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What is heartburn?

Heartburn is a digestive issue that occurs when acid from your stomach splashes up into your oesophagus (the tube that carries food from your mouth to your stomach).1 This causes an unpleasant burning feeling in your chest and throat, often shortly after eating a meal or lying down.1-3

Heartburn is also known as acid indigestion.4

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Understanding what causes heartburn

Your gastrointestinal tract (also called the GI tract) is part of your body’s digestive system.5 It’s a long tube that runs from your mouth to your anus, with your oesophagus, stomach, small intestine and large intestine in between.5

The Digestive System

Digestive System

The food you eat travels from your mouth, down your oesophagus and into your stomach.1,6 Your stomach contains gastric acid, which breaks down the food so it can be passed into the small intestine in small portions.5

There is a ring of muscle at the end of your oesophagus, called the lower oesophageal sphincter.1,5,6 It closes off the opening between your stomach and oesophagus.1 This sphincter should only relax when you swallow, allowing the lower end of your oesophagus to open so the food can enter your stomach.5,6

However, if this sphincter doesn’t work properly, your GI tract where your oesophagus and stomach meet isn’t kept closed.1 This means gastric acid can sometimes flow back up into your oesophagus, even reaching your throat and mouth, causing the discomfort of heartburn.1

Did you know?

Research suggests that over 50% of the general population may suffer from heartburn, and one-third report a feeling of acidic juices coming back up their oesophagus (called acid regurgitation or reflux).7,8

Healthy

Healthy Digest

Heartburn

Digestive Sopen

Symptoms of an acid reflux condition:1,8

  • A burning sensation in your chest, moving up into your throat (heartburn)
  • A sour or bitter taste in your mouth (acid regurgitation)
  • Symptoms affecting your throat, like hoarseness or a cough
  • Bad breath
HR1

Heartburn risk factors and triggers

The following factors can contribute to acid regurgitation and increase your risk of experiencing heartburn:9

  • Eating certain foods, especially spicy and fatty foods or citrus fruits
  • Drinking certain beverages, like alcohol, fizzy drinks, caffeinated drinks or citrus juices
  • Smoking cigarettes
  • Stress
  • Being overweight
  • Taking certain medications

How to treat heartburn and acid regurgitation

Antacids and alginates

Antacids work by making your stomach juices less acidic.2,10 Alginates form a 'raft' over your stomach contents.2

Antacids and alginates are useful for patients with mild or sporadic symptoms, but they do not decrease the production of acid in the stomach.2,8,10 They also usually need to be taken often.10

H2-receptor blockers and PPIs (Proton-pump Inhibitors) work differently: they decrease the amount of acid produced in your stomach and reduce the risk of potential damage caused by acid reflux.2

H2-receptor blockers

H2-receptor blockers work by blocking one of the three pathways responsible for acid production.11 This reduces acid production but there are still two other pathways that can trigger the production of acid in the stomach.11

PPIs (Proton-pump Inhibitors)

PPIs are currently the medication that most effectively decreases the amount of acid produced in the stomach.2,8 They act on the pump in our cells that is responsible for making gastric acid.10,11

They therefore act to block acid production regardless of which of the three pathways may have triggered the excess acid production10,11 and relieve symptoms of heartburn and hyperacidity.2 

PPIs can be taken once daily for up to 14 days, without a prescription.11

Ask your pharmacist about the once-daily acid-reducing OTC heartburn treatment options available.
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References

1. Heartburn patient information from BMJ. BMJ Best Practice. 2020.

2. Malan L, Labuschagne Q, Schellack N, et al. Gastro-oesophageal reflux: an overview of the pharmacotherapeutic treatment options. South African Family Practice. 2017 Jul;59(3):41-44.

3. Van Rensburg K. Gastro-oesophageal reflux disease (GORD). South African Pharmaceutical Journal. 2010;77(10):4.

4. Heartburn. Medline Plus. National Library of Medicine [cited 2020 Nov 18]. Available from: https://medlineplus.gov/heartburn.html.

5. Your digestive system and how it works. NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases [cited 2020 Nov 18]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works.

6. How does the stomach work? InformedHealth.org. Institute For Quality and Efficiency in Healthcare (IQWIG); 2016 [cited 2020 Nov 18]. Available from: https://www.ncbi.nih.gov/books/NBK279304/.

7. Cohen E, Bolus R, Khanna D, et al. GERD symptoms in the general population: prevalence and severity versus care-seeking patients. Digestive Diseases and Sciences. 2014 Oct;59(10):2488-2496.

8. Zuckerman MJ, Carrion AF. Gastro-esophageal reflux disease. BMJ Best Practice. 2019.

9. Oliveria SA, Christos PJ, Talley NJ, et al. Heartburn risk factors, knowledge, and prevention strategies: a population-based survey of individuals with heartburn. Archives of Internal Medicine. 1999 Jul;159(14):1592.

10. Mejia A, Kraft WK. Acid peptic diseases: pharmacological approach to treatment. Expert Review of Clinical Pharmacology. 2009 May;2(3):295-314.

11. Data on file.