Heartburn Disease: Causes and Risk Factors
On a general note, we are all potentially prone to develop heartburn disease, medically referred to as Gastroenteroreflux Disease (GERD); although older people with heartburn disease tend to have a more serious condition than younger people with the problem. Not unusual, we experience a recurrent sensation of chest pain manifesting as a burning sensation in the central portion of the chest, stating from just the uppermost and left-central part of the abdomen from where the burning sensation radiates upward into the central part of the chest wall behind the breast bone (sternum).
This “heartburn” experienced is often accompanied by a regurgitation of the acid produced inside the stomach back into the food pipe (esophagus). It is the irritating and corrosive effect of the acid regurgitated into the esophagus from the stomach that is experienced as heartburn and sometimes as an intense and very discomforting pain in the chest.
The food pipe The esophagus, also called the food pipe, is a narrow muscular tube, about twenty-five centimeters long; it begins below the tongue and ends at the stomach. It consists of three basic layers: an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands.
The esophagus is narrowest at the top and bottom; it also narrows to a lesser degree in the middle, where it passes the aorta (the largest blood vessel coming from the heart) at the chest.
Wave-like muscle contractions, known as peristalsis, move food down through the esophagus and into the stomach. In the stomach, acid and various enzymes, notably hydrochloric acid and pepsin, break down and digest the starch, fat, and protein in food.
How Heartburn develops Unlike the inner lining of the stomach, which has a thin layer of protective mucus, the lining of the esophagus offers only a weak defense against stomach acid and other harmful substances. Perhaps the most important structure in protecting the esophagus is the lower esophageal sphincter (LES), which is a band of muscle around the bottom of the esophagus where it meets the stomach.
The LES opens after a person swallows to let food enter the stomach and then immediately closes to prevent regurgitation of the stomach contents, including gastric acid. It maintains this pressure barrier until food is swallowed again.
Mild temporary heartburn caused by overeating acidic foods can happen to anyone, particularly when bending over, taking a nap, or engaging in lifting after a large meal high in fatty, acidic foods.
Persistent gastroesophageal reflux disease however, may be due to abnormal biologic or structural factors, which include malfunction of the lower esophageal sphincter (LES) muscles, defects or injuries in the lining of the esophagus, peristalsis problems, over-acidic stomach contents, and other problems.
Asthma and heartburn About half of asthmatic patients also have Heartburn disease. It is not entirely clear whether asthma is a cause or effect of the heartburn disease. It is speculated that the coughing and sneezing accompanying asthmatic attacks cause changes in pressure in the chest that can trigger reflux.
Foods Foods that can weaken LES muscular tone include garlic, onions, chocolate, fat, peppermint, spearmint, and coffee. Caffeinated drinks and decaffeinated coffee increase acid content in the stomach. Other acidic foods include citrus and tomato products.
All carbonated beverages, so called mineral drinks increase the risk for symptoms of heartburn disease by bloating the abdomen and causing pressure that forces acid to back up into the esophagus.
Smoking and alcohol can contribute to heartburn disease Alcohol, particularly in large quantity, relaxes the LES muscles and also may irritate the mucous membrane of the esophagus. Smoking can also reduce muscle function, increase acid secretion, reduce prostaglandins and bicarbonate production, and decrease mucosal blood flow; all of which will promote heartburn or make it worse.
Obesity Obese individuals are at a risk of developing heartburn disease this is because obesity tends to increase acid in the esophagus, thereby significantly increasing the risk of heartburn disease.
Drugs A number of drugs particularly those that relaxes smooth (“white”) muscles can cause the Lower Esophageal Sphincter to relax and function poorly. Included here are some antihypertensives like the calcium channel blockers, anti-cholinergics like buscopan, anti-asthma drugs e.g. beta- and alpha-adrenergic agonists, dopamine, sedatives, and some common pain relievers.
As mentioned earlier, Non-steroidal antiinflammatory drugs (NSAIDs) i.e. aspirin and aspirin-like drugs, may also cause heartburn disease. However, such symptoms did not become evident until after about six months of regular use.
Ordinarily, taking an occasional aspirin or aspirin-like medications like Ibuprofen, Indomethacin, Piroxicam etc is not likely to harm someone who has no heartburn disease and no other risk factors for or indications of ulcers. However, Paracetamol (acetaminophen) is usually a good alternative for those who want to relieve mild pain and avoid the aforementioned drugs.
Other Causes Pressure on the abdomen caused by factors such as obesity or tight clothing can contribute to acid-backing up into the esophagus leading to heartburn. Similarly, weakened peristaltic movement in the esophagus may contribute to heartburn disease. In the same vein, if the mucous membrane lining the esophagus is impaired, even a normal amount of acid can harm the esophagus.