Is Your Heart on Fire?
Meet your esophagus. Your esophagus is a muscular tube connecting your oral cavity to your stomach. It’s purpose is to propel food downwards towards the stomach. The junction of your esophagus and stomach is demarcated by a ring of muscles called the lower esophageal sphincter. Since there’s a lower esophageal sphincter, you would normally be expecting an upper esophageal sphincter. You’re correct, there is one. The lower esophageal sphincter or LES for short, prevents food from going back up the esophagus from your stomach. It makes sure that the food stays in the stomach for digestion.
The stomach acts like a cement mixing truck. It mixes food, enzymes and acid. The lining of your stomach is protected by a barrier from the acids. Unfortunately for the esophagus, this barrier is absent. If the acid from the stomach makes its way to the esophagus, inflammation of the lining of the esophagus can happen.
Heartburn is actually the burning sensation/feeling/symptom that you experience when acid washes back into the esophagus. It’s a manifestation of a disorder called GERD. GERD stands for gastroesophageal reflux disease. To keep our tongue from getting tied, let’s just call it GERD. It’s called heartburn because of the burning sensation located near your heart (sometimes making your heart feel likes it’s on fire). Don’t worry though, the esophagus and heart have separate compartments; the esophagus is more anterior or nearer to your sternum).
Note: Some patients and doctors use the terms heartburn and GERD interchangeably. Heartburn is what the patient actually feels or experiences. GERD is the condition which predisposes one to have heartburn. For our purposes, we will use heartburn for the pain experienced by the person.
Heartburn Etiologies (Causes)
Foods. The food we drink and eat can cause an increase in the secretion of stomach acid. This type of setting predisposes one to develop heartburn. The greater the amount of stomach acid produced,the higher the chances of acid reflux. The following are common examples:
- alcohol (are you still surprised?)
- soft drinks and other carbonated beverages
- fruit juices like pineapple, grapefruit and orange
- chocolate (what!?)
- tomatoes and other acidic foods
Foods with a high concentration of fat can affect the function of the LES. They stimulate the LES to relax thereby allowing stomach acid to reflux (return) into your esophagus. Your oral cavity is like a cement mixing truck (cement mixer no. 1), the muscles of mastication (chewing) continuously mix the food in order to start digestion. If you take the time to chew (which you should), your esophagus has enough time to prepare for the passage of food. This will translate into better reception by the stomach (cement mixer no. 2). Food eaten slowly will also dump slowly into the stomach, thereby not shocking it. Food will stretch the walls of the stomach gradually. Ultimately, your stomach will not react violently. Eating slowly allows better preparation time and advanced digestion.
Drugs. Prescription and over-the-counter meds can cause more acid secretion in the stomach. These include:
- NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen
Excess Weight. An excessive accumulation of fat around the abdomen raises the pressure inside the abdominal cavity and pushes the stomach upwards. The stomach contents follow this motion and, acid along with other food particles, can flow back into the esophagus. This may be another motivating factor for you to lose that spare tyre around your abdomen.
Smoking. Another negative effect of smoking (besides being a risk factor for lung cancer) is making the LES relax similar to the effect produced by high fat content foods.
Pregnancy. The growing baby inside the mother’s uterus tends to increase the pressure in the abdominal cavity predisposing the passage of acid through the LES.
Hiatal Hernia. This hernia is located in the chest cavity. The lower area of the diaphragm becomes weak and allows a portion of the stomach to enter into the chest cavity producing a hiatal hernia. This is a good setting for heartburn because the change in position of the stomach can have negative effects on the how the LES works.
Esophageal Diseases. Let’s not forget about the esophagus. Diseases which are native, or those which primarily originate from the esophagus can affect the LES and present as heartburn. Examples include sarcoidosis and scleroderma.
Hypochlorhydria (Low stomach acid). Excess amounts of stomach acid is commonly thought to be the cause of heartburn however, low stomach acid production can also be involved in this condition. Just like the oral cavity, your stomach also acts like a cement mixing truck (cement mixer no. 2). Before your food goes into the small intestine from your stomach, it has to pass a valve called the pyloric valve. The opening of this valve is triggered by stomach acid. Low stomach acid will not open the valve and your stomach (cement mixer no. 2) keeps on mixing and churning the food. Residual acid included in the mixture can still damage the esophagus because the mixture can rush back up and down the lower third of the esophagus. The more time food stays in your stomach, more fermentation takes place. This releases gas which forces the LES to open (remember gas rises, so the direction is upward), exposing more of the esophagus to stomach acid. . Take good care of your cement mixers (oral cavity and stomach) and they will take good care of your esophagus.
Stress. Your brain and esophagus may be a lot closer than you think. Scientists have stated that the stress YOU THINK ABOUT causes a lot of anxiety and may enable activation of the pain receptors located in your esophagus. Your perception of heartburn is then greater than someone who’s not stressed about something. Indirectly, when you’re stressed out, you may do things haphazardly like eating in a hurry and swallowing huge chunks of food. In addition, when you’re stressed, you want some comfort food right? Here comes fat then (if you’re favorite comfort food contains high amounts of fat)…so that means more relaxation time for your LES.
If you occasionally experience heartburn, that’s fine. There are some natural remedies out there which can help alleviate the pain. Frequent bouts of heartburn can be a symptom of an underlying disease which should be checked out by your physician.