Understanding Heartburn

Heartburn affects one-third of Irish people and Covid-19 stresses are making things worse, writes Ian Madigan

Heartburn really sticks in the craw of Irish people, onethird of whom suffer from the condition regularly. Research from iReach to coincide with Heartburn Awareness Week in October shows that the heartburn situation is worsening. For people who suffer from it, one in five reported that their heartburn had deteriorated since the beginning of the Covid-19 pandemic.

Heartburn happens when stomach acid contents flow up into the oesophagus, the tube connecting the stomach to the mouth. Stomach acid is strong enough to dissolve metal and is prevented from destroying your stomach walls by a layer of mucous (if that fails, stomach ulcers can be caused).

The stomach juices are also kept in the stomach by a valve where the stomach connects with the oesophagus. However, this valve occasionally opens to let air out, such as when you belch. Sometimes, the valve also relaxes too much and for too long, which lets stomach acid escape into the oesophagus. That can cause the burning sensation, sour taste and coughing that comes with heartburn.

Most people will experience heartburn occasionally, but for three in 10 people in Ireland symptoms occur more than twice a week. The generic term for the condition is acid reflux, of which heartburn is a symptom. If it happens in a chronic or more severe fashion — two or more occurrences each week meets the definition of ‘chronic’ — it is called gastroesophageal reflux disease.

A range of triggers can cause a heartburn attack. Eating rich or spicy food is the main heartburn trigger for more than half of sufferers. Other common triggers are eating too much

Heartburn sufferer Mick Galwey at the launch of Heartburn Awareness Week

(34%) and stress (31%). Certain foods take longer to digest and a large meal keeps the stomach stuffed. Both of these factors are thought to put pressure on the valve stopping acid from escaping into the oesophagus.

The links between stress/anxiety and heartburn are less well understood, but it is believed that stress heightens your perception of pain, so that even minor increases in the level of stomach acid are felt. Stress can also interfere with the cells in your stomach that produce the mucous keeping stomach acid away from the stomach walls. When asked about their heartburn worsening during the Covid-19 pandemic, half of sufferers blamed stress, while one in four cited work-related stress. Onethird pointed to increased snacking as the cause.

Heartburn triggers vary for different people but the most well-known causes include overeating, smoking, lack of exercise and lying down after eating a large meal. The most common over-the-counter treatments for heartburn include antacids like Rennie, which uses ingredients such as calcium carbonate to neutralise stomach acid, and alginates such as Gaviscon, which float on top of the stomach acid and prevent it from entering the oesophagus. Don’t take Gaviscon if you are also taking aspirin or ibuprofen, as it can affect your body’s ability to absorb the painkillers.

Other popular treatments for heartburn include proton pump inhibitors (PPIs) such as those used in the medication Nexium, which can reduce the production of stomach acid. Very effective for short-term use, PPIs should not be a casual go-to every time you have heartburn, as research links long-term PPI use with a heightened risk of pneumonia, and infections that can cause severe diarrhoea. Additionally, Swedish researchers in early 2020 reported that long-term PPI usage could increase the risk of developing dementia.

‘Eating rich or spicy food is the main heartburn trigger for most people’

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