What is Heartburn?
Heartburn also known as indigestion is where the acid from the stomach used to help digest the food you eat moves up into the oesophagus, the tube that takes your food to your stomach. The lining of the oesophagus is not designed to cope with high acid levels and so a burning sensation can be felt in the area of the lower to upper chest area. In some cases the acid can regurgitate all the way up into the mouth. Persistent acid heartburn can create more serious long term issues.
What are some other names for heartburn?
Heartburn is also known as:
- Acid reflux
- Oesophageal reflux
- GERD (Gastro Esophapgeal Reflux Disease, spelt the American way)
- GORD(The Australian spelling)
This is persistent acid reflux that occurs more than twice a week.
What is silent reflux?
Silent reflux is where the stomach acid flows up into the oesophagus but there are not common symptoms such as pain and burning.
What are the symptoms of silent reflux?
- Sense of something stuck in the throat
- difficulty swallowing
- hoarse voice
- regular throat clearing
- difficulty breathing
- post-nasal drip sensation
What are some acid reflux symptoms or heartburn symptoms?
- chest or upper abdominal pain
- difficulty or pain when swallowing
- Throat problems including hoarse voice, laryngitis
- stomach ache
- dry, persistent cough
- asthma and recurrent respiratory infections
- tooth decay and gum disease
- bad breath
What causes heartburn or reflux?
- Hiatus hernia – part of the stomach moves through the diaphragm forcing acid into the oesophagus
- Oesophageal sphincter dysfunction – the valve between the stomach and the oesophagus is faulty
- Smoking– increases acid secretion and damages mucous membranes that protect the oesophagus lining and stomach lining.
- Pregnancy– later stages of pregnancy put more pressure on the stomach due to growth of the foetus resulting in reflux
- Obesity– increases the pressure on the stomach resulting in higher risk of acid reflux or indigestion
- Eating close to going to bed – lying down with a full stomach increases the pressure on the oesophageal valve running the risk of it opening and causing stomach acid to enter the oesophagus
- Pain relief medication – some pain relief medication can aggravate the digestion causing increased acidity and potential for indigestion. There have also been some findings recently about the potentially damaging long term affectsof some pain medication.
- Stress– increased stress will aggravate your digestion and prevent it from functioning properly and can lead to a wide range of symptoms including heartburn and indigestion, constipation, diarrhoea, bloating and pain
What foods affect heartburn or acid reflux?
- Citrus fruits
- Fatty foods
- Deep fried foods
- Spicy foods like chilli and curry
How is heartburn diagnosed?
- Endoscopy – using a camera inserted into the throat to look for any tissue changes or obstructions.
- Tissue biopsy assessing tissues at the cellular level to make sure there are no abnormal cell changes which may indicate pre-cancerous cells
- Barium meal X-ray – this is where a chalky liquid is swallowed that is easy to pick up on x-ray and can help to show any obstructions or structural problems with the stomach or oesophagus.
- esophageal manometry – a pressure test of the oesophagus to see if the valve is functioning properly
- impedance monitoring – this measures the rate fluid moves through the oesophagus to the stomach and again helps to assess whether there is a structural or functional problem of the oesophagus
- pH monitoring – testing acidity levels in the stomach
What are the risks associated with heartburn or reflux?
Long term persistent acid reflux or indigestion can result in:
- Esophagitis: inflammation of the lining of the oesophagus that can cause irritation, increased inflammation, potential bleeding and ulceration.
- Strictures: with long term exposure scars can form along the oesophagus resulting in reduced flexibility of the tissue. This can pain and difficulty swallowing and food getting stuck when eating.
- Barrett’s esophagus: This is a further stage where the continued exposure to stomach acid of the oesophagus lining results in cellular and tissue changes.
- Cancer – Ongoing cellular changes can result in abnormal cell formation which is what happens in the case of cancer.
How is heartburn treated by western medicine?
Western science has a range of options to assist with reducing the symptoms associated with heartburn and indigestion.
- Protein Pump Inhibitors and H2 blockers– these reduce the production of stomach acid to reduce the risk of heartburn and acid reflux.
- Antacids– these are generally available without prescription and are designed to also reduce acid in the stomach. They generally provide rapid relief but only over the short term. They are not designed for long term use. Antacids contain chemicals such as calcium carbonate, sodium bicarbonate, magnesium hydroxide and aluminium hydroxide.
- Alginic acid– these medications create a barrier between the stomach acid and the oesophagus to prevent burning and damage to the lining.
- Sucralfate acid suppressants– are used generally to prevent the return of ulcers but can be used in the management of indigestion and reflux by protecting the oesophagus lining from stomach acid
- Potassium-competitive acid blockers– help to reduce acid levels in the stomach
- Transient lower esophageal sphincter relaxation (TLESR) reducers– relax the oesophagus which can take the stress of the valve or sphincter between the stomach and the oesophagus
- GABA(B) receptor agonist-relax the oesophageal sphincter
- mGluR5 antagonist-relax the oesophageal sphincter
- Prokinetic agents used in conjunction with protein pump inhibitors to increase peristalsis which is the muscular contraction that moves food down through your oesophagus and the rest of your digestive system.
- Pain relievers– in some cases pain can significantly increase stress on the nervous system indirectly affecting the digestive function. Pain reliefmethods may assist in reducing heartburn and reflux symptoms.
- Antidepressants –in some cases stress, anxietyor depressioncan affect your nervous system which can lead to poor digestive function including things like heartburnand indigestion.
What are some side effects of heartburn or acid reflux medication?
- Reduced digestive function– by decreasing acid levels your ability to absorb nutrients effectively can be significantly impaired. Appropriate acid levels are necessary for calcium, Vitamin D and B12 absorption. Gut bacteria vital to your digestion can be affected.
- Dementia– has been seen as a potential risk associated with protein pump inhibitors
- Kidney function– One study (1) in 2016 suggested that use of PPI’s could potentially increase the risk of chronic kidney disease by 20 – 50 %
- Increased infections
- Higher risk of bone fracture and osteoperosis
- Stomach pain
- Nausea/ vomiting
What are some heartburn remedies?
- Diet – a whole food diet will remove most aggravating foods. A focus on lots of vegetables, animal protein for not vegetarians or vegans and fruit is the best approach. Avoid dairy, sugar, wheat, alcohol and fatty greasy foods will assist in reducing the symptoms of indigestion
- Alcohol– initially removing alcohol from the diet for a month to 6 weeks can have a significant effect in reducing indigestion and acid reflux. Long term cessation is not likely but it is important to recognise that high alcohol intake will create heartburn.
- Smoking– with out being preachy let’s face it, smoking does nothing for your health and lots to damage it. Looking at ways to reduce or remove smoking from your life will increase your health dramatically and save you a significant amount of money. For help with smoking cessation you might want to consider acupuncture and hypnotherapy.
- Stress management – there is now very strong evidence connecting the function of the digestion to the brain. High mental or emotional stress levels will increase stress on the digestion leading to long term impairment and damage.
How does Chinese medicine view heartburn and indigestion?
Chinese medicine considers that the digestion functions by moving food and liquids downward and out of the body. Any disruption to this normal function like in the case or indigestion or acid reflux highlights an imbalance that needs to be corrected in order to restore health to the body and prevent long term problems from occurring.
Quite often acid reflux or indigestion will not be an isolated symptom and so Chinese medicine looks at the big picture. You may find additional symptoms such as constipation, diarrhoea, fatigue, insomnia, low mood,anxiety to name a few. By taking into account the whole story Chinese medicine aims to attend to all factors that may be contributing not just to the symptoms associated with reflux but the entire system.
Chinese medicine aims to reduce symptoms associated with acid reflux such as pain, burning, bloating and improve digestive function.
What does the research say about Chinese medicine, acupuncture and heartburn?
One systematic review of randomised control trials (2) suggests an effect using acupuncture on digestive function particularly in the case of reflux.
A systematic review of acupuncture randomised control trials (3) showed acupuncture showed superior results to control and medication in the treatment of acid reflux however there was a perceived bias in the interpretation of the results.
In 2017 a systematic review (4 ) of 12 randomised control trials totalling 1235 participants found acupuncture to have a postitive effect in the treatment of gastro-oesophageal reflux otherwise known as heartburn, indigestion or acid reflux. The trial sizes were not large enough to be considered adequate however showed promising results.
A meta analysis (5) of 5 systematic review totalling 22 randomised control trials founds that acupuncture in combination with prokinetic medication had the highest chance of successful outcomes in the treatment of functional dyspepsia (acid reflux). The review also recommended those patients who did not respond to prokinetic drugs use acupuncture and moxibustion as an alternative.
- Benjamin Lazarus, MBBS1,2; Yuan Chen, MS1; Francis P. Wilson, MD, MS3; et al Yingying Sang, MS1; Alex R. Chang, MD, MS4; Josef Coresh, MD, PhD1,5; Morgan E. Grams, MD, PhD1,5JAMA Intern Med. 2016;176(2):238-246. doi:10.1001/jamainternmed.2015.7193
- Lan L, Zeng F, Liu GJ, Ying L, Wu X, Liu M, et al. Acupuncture for functional dyspepsia. Cochrane Database Syst Rev. 2014(10):Cd008487.
- Kim KN, Chung SY, Cho SH. Efficacy of acupuncture treatment for functional dyspepsia: A systematic review and meta-analysis. Complement Ther Med. 2015 Dec;23(6):759-66.
- Jiajie Zhu, Yu Guo, Shan Liu, Xiaolan Su, Yijie Li, Yang Yang, Liwei, Hou, Guishu Wang, Jiaxin Zhang, Jiande JD Chen, Qingguo Wang, Ruhan Wei, Wei Wei Acupuncture for the treatment of gastro-oesophageal reflux disease: a systematic review and meta-analysis. British Medical Journal 2017
- Robin S. T. Ho, Vincent C. H. Chung, Charlene H. L. Wong, Justin C. Y. Wu, Samuel Y. S. Wong & Irene X. Y. Wu. Acupuncture and related therapies used as add-on or alternative to prokinetics for functional dyspepsia: overview of systematic reviews and network meta-analysis. Scientific Reports volume 7, Article number: 10320 (2017)
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