The Causes Of Heartburn Are Many & Varied
Just to remind you of the terminology that we’ve been employing on this site, acid reflux is actually the movement of stomach contents up into the esophagus, while heartburn is the sensation that results from this — a very noticeable and often painful burning sensation.
So what causes acid reflux? Well, where the esophagus enters the stomach, there’s a sphincter, a ring of muscle, which is designed to act as a valve to prevent the stomach contents moving back into the esophagus instead of passing forward into the small intestine.
This is needed because the esophagus is not lined with cells which are able to protect themselves from the effect of the gastric juices in the stomach. The valve is called the lower esophageal sphincter or LES; it’s located at the point where the esophagus goes through the diaphragm into the stomach. The diagram makes this clearer.
Obviously if anything goes wrong with this sphincter, the stomach contents can move up into the esophagus, causing acid reflux and the burning sensation we know as heartburn.
There are several reasons why the LES may not work properly.
The first is that the muscles have lost the ability to contract correctly. Or they may simply be unable to keep the valve shut if the opening in the diaphragm through which the esophagus enters the stomach has expanded in some way. For example, the tissue may get weaker as you get older.
Another reason why the LES may fail to keep the stomach contents where they should be is that the pressure in the stomach, for some reason, is much higher than the valve can withstand. This can be one of the causes of acid reflux happening spontaneously.
Before we look at the more scientific aspects of this condition, we can summarize the immediate causes of acid reflux – the kind of things you do in everyday life which may stimulate it.
(And before we do that, here’s a video from the Mayo Clinic! Very nice!)
However, this does not mean that all of the factors listed below are likely to produce reflux – that’s particularly true in the case of asthma, where scientists are still arguing whether asthma causes acid reflux, or acid reflux causes asthma, or if indeed there is any causative relationship between them at all.
1) Eating Large Meals
Eating large meals may not be a primary cause of reflux, but it can certainly make the symptoms worse in those who are experiencing it.
Certainly if you have acid reflux symptoms it’s well worth eating fewer and smaller meals, and also keeping a food diary for an acid reflux diet in which you record everything you eat, so that you can establish which foods might be making your symptoms worse.
If you keep a food diary and you notice that eating a certain food produces more reflux, it’s easy to cut that food out of your diet. You may then find that your symptoms improve.
2) Bending Over and Other “Provocative Postures”
As you may have noticed, gravity is an important factor in keeping the contents of the stomach where they should be. When you bend forward or lie down, it’s much easier for the stomach contents to rise into the esophagus, with the resulting acid reflux causing heartburn. Unfortunately, you may also find the same is true of lifting heavy objects, and it’s not always possible to avoid this.
Even so, taking responsibility for your condition and learning which factors are likely to intensify the reflux and cause heartburn pain can be helpful in changing your lifestyle so that you can minimize things which promote reflux.
3) Hiatus Hernia (Also Known As Hiatal Hernia)
This is a very important acid reflux cause (see more about hiatal hernia here). For now, suffice it to say that hiatus hernia is a condition in which the opening in the diaphragm through which the esophagus passes is so large that part of the stomach is able to move upwards into the chest cavity alongside the esophagus.
The majority of hiatal hernias are the sliding type, which means that the stomach is free to move backwards and forwards through the opening. These tend to be much less serious than theparaesophageal hernia, when part of the stomach is permanently fixed in the chest cavity.
Hiatal hernias are linked to belching, discomfort, burping, acid regurgitation, nausea and even vomiting.
You can reduce the chance of your hiatal hernia causing acid reflux by avoiding those activities which tend to make it problematic: lifting heavy weights, coughing, straining on the toilet, excessive physical exertion, and bending forward. We also know that pregnancy and obesity can promote hiatal hernias and acid reflux, although you may find it less easy to avoid the impact of these two conditions than some of the others.