Find out what's really causing uncomfortable heartburn.

By Amanda Gardner
September 14, 2018

If you've ever had heartburn, you know the uncomfortable burning sensation in your chest and throat is no fun. Heartburn is a symptom of acid reflux, when acid from your stomach bubbles up into your esophagus, the tube connecting your stomach to your throat. Your esophagus is much more sensitive than your stomach, which is built to handle the corrosive effects of acid.

A little acid reflux once in a while is usually nothing to worry about–it’s likely you just ate or drank too much. “Everyone refluxes a little bit,” says Lawrence Schiller, MD, past president of the American College of Gastroenterology.

If the reflux becomes frequent and severe enough, you may have gastroesophageal reflux disease (GERD). While this needs to be treated to avoid complications (including a higher risk of esophageal cancer), you can often take care of or even prevent occasional acid reflux on your own with lifestyle changes like eating smaller meals and losing excess weight. Here are some of the more frequent causes of the condition.

RELATED: 11 Surprising Symptoms of Acid Reflux

Certain foods and drinks

Many people complain that they get reflux after eating certain foods. Common culprits include items high in fat, chocolate, spicy foods, citrusy or acidic foods like oranges and tomatoes, mint, garlic, and onions, as well as carbonated drinks.

These foods may be more difficult to digest, producing extra stomach acid that can end up in the esophagus. Fatty foods may also relax the lower esophageal sphincter (LES), which usually acts as a “lid” on the stomach. “The LES prevents the backflow of acid from the stomach up to the esophagus,” explains Elena Ivanina, DO, MPH, a gastroenterologist at Lenox Hill Hospital in New York City. Sometimes, though, the LES doesn’t do its job as well as it should.

Doctors often counsel lifestyle changes–including avoiding these triggering foods–to combat reflux symptoms before trying medications. “That’s something people can do without needing to spend a lot of money on medicine,” says Dr. Schiller, also the program director of the gastroenterology fellowship at Baylor College of Medicine in Dallas.

RELATED: 7 Foods That Cause Acid Reflux

Obesity

Obesity is one of the main drivers behind both acid reflux and GERD. It may also increase the risk of GERD complications like Barrett’s esophagus, a condition involving precancerous changes in esophageal cells.

It’s not just extra fat that seems to raise the risk. It’s “central obesity,” which means more fat around your middle, says Dr. Ivanina.

Experts believe extra abdominal fat adds pressure to the stomach, forcing acid up into the esophagus. Hormones could also play a role. People who are obese have more circulating estrogen, which has been linked with GERD symptoms. Postmenopausal women using hormone therapy also have an increased risk of reflux.

Studies have shown that losing weight either through diet and exercise or bariatric surgery can ease symptoms of reflux.

Hiatal hernia

A hiatal hernia is when the top part of your stomach bulges up into your chest cavity, preventing the LES from closing properly.

Many people with hiatal hernias have no symptoms at all. In other cases, the hernia can be caused by GERD, and in still others, GERD is a symptom of the hernia.

Hiatal hernias are more common after the age of 50 and in people who are obese. They sometimes also happen after coughing, vomiting, or a physical injury.

Losing weight along with a healthy diet can help control reflux symptoms due to a hiatal hernia. Some people with reflux due to hiatal hernias may benefit from over-the-counter or prescription heartburn medicines. In extreme cases, surgery may be needed to push the stomach back down and reinforce the barrier between the stomach and the esophagus.

RELATED: 13 Foods That Fight Acid Reflux

Eating a large meal and then lying down

Eating a large meal at any time can trigger acid reflux, but it’s especially troublesome if you do it right before you go to bed or decide to lounge on the couch.

Blame it on gravity. “Eating right before lying down leads to reflux since the stomach is full while one is lying down and it is easier for the acid to back up into the esophagus,” explains Dr. Ivanina. “Large meals also may overcome the esophageal barrier and lead to increased acid exposure.”

Try eating several small meals staggered throughout the day instead of fewer large meals. Don’t lie down until two or three hours after you eat and, if you still have problems, try raising the head of your bed a few inches to offset the effect of gravity.

“A lot of people get some relief from sleeping on an incline or with a wedge under their body,” says Dr. Schiller.

Smoking

Smoking can damage your digestive system just as it damages so many other parts of your body. Even secondhand smoke and chewing tobacco can contribute to reflux by relaxing the lower esophageal sphincter.

“Smoking and alcohol both contribute to reflux as they lower LES pressure, reduce acid clearance, and weaken protective esophageal functions,” says Dr. Ivanina.

Research has shown that quitting smoking can improve reflux (as if you needed another reason to quit, or to not start in the first place).

Smoking may also contribute to reflux by making you cough. “A lot of people who smoke cough, and every time you cough, you’re increasing pressure in your belly and promoting reflux,” says Dr. Schiller.

RELATED: 7 Kinds of Coughs and What They Might Mean

Pregnancy

As many as half of all pregnant women experience acid reflux. It can start at any point when you’re expecting, but it’s more common after 27 weeks.

“It’s [often] blamed on hormones,” says Dr. Schiller. “The uterus gets bigger and increases pressure on the belly. Hormones are higher, which tends to relax the sphincter.”

You’re more likely to have acid reflux when you’re pregnant if you’ve had it before or if you’ve been pregnant before.

Paying close attention to your diet and eliminating trigger foods are your best bet for reducing acid reflux symptoms when you’re pregnant. Talk to your doctor before trying any over-the-counter medications, as not all are safe to take during pregnancy. The reflux should subside after your baby is born.

Medications

Even though medications can magically relieve much of what ails us as human beings, they all have side effects. And sometimes the side effect is acid reflux. Drugs that can aggravate reflux include:

  • Pain relievers like ibuprofen (Advil and Motrin) and aspirin
  • Blood pressure drugs called calcium channel blockers
  • Antihistamines for allergies
  • Sedatives, including benzodiazepines
  • Tricyclic antidepressants like amitriptyline (although these aren’t used that often anymore)
  • Certain antibiotics, including tetracycline
  • Oral osteoporosis drugs
  • Anticholinergic drugs, used to treat a variety of disorders from overactive bladder to COPD
  • Opioids

Iron and potassium supplements may also contribute to reflux. Talk to your doctor if you think any of your medications are contributing to reflux. He or she may be able to suggest an alternative without this side effect.

RELATED: 9 Reasons Not to Ignore GERD Symptoms

Stress

An oft-cited Gallup poll found that nearly two-thirds of people with heartburn said stress worsened their symptoms. No one is sure why. Experts have speculated that anxious people may produce more stomach acid, and some studies indicate that, during times of stress, your perception of the discomfort of reflux is heightened.

Stress can also propel us toward other behaviors that can trigger acid reflux, like smoking, drinking alcohol, skipping the gym, and stress eating. Chronic reflux itself may aggravate stress.

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Scleroderma

Scleroderma is an autoimmune disease that attacks the body’s connective tissue. Many people with scleroderma list acid reflux as a symptom. Tissue scarring that happens with scleroderma causes food to move more slowly through your digestive tract and can prevent the LES from closing properly. Other digestive symptoms in people with scleroderma include constipation and diarrhea.

The same basic strategies to ease reflux can help scleroderma patients as well: Avoid trigger foods and alcohol, don’t lie down after eating, eat smaller meals, and lose weight if you need to. Over-the-counter antacids may also help, but talk to your doctor before using them.

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