If you’ve ever experienced acid reflux (heartburn), you know just how uncomfortable that harsh burning sensation in your chest can be, especially when it lasts for hours at a time. So what’s causing it? The general cause of heartburn is a problem with the lower esophageal sphincter (LES). This valve normally lets food pass into the stomach but prevents it from coming back up into the esophagus, but in people with chronic heartburn, the LES valve doesn’t close properly, and acid refluxes into the esophagus. Because the esophagus doesn’t have the same protective lining as the stomach, you experience a burning feeling.
There are several reasons the LES valve may not be functioning properly. Heartburn causes include:
1. Weak LES Valve
In some people, the ring of muscle that forms the LES valve is weak and unable to form a complete barrier. This is more common in older or obese individuals.
2. Delayed Gastric Emptying
Delayed gastric emptying (also called gastroparesis) is a condition in which the stomach takes too long to digest food, leading to acid reflux. This condition is fairly unusual, and its cause is not entirely known, but it is known that it is more common in people with diabetes. It is believed that chronic high blood sugar may damage the vagus nerve, which controls the movement of food in the digestive tract.
3. Hiatal Hernia
A hiatal hernia occurs when part of the stomach extends past the diaphragm into the chest, preventing the LES valve from closing properly. Chronic acid reflux is often the only symptom of this condition.
The hormone progesterone, which is produced during pregnancy, may relax the LES valve and cause acid reflux. Pressure on the abdomen may also cause heartburn to come and go during later pregnancy. For most women, chronic heartburn does not continue after giving birth.
5. Eating Large Meals
Much like pregnancy, eating large meals can put additional pressure on the abdomen, leading to acid reflux. Being obese may also increase the risk of chronic heartburn.
6. Certain Foods and Beverages
Highly acidic foods, such as oranges and grapefruit, often exacerbate heartburn. However, there are many other potential food and drink triggers, including alcoholic or carbonated beverages, coffee, chocolate, tomatoes, spicy food, fried food, or foods that are high in fat. Not everyone with acid reflux gets heartburn from the same foods and drinks, so it is a good idea to keep a food journal if you’re not sure what causes your symptoms.
7. Certain Medications
Some over-the-counter and prescription medications may worsen your heartburn by weakening the LES valve, increasing inflammation of the esophagus, or slowing digestion. These include certain antidepressants, asthma medications, sedatives, potassium or iron supplements, antibiotics, and NSAIDs.
If you regularly experience heartburn, you may be able to treat your condition through certain lifestyle changes, including eating smaller meals, avoiding foods that you know trigger heartburn, avoiding alcohol, and quitting smoking. There are also certain over-the-counter and prescription heartburn medications you can take to get heartburn relief. Antacids (such as Pepcid, Tagamet, and Zantac) and proton pump inhibitors (such as Nexium, Prevacid, and Prilosec) decrease acid production, which may reduce your heartburn. If you have chronic heartburn, talk to your doctor about medications and behavioral changes that may help. For more information about heartburn medicine, visit our Heartburn condition page.