What Causes Heartburn?

Just about everyone suffers from heartburn – that nagging, burning pain in the lower chest - occasionally. It’s common, but what causes heartburn? Why does it happen?

Aside from idle curiosity, it’s good to know the causes of heartburn because knowing the cause might suggest how to go about treating it.

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As I was researching this subject I was surprised to discover that there are different theories about how heartburn comes about. I'll start with the most common theory, and then tell you about some of the other ones that were a surprise to me.

The generally taught mechanism of heartburn is that it is caused by acid from the stomach backing up into the esophagus, where it causes irritation and the typical burning sensation.

So even though it’s called heartburn, it isn’t caused by the heart.

There are several reasons why this backing up of the stomach acid, which is referred to as reflux, can happen.

One is simply over eating. An overly full stomach is likely to reflux.

Also, being overweight increases the pressure in the abdominal cavity which tends to push things out of the stomach.

Other mechanical things like bending over or lying down with a full stomach can lead to reflux as well.

There can also be a problem in the esophagus itself. In the lower end of the esophagus, just as it empties into the stomach, there’s a specialized area of muscle called the lower esophageal sphincter (LES). Normally, this stays contracted (except when you swallow) and has a higher pressure than the rest of the esophagus. It functions like a valve to keep gastric content in place.

If the LES becomes weak, then reflux can happen.

One indirect cause of heartburn is a hiatal hernia, however a hiatal hernia doesn’t always cause heartburn and reflux.

A hiatal hernia refers to part of the stomach sliding up into the chest cavity. When that happens, the LES is often disrupted and so reflux and heartburn can occur.

However, many people have a small hiatal hernia and no heartburn. And you can have heartburn without having a hiatal hernia. So they can go together, but don’t always.

I mentioned above that there are competing theories about the causes of heartburn. One surprising one is that reflux is caused by low stomach acid.

The thinking in this theory is that high acid in the stomach is a signal for the LES to become tighter and low acid a signal for it to become more relaxed. If that’s the case, low acid increases the chance of reflux and heartburn.

People who subscribe to this theory say that this is why the folk remedy of taking cider vinegar works for acid reflux. By taking acid, you increase the LES pressure, reducing the chance of reflux occurring. It certainly is an interesting theory. It scratch that

It may be that heartburn has different causes in different people and that's why they're so many different ways of treating it available - each cause needs its own treatment.

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