Heartburn causes
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Understanding the Causes of Heartburn
Heartburn is a common gastrointestinal symptom characterized by a burning sensation in the chest or upper abdomen. It is often associated with gastroesophageal reflux disease (GERD), but its causes can be multifaceted and complex. This article explores the various mechanisms and factors contributing to heartburn, drawing insights from recent research.
Acid Reflux and GERD
Acid Reflux as a Primary Cause
Acid reflux is traditionally considered the primary cause of heartburn, particularly in patients with GERD. The reflux of gastric acid into the esophagus irritates the esophageal lining, leading to the characteristic burning sensation1. This is especially evident in conditions like reflux esophagitis and Barrett's esophagus, where acid suppression therapy is often effective1.
Heartburn in Pregnancy
Pregnancy is a unique condition where heartburn is prevalent due to hormonal changes and increased abdominal pressure. Studies have shown that acid reflux is a significant cause of heartburn in pregnant women, with a high percentage of those experiencing heartburn showing positive results in acid perfusion and reflux tests3. This suggests that the regurgitation of gastric acid plays a crucial role in pregnancy-related heartburn3.
Non-Acidic Reflux and Other Mechanisms
Weakly Acidic and Non-Acidic Reflux
While acid reflux is a well-known cause, weakly acidic and non-acidic reflux also contribute significantly to heartburn, particularly in patients with nonerosive reflux disease (NERD). These patients often do not respond well to acid-suppressive therapy, indicating that other factors, such as non-acidic refluxate components and esophageal hypersensitivity, play a role1 6.
Esophageal Hypersensitivity
Esophageal hypersensitivity is another critical factor in heartburn, especially in patients with normal endoscopic findings. Research indicates that a significant subset of heartburn sufferers have a lower threshold for esophageal sensation and pain, which can be triggered by both mechanical and chemical stimuli10. This hypersensitivity can explain why some patients experience heartburn despite normal acid contact times and endoscopic results10.
Functional Heartburn and Esophageal Motility
Functional Heartburn
Functional heartburn is a condition where patients experience heartburn symptoms without any evidence of acid reflux or esophageal damage. This condition is often diagnosed through a combination of endoscopy, reflux testing, and esophageal manometry7 9. Treatment for functional heartburn may include neuromodulators, psychological interventions, and complementary medicine options, as traditional acid suppression is often ineffective7 9.
Esophageal Motility Disorders
Esophageal motility disorders can also contribute to heartburn. Studies on pregnant women have shown that neuromuscular dysfunction of the esophagus may play a role in heartburn, although the evidence is not entirely conclusive4. Manometric studies can help identify these motility issues, providing a clearer understanding of the underlying mechanisms4.
Dietary Factors
Food-Induced Heartburn
Certain foods are known to trigger heartburn by affecting the lower esophageal sphincter or directly irritating the esophagus. Research has shown that foods with high osmolality can cause esophageal pain in individuals with acid-sensitive esophagi, suggesting that dietary modifications can be an effective strategy for managing heartburn5.
Conclusion
Heartburn is a multifactorial condition with various underlying causes, including acid reflux, weakly acidic and non-acidic reflux, esophageal hypersensitivity, functional heartburn, and esophageal motility disorders. Understanding these diverse mechanisms is crucial for developing effective treatment strategies and improving patient outcomes. Further research is needed to explore these pathways and refine therapeutic approaches for heartburn management.
Sources and full results
Most relevant research papers on this topic
Mechanisms of heartburn
Heartburn in patients with GERD, particularly those with nonerosive reflux disease (NERD), is influenced by weakly acidic reflux and non-acid-related events, with non-acid-related events playing a significant role.
Heartburn in pernicious anemia--a consequence of bile reflux.
Heartburn in pernicious anemia patients may result from bile reflux, despite the absence of gastric acid.
Case Report
Highly CitedReflux esophagitis as the cause of heartburn in pregnancy.
Heartburn in pregnancy is caused by esophagitis, resulting from the regurgitation of gastric acid on the mucosa of the distal esophagus.
Observational StudyHeartburn in late pregnancy. Manometric studies of esophageal motor function.
Late pregnancy heartburn is common and disappears after delivery, making it an ideal experimental period for studying esophageal motility.
Non-RCT
Large Human TrialHighly CitedFood-induced heartburn: effect of osmolality.
Foods with high osmolality cause pain in acid-sensitive esophagus, while acid-negative subjects show no such pain.
Non-RCTThe pathogenesis of heartburn in nonerosive reflux disease: a unifying hypothesis.
Abnormal tissue resistance is the main cause of heartburn in nonerosive reflux disease, reconciling various proposed mechanisms and reaffirming the definition of reflux-associated "heartburn" as an acid-mediated event requiring antacids.
Highly CitedUntangling Non-erosive Reflux Disease From Functional Heartburn.
Non-erosive reflux disease (NERD) and functional heartburn are common causes of refractory heartburn, and both can be treated with medical, endoscopic, and surgical approaches.
Heartburn : gut health
Heartburn is caused by stomach acid returning into the oesophagus, causing a burning sensation and sometimes causing a bitter or sour taste in the mouth.
Diagnosis and Management of Functional Heartburn
Functional heartburn (FH) is diagnosed through endoscopy, reflux and motility testing, and can be managed with lifestyle modifications, pharmacological interventions, and alternative therapies.
Esophageal hypersensitivity may be a major cause of heartburn
A significant subset of chronic heartburn sufferers have a lower threshold for esophageal sensation and pain, potentially impacting their treatment options.
Observational StudyHighly Cited