What Are Some Common Causes of Heartburn?

Heartburn and acid reflux are fundamentally caused by a loose or weakened lower esophageal sphincter (LES). If you’ve read some of our blogs, you’ll know that we talk about the LES a lot. We talk about this little band of muscular tissue so much because it’s critical to the acid reflux discussion. In a normally-functioning esophageal sphincter, food passes through but does not reverse direction unless vomiting occurs. For patients with GERD or occasional acid reflux, regurgitation happens more frequently than it should, causing pain and burning. Let’s take a look at some foods that trigger heartburn, the causes of heartburn at night, and how to handle heartburn and pregnancy.

Causes of Heartburn at Night

Again, a normally-functioning LES will not allow stomach contents to reflux, even when lying down. However, a compromised or weakened LES will. Some patients find that their symptoms are only problematic at night because of the angle at which the stomach and esophagus lay while lying down.

What You Can Do About it

If you only experience heartburn at night, elevating your upper body - not just your head - may be a good place to start. If you find that you still wake up with acidic reflux or complete respiration into your larynx and windpipe, you may want to take an antacid before bedtime as well. Keep in mind that antacids do not neutralize enzymes like pepsin, and nighttime reflux can still cause damage to your esophagus even if it doesn’t burn.

Another way to prevent nighttime heartburn is to avoid eating in the 2-3 hours before going to bed. This usually means no more late-night snacking!

Heartburn and Pregnancy

Heartburn and pregnancy seem to go together like peanut butter and jelly, though they aren’t nearly as enjoyable a combo. During pregnancy, all of your insides get moved and pushed upward into the body cavity - much to the chagrin of your stomach and LES. This upward pressure, when combined with hormonal factors (pregnancy hormones tend to loosen up muscular and fibrous bands of tissue in preparation for labor), makes for a very compromised LES. 

What You Can Do About it

Most women find that their heartburn symptoms disappear after giving birth, but not all will see their symptoms subside - especially women who choose to breastfeed or bottle-feed expressed breastmilk. During pregnancy, you will need to employ a variety of techniques to help reduce your symptoms, including elevating your upper body during sleep and taking antacids or other medications that are safe during pregnancy.

Foods That Trigger Heartburn

It’s important to not get heartburn triggers confused with the cause of heartburn (a weakened LES). With that out of the way, let’s take a look at some common triggers that may make your heartburn symptoms worse:

Some foods tend to make the symptoms of heartburn feel worse, while other foods physically impact the LES in some way, aggravating and increasing the prevalence of symptoms. For example, capsaicin (the “spicy” part of spicy foods) doesn’t directly loosen the LES (in fact, it appears to increase LES motility); however, it does increase the burning sensation of any stomach contents that reflux during heartburn. Caffeine, on the other hand, does loosen the LES and increase gastric secretions, making it easier for stomach contents to regurgitate and cause symptoms.

What You Can Do About It

In order to minimize your symptoms, it is recommended that GERD patients stay away from all trigger foods (regardless of the mechanism by which acid reflux is triggered). These foods that trigger heartburn include the two above, theobromine (found in chocolate), tomato products, carbonated beverages, alcohol, citrus fruits and juices, and some painkillers.

Other Lifestyle Factors & What You Can Do

Overeating, smoking, being overweight, and heavy alcohol use are all attributed to GERD. Working with your reflux doctor, you may start working on eliminating some or all of these contributing factors. Losing weight, avoiding foods that trigger heartburn, eating smaller portions, quitting smoking, and reducing alcohol intake are all good places to start when considering lifestyle changes. If nothing else is working, talk to your doctor about reflux surgeries - these can end your heartburn troubles for good.