Heartburn- Why you should know about it?-By Dr Harold Gunatillake

Heartburn- Why you should know about it?-By Dr Harold Gunatillake

Dr Harold Gunatillake


25 million adults experience heartburn daily- so says the stats.

About one third of them experience heartburn at least once a month in the US.

It is a feeling of burning sensation behind your heart in the gullet, food related and due to a weak gastroesophageal sphincter muscles mechanism, resulting in acid reflux into your gullet.

It is not a life-threatening disease, but annoying and can lead to sleepless nights, and cause complications, such as inflammation of the lower third of the gullet, referred to as esophagitis, progressing to ulcers and narrowing of the esophagus called a stricture.

Even babies are born with this weak valve mechanism. Therefore, all babies are held vertically and given a pat on the upper back after a feed by the mother.

It is very common among the Indians and Sri Lankans due to eating spicy food.

Heartburn is only a symptom, but the disease is called Gastro-esophageal reflux disease or GERD.

The lower esophageal inner lining is more alkaline and cannot stand any acid fluid. Any reflux of acid juice from the stomach due to a weak sphincter mechanism causes inflammation resulting in that burning feeling. This causes the symptom of heartburn.

How does the valve system work at the gastro-esophageal junction to form a anti-reflux barrier, preventing acid gastric juice and food regurgitation?

The gullet goes through an opening in the diaphragm. This opening is called the hiatus.

The smooth muscles at lower end of the gullet entering the stomach are more thickened and contracts to help prevent reflux of food just eaten. This is referred to as the lower esophageal sphincter (LES).

The diaphragm also has an external sphincter-like mechanism that works as an acid reflux barrier

In addition, there is a valve mechanism at the junction of the lower end of the esophagus and the entrance to the stomach, that relaxes for food to enter but prevents regurgitation into the esophagus.

So, the weakening of this sphincter system, and sometimes due to widening of the hiatus of the diaphragm mainly due to obesity, part of the stomach can get displaced into the chest. This is referred to as a hiatus hernia. Hiatus hernia is common but not all people with a hiatal hernia have reflux.

Obesity seems to be major cause of hiatal hernias due to widening of the hiatus in the diaphragm.

Other causes of GERD are pregnancy, smoking, excess alcohol use and consumption of a variety of foods such as coffee, citrus drinks, tomato-based products, chocolate, peppermint, chewing gum and fatty and spicy foods.

When you feel heart burn for the first time, you may think that it is anginal pain from the heart.

A few years ago we returned from a dinner party, about midnight. After about half an hour later my wife complained of severe chest pain. She has stents put in her main coronary arteries.

She does not drink alcohol, but that night she has had two glasses of white wine with dinner.

Obviously, one would think that she was having heart pain and rush to the closest hospital.

I always carry a small cardiac monitor with me wherever I go. It is a simple device to get a ECG tracing by pressing this devise against the left side of the chest, about the apex beat of the heart, and it gives a tracing with recording. The record will say whether the wave form is normal or not. If it reveals abnormal tracing one must think of heart problem.

When I checked with this devise, I found that the reading was normal wave form.

So, the obvious diagnosis is acid reflux.

I asked her to drink some cool milk from the refrigerator. She did and burped and she was feeling better.

I think, every one of us must carry this device in the pocket for an emergency. It costs you about $ 400.

Another irritating symptom with acid reflux is a chronic cough, sore throat, or chronic hoarseness due to regurgitation of the acid gastric juice.

This may be mistaken for a throat inflammation and may miss the diagnosis.

Precaution to minimize heart burn.

Over-eating especially the night meal may cause heartburn in bed. Have a light meal early and retire to bed late. Eat small meals more frequently like the Chinese to neutralise the gastric juice.

Eating certain foods, including onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoes or tomato-based products may cause heartburn.

Drinking certain beverages, including citrus juices, alcohol, caffeinated drinks, and carbonated drinks may cause heartburn.

Acidic and Alkaline Foods

There are acidic foods, there are alkaline foods. It may be necessary to focus on balancing acid and alkaline in the diet, mostly by eating more vegetables and certain fruits and fever meats and processed foods. The focus is on low acid food eating to minimize the symptoms caused by acid reflux. Now it seems becoming clear that the Western diet is more acidic and may be responsible for the increased risks of diabetes and heart disease.

Getting slim is important. The valve mechanism at the junction of oesophagus and stomach referred to as the cardia may not function efficiently in obese subjects.

Smoking increases acid secretion, and it is better to give up totally.

Wearing tight cloths, tightening with a waist belt may exacerbate episodes.

Always rest your head on at least three pillows. Sitting up position relieves the condition. Sleeping by turning onto your left side helps in preventing acid juice eructing into the lower gullet.

In a study in The Journal of Clinical Gastroenterology, scientists recruited a group of healthy subjects and fed them high-fat meals on different days to induce heartburn. Immediately after the meals, the subjects spent four hours lying on one side or the other as devices measured their esophageal acidity. Ultimately, the researchers found that “the total amount of reflux time was significantly greater” when the subjects lay on their right side.

Alcohol and certain medications like anti-inflammatories, and aspirin can bring about heartburn.

Avoid constipation and straining in the toilet. Eating high fibre diet and fruits may help.

Most people can control their GERD taking the necessary precautions and change in lifestyles. A few may need surgery, if the antacid medication does not give relief.

Hope this video talk was useful,

Stay at home, stay safe and goodbye for now.

Safe Foods for Heart Burn patients

Food Group     Foods With Little Potential to Cause Heartburn

Fruit    • Apple, fresh; Apple, dried; Apple juice; Banana

Vegetables     • Baked potatoes; Broccoli; Cabbage; Carrots

  • Green beans; Peas

Meat   • Ground beef, extra-lean; Steak, London Broil; Chicken breast, skinless; Egg whites

  • Fish, no added fat

Dairy   • Cheese, feta or goat; Cream cheese, fat-free;Sour cream, fat-free; Soy cheese, low-fat


Bread, mult-grain or white; Cereal, bran or oatmeal

  • Corn bread
  • Rice, brown or white; Rice cakes

Beverages       • Mineral water

Fats / Oils      • Salad dressing, low-fat

Sweets / Desserts       • Cookie, fat-free; Jelly beans; Red licorice Potato chips, baked


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