition can usually be managed with lifestyle adjustments and medication, but in extreme cases surgery may be needed to ease the symptoms.

Symptoms of Acid Reflux or GORD

The most usual symptoms include:

• A painful and burning feeling in your chest (heartburn) most commonly after eating. This often comes on after going to bed or can wake you in the night.
• Food regurgitating into your gullet and sometimes reaching your mouth.
• Trouble swallowing (known as dysphagia).
• The sensation of a lump or blockage in your throat.

If you suffer with acid reflux during the night, you could find that you develop a cough which doesn’t completely go away. You may also succumb to laryngitis which is when the vocal cords become inflamed. If you have asthma, the acid reflux may make it worse or in some cases it can bring on asthma attacks even if you have never been prone to them before.

You should get urgent medical advice if you are experiencing chest pain, or shortness of breath, particularly if it is combined with pain in your arm or jaw.

It would be advisable to see your GP if you are getting very severe or frequent acid reflux symptoms or if you are needing to take over-the-counter heartburn medication more often than twice a week.

What are the Main Causes of Acid Reflux?

There are various lifestyle choices as well as medical issues which can heighten or aggravate your risk of suffering with GORD. These include:

• Carrying too much weight
• Hiatal hernia
• Later stages of pregnancy when the size of the baby is pushing upward and constricting your stomach
• Constipation
• Scleroderma which is a connective tissue disorder
• Smoking
• Eating large meals, especially late in the evening
• Eating fatty or fried foods
• Alcohol or coffee can be triggers
• Certain medications such as aspirin

There are a few medical conditions which may arise from oesophageal inflammation:

• Oesophagitis – this is a result of chronic inflammation caused by stomach acid attacking the lining of the oesophagus. This can cause bleeding and sometimes ulcers might develop. This condition can make swallowing difficult and painful.
• Oesophageal Stricture – is when stomach acid causes scar tissue in the lower oesophagus. The scar tissue narrows the food pipe and results in swallowing difficulty.
• Barrett Oesophagus – when damage from acid results in changes to the lining of the oesophagus. These changes may be associated with an increased risk of oesophageal cancer.

Indigestion

Also known as dyspepsia, indigestion usually makes itself known with a heavy or burning pain in your upper abdomen, and it usually follows soon after a meal. The pain may sometimes spread into your back.

The most common symptoms include:

• A feeling of being very full or bloated
• Nausea
• Belching
• Regurgitating food into your oesophagus

Indigestion affects many people, is not usually serious, and only occurs now and again.

What are the Main Causes of Indigestion?

When acid from the stomach makes contact with the sensitive lining of the digestive tract, known as the mucosa, the acid breaks down the lining and this causes irritation.

In most cases indigestion is caused by eating, particularly when certain foods are involved or if the meal is too large or eaten too hurriedly. There are other factors which may trigger a bout of indigestion, such as stress, smoking, alcohol, pregnancy, or certain medications.

Self-Help for Indigestion

It is usually possible to deal with indigestion by making simple dietary and lifestyle changes. Perhaps try eating smaller meals more frequently, or just cutting down on quantity. Notice what you have eaten prior to an attack of indigestion and experiment by leaving out these foods for a while to see if the indigestion recurs. Gradually reintroduce them one at a time until you have identified the culprit. It can sometimes be something as unlikely as a sprinkling of chilli powder in a dish, or a swirl of cream in your soup. Fresh bread and pastry are other common culprits.

There are various over-the-counter antacid medications available in either tablet or liquid form. They are very helpful but should only be taken occasionally. If you find you are reaching for them on a regular basis you should ask your GP to check out the reason for the continuing need. Very rarely indigestion may by an indication of a more serious condition so this needs to be investigated. If an underlying condition is suspected to be the cause of frequent bouts of indigestion the most usual next step would be a referral for an endoscopy.

In general, most people will not need to seek medical advice for indigestion but there are a few issues that shouldn’t be ignored. If any of the following apply, then a discussion with your doctor is advisable:

• Losing weight without intentionally dieting
• Difficulty in swallowing
• Persistent vomiting
• Iron deficiency anaemia
• If you have a lump in your stomach
• Blood in your vomit or stools

These symptoms may be a sign of something more serious than general indigestion.

Natural Supplements to Help Relieve Symptoms of Heartburn, Reflux, and Indigestion

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Natural Remedies for Relieving Digestive Discomfort

Here are some self-help methods you can try to get relief from indigestion, heartburn, and acid reflux:

• Fresh ginger, crushed and made into a tea with boiling water is very soothing to the digestive tract.
• Peppermint tea is soothing and helpful for cases of indigestion but shouldn’t be taken for heartburn or acid reflux as peppermint can cause the relaxing of the lower oesophageal sphincter, allowing more stomach acid to flow back.
• Chamomile tea is good for helping with sleep and calming anxiety, but it can also ease digestive discomfort and relieve indigestion by reducing the amount of acid in the gastrointestinal tract. Chamomile is also an anti-inflammatory so may help to ease pain.
• Apple cider vinegar can be added to a mug of hot or cold water (just a couple of teaspoons is enough) and this can ease indigestion. If you drink it about half an hour before a meal, it acts as a preventative.
• Fennel seed is an antispasmodic herb and is also effective for soothing indigestion. Put half a teaspoon of crushed seed in water and allow it to simmer for ten minutes before straining and drinking. Fennel seeds can also be chewed.
• Sodium Bicarbonate can neutralise stomach acid. Mix half a teaspoon of baking soda to 4 ounces of warm water and drink. A study conducted in 2013 found that adults should have no more than seven ½ teaspoons in a 24-hour period, and no more than three ½ teaspoon if over the age of 60.
• Lemon water can neutralise stomach acid as it has an alkaline effect. Mix one tablespoon of lemon juice in hot water and drink a few minutes before eating.
• Liquorice root is an anti-spasmodic and can also calm inflammation in the gastrointestinal tract. It may be chewed or made into a tea by bruising the root and adding it to boiling water. It is not advisable to take more than 2.5 grams of dried liquorice root per day as it can cause sodium and potassium imbalances and high blood pressure if taken in large doses.
• Chewing gum. This may sound an unlikely solution, but chewing gum causes an increase in saliva, and this acts as a buffer to acid. Chewing gum also causes you to have to swallow more often and this helps to push the acid back down from your oesophagus. It may be a good idea to choose sugar-free gum to protect your teeth.
• Reduce portion sizes. You may benefit from eating much smaller meals but more often. A large meal in the evening is particularly bad if you suffer with heartburn so make sure you don’t eat within about two or three hours before bedtime. A small breakfast, lunch, and supper with two healthy snacks in between may be the key to relieving your indigestion, heartburn, and reflux problems.
• Eat more slowly. Chew food thoroughly before swallowing and just take your time.
• Lose weight. If you are carrying too much weight, particularly in your abdominal area, it would be helpful if you could shed some pounds/kgs. Excess fat in the abdomen can press against the stomach, forcing acid to rise-up into the oesophagus.
• Tight clothing. Avoid tight clothing such as belts, tight-fitting jeans or restrictive elasticated shapewear.
• Drink plenty of water. It has the effect of helping the breaking down of food.

Can Stress Cause Heartburn, Acid Reflux, and Indigestion?

There may be times when you experience a flare up of symptoms of heartburn, acid reflux, and indigestion. It is highly likely that these times are when you are more stressed than usual. Results of studies in the USA show that stress may be a main trigger for gastrointestinal issues, and in one study, a cross-section of 2,500 participants from the general-public, with ages ranging from 18-40 years, was taken. Diagnosis was made via a questionnaire entitled the Frequency Scale for the Symptoms of GERD. Records from The Hospital Anxiety and Depression Scale were used to assess anxiety and depression.

Of all the participants, 401 were found to be sufferers, and anxiety was found to be significantly more prevalent in those participants. They also had a higher tendency to depression compared to those without symptoms.

Another study published in the American Journal of Internal Medicine, interviewed 12,653 people with GERD and concluded that nearly half reported stress as the greatest factor for worsened symptoms, even when taking medication.

When you are stressed and especially when the stress is coupled with exhaustion, this can cause body changes which may lead to an increase in acid reflux. However, it is still debatable whether stress increases the production of stomach acid. Some medical scientists believe that stress causes heightened sensitivity to smaller amounts of acid in the oesophagus.

This theory is backed up by research that shows that stress may cause the brain to turn up the sensitivity of pain receptors, making you physically more aware of slightly heightened acid levels. It has also been found that stress depletes the production of prostaglandins which are substances that give protection to the stomach against the caustic effect of acid. This may also be a reason for added gastroesophageal discomfort during times of stress.

Self-Help Methods to Manage Stress

Coping techniques for helping yourself when stress levels are high are well worth practising. There are various recommended methods of reducing the damaging effect of stress in general, and particularly when it is causing indigestion, heartburn, and reflux. Some of these are:

• Stand up and walk about
  • Even if it’s only a stroll around your workplace, perhaps looking out of the windows. If you are at home and have a garden, take a walk around looking at plants. This helps to loosen tight muscles, taking pressure from your abdomen. Just this simple act of wandering around for a while gives you a break from whatever you are concentrating on and releases some feel-good hormones.
• Mindfulness
  • Make mindfulness a part of your daily routine. The short amount of time you need to spend in practising mindfulness can make a very positive change in how you handle stress and anxiety. There are some extremely good mindfulness apps available.
• Avoid certain foods
  • Avoid foods that you find hard to digest and which add to your discomfort. There are certain things such as whole citrus fruits and fruit juice, tomatoes, cream, butter, cheese, fatty and processed meats, curry or any spicy meals, coffee and chocolate which may act as triggers for your digestive problems.
• Sleep
  • Make sleep a priority. It isn’t always easy when you have things on your mind but there are techniques which can help greatly. Read more about getting quality sleep.
• Say No
  • Get brave about saying NO. Your health must be your priority so don’t let others try to fill your time with the things they want you to do. It’s perfectly fine to say no to anything that you will find either too stressful or that will leave you short of time for your own needs.
• Laughter
  • Laughter is a wonderful stress reliever. Watch a comedy film or read a book by an author with a flair for humour such as P G Wodehouse. These can be superb interludes in your day or evening to break that stress cycle and just divert your mind onto something much more pleasant and comforting.
• Enjoy quality time with your cat or dog.
  • Just the action of stroking a lovely animal has been proven to calm you. If you have a dog, then a walk each day is a necessity which brings lots of spin-off advantages for both of you.

You may wish to read more about stress, the way it affects you physically as well as mentally and some in-depth ideas for dealing with it.

Medical Treatment for Gastro-oesophageal Disease

Over-the-counter anti-acid products can help symptoms in the short term but will not correct the problem. It’s important to have a word with your GP if you find you are reaching for this type of medication on a regular basis and for an extended length of time.

Your doctor may suggest a course of treatment with a medicine known as a PPI (proton pump inhibitor). This is usually prescribed initially for four weeks, and for more severe conditions may be extended to eight weeks.

If, after the course of treatment, the symptoms recur, you may be offered an ongoing prescription for this type of drug, but at a lower dose.

There are various PPI drugs available, and your GP will suggest the most appropriate for your condition:

• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Esomeprazole (Nexium)
• Rabeprazole (AcipHex)
• Pantoprazole (Protonix)

If the PPI medication fails to put things right for you, your doctor may offer a medicine known as a H2 blocker. You may also be referred to a gastroenterologist for further investigation.

In some cases, usually following a consultation with a gastroenterologist, you may be offered surgery. This will mean you won’t have to take long-term medication. The type of surgery for reflux is laparoscopic fundoplication. This procedure is performed using keyhole technique and the surgeon folds and stitches the top of the stomach to reduce the opening where the oesophagus meets the stomach. This reduces the amount of stomach contents re-entering the oesophagus.

Further Information and Advice

There are certain organisations who offer advice and support for those suffering with gastro-oesophageal issues.

• National Institute for Health and Care Excellence - NICE Guidelines for Treatment of Reflux in Adults
• Action Against Heartburn

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