Heartburn: where it comes from and what can help: causes, symptoms and relief

The oesophagus (also: gullet) starts in the upper part of the throat and extends to the entrance of the stomach. It is an important part of your upper digestive system. When we swallow, the oesophagus's job is to transport food or liquids into the stomach. This happens through wave-like contractions, also called peristalsis.

The oesophagus is an elastic tube about 25 cm long, made of four tissue layers: on the inside is the smooth mucous membrane, which lets food pass easily. Beneath it are two layers of stabilising connective tissue that enclose a layer of muscle.

The lower part of the oesophagus, the so-called oesophageal sphincter, is responsible for preventing the backflow of gastric juice. You can think of it as a kind of muscular valve that stops acid and food from flowing back (reflux) from the stomach into the oesophagus.

Your stomach is an important organ of your digestive system. It is sack-shaped and divided into 3 parts:

Fundus: The fundus is the upper part of the stomach, above where the oesophagus enters. It takes in food and stores it temporarily before it moves further into the stomach.

Body (corpus): The body of the stomach is the largest part and extends from the lower edge of the fundus to the stomach exit, the pylorus. This is where the main digestion takes place.

Pylorus: The pylorus forms the lower part of the stomach and is a muscular sphincter that separates the stomach from the duodenum. It regulates the passage of food and stomach contents into the gut.

The stomach wall is also complex and made up of several layers. As in the oesophagus, the mucous membrane (mucosa) lines the stomach and contains special cells that produce stomach acid and digestive enzymes. For example, pepsin, which is responsible for breaking down protein, is produced here. Parietal cells produce hydrochloric acid, which lowers the pH in the stomach and so activates the digestive enzymes. Mucous cells produce the protective layer of mucus that shields the stomach wall from the acid. Above that lies the muscle layer, which is responsible for stomach peristalsis. The outer layer of the stomach is the peritoneum.

Once the food has been partly digested in the stomach, it is called chyme and is passed on through the pylorus into the duodenum to continue the digestive process.

The causes of heartburn are many. Bad habits in your daily life, such as the wrong diet, too much stress and smoking, can already trigger heartburn. Here we list the most important aspects.

Certain foods and drinks: Certain foods and drinks, including fatty, fried and acidic dishes with hot spices, as well as alcohol and caffeinated and acidic drinks, can encourage heartburn. The symptoms often appear right after eating.

Lying down and bending over: Lying down or bending over after eating can make it easier for gastric juice to flow back into the oesophagus.

Pregnancy: Pregnant women are more prone to heartburn because of hormonal changes and the growing uterus. The pressure of the growing baby can squeeze the stomach and encourage gastric juice to flow back into the oesophagus. You'll find more on heartburn and pregnancy in one of the chapters below.

Being overweight and obesity: Excess weight can weaken the lower oesophageal sphincter, which can encourage reflux disease with heartburn.

Smoking: Smoking also encourages reflux disease and with it heartburn.

Medication: Certain medications such as non-steroidal anti-inflammatory drugs (NSAIDs), certain blood pressure medications, anticholinergics and some osteoporosis medications can cause or worsen heartburn.

Stress: Stress can increase the production of gastric juice and affect the normal function of the digestive system, which can lead to reflux disease and heartburn.

Heartburn (reflux) happens when the lower oesophageal sphincter no longer works properly or is weakened. That allows the stomach contents, together with stomach acid and bile acid, to flow back into the oesophagus. The acids irritate the sensitive lining of the oesophagus, which can lead to an unpleasant, burning feeling in the chest or upper abdomen. This symptom is known as heartburn.

Heartburn often occurs after eating, especially after fatty or acidic meals, and in individual cases can be harmless. Other factors that can trigger heartburn are being overweight, pregnancy, certain medications and smoking. When heartburn is chronic, we speak of gastro-oesophageal reflux disease (GERD).

Most cases of occasional heartburn (reflux) can be kept in check with changes to lifestyle and diet. These include avoiding large meals, avoiding fatty or acidic foods, maintaining a healthy weight, avoiding tight clothing around the abdomen, sitting upright after eating and avoiding smoking.

Heartburn, or reflux disease, can show itself through several symptoms. They make everyday life harder and can considerably reduce your quality of life.

Burning feeling and pain in the chest: A burning sensation behind the breastbone is characteristic of heartburn or reflux disease. It normally occurs behind the breastbone, the so-called sternum, and can reach up to the throat. The burning can be intense and get worse when you bend forward or lie down. Heartburn is often described as a feeling of heat or burning acid behind the breastbone that sometimes radiates up into the throat or pharynx.

Sour taste in the mouth & regurgitation: Because gastric juice flows back, you may notice a bad taste in your mouth as well as sour regurgitation.

Trouble swallowing: Some people feel that food or liquid gets stuck when swallowing or travels slowly through the oesophagus.

Cough and hoarseness: Stomach acid flowing back into the oesophagus can also lead to a cough and hoarseness, especially if heartburn happens regularly.

To prevent heartburn, you should be clear about what is causing it. In most cases, changing your everyday habits can already bring a clear improvement.

Changes to lifestyle and diet: There are certain behaviours and foods that trigger heartburn (reflux) and can therefore make reflux disease worse. By adjusting your everyday habits you can reduce heartburn and help prevent reflux disease.

Medication to reduce stomach acid: In some cases, over-the-counter medications such as antacids (to neutralise stomach acid), H2 blockers (to reduce stomach acid production) or proton pump inhibitors (to inhibit stomach acid production) can be used against heartburn. It's important to take these medications under a doctor's guidance, to take potential side effects and interactions with other medications into account.

Avoiding triggers: Identify possible triggers that cause heartburn for you and try to avoid them. It can help to keep a food diary to spot possible links between certain foods or activities and heartburn.

Weight loss: Being overweight or obese encourages reflux disease. Losing weight may help ease the symptom of heartburn. Get advice on healthy ways to lose weight from an expert you trust.

Surgery: In severe cases of heartburn that don't respond to other approaches, an operation to strengthen the lower oesophageal sphincter may be considered.

If acidic stomach contents regularly flow back into your oesophagus, this can damage the sensitive lining of the oesophagus. This can lead to inflammation (oesophagitis), which in turn can lead to pain, regurgitation and trouble swallowing, and increased sensitivity of the oesophagus.

Long-term, unmanaged heartburn can lead to so-called Barrett's oesophagus. In this condition the tissue at the lower end of the oesophagus changes and becomes similar to the tissue of the stomach. Barrett's oesophagus raises the risk of oesophageal cancer.

Chronic heartburn can lead to chronic inflammation of the oesophagus, which can lead to ulcers in the oesophagus (peptic ulcers). These ulcers can be painful and lead to bleeding or other complications.

In some cases heartburn can reach the airways and cause breathing problems such as cough, asthma, wheezing or recurring pneumonia.

Heartburn often occurs at night and can disturb sleep. Lack of sleep can lead to a range of health problems, including tiredness, reduced cognitive function and reduced quality of life.

So try to work as many alkaline foods as possible into your meals. Some foods also tend to produce acidic by-products in the body. These include fizzy drinks, alcohol, meat, sugar and refined grain products. It can make sense for you to cut back on these foods. In the table below you can see which types of fruit and veg are especially low in acid and therefore easy to tolerate.

High-fibre foods like wholegrain products, fruit, vegetables and pulses help improve digestion and regulate the acidity in the stomach.

Lean meat like chicken, turkey or fish, as well as low-fat dairy products like yoghurt and mild cheese, support the function of the sphincter at the lower end of the oesophagus and go perfectly with steamed vegetables. Plant-based alternatives that are also high in fibre include beans, lentils and tofu.

Avoid fried food and work healthy fats like avocado, olive oil and nuts into your meals in small amounts.

If you drink enough water, herbal teas and diluted fruit juices, you also support your acid-base balance.

It's better to eat small portions more often and take your time eating. Avoid large, heavy meals, as they can overload the stomach.

Everyone may react differently to certain foods. Feel free to keep a food diary to find out which foods trigger heartburn for you, and then try to avoid them.

You can simply dissolve these powders with selected minerals in water and drink them. You can take them for a short period, for example during pregnancy. We don't recommend taking them long term without finding out the cause, though.

Chewing sugar-free gum stimulates the flow of saliva, which can help neutralise stomach acid and ease heartburn.

A small glass of cold milk can have a soothing effect on the stomach and temporarily neutralise stomach acid.

Antacids are over-the-counter medications that neutralise stomach acid and can ease heartburn. They usually contain active ingredients such as aluminium hydroxide, magnesium hydroxide or calcium carbonate. Follow the instructions on the packaging and consult a doctor if needed.

Various herbs, spices and roots in tea blends are known for having anti-inflammatory properties and a soothing effect with heartburn. How about ginger or chamomile? In our Happy Stomach tea you'll find plenty of herbs for a good gut feeling.

A teaspoon of baking soda in a glass of water can have an alkaline effect and help neutralise stomach acid. It's important, though, to take baking soda only occasionally and not regularly, as it can lead to an overproduction of stomach acid.