Chronic heartburn or gastro-oesophageal reflux disease ( GERD) is a severe form of heartburn, a disorder in which the acid from the stomach refluxes back up in the oesophagus to cause pain and inflammation.

In this disease, the lower oesophageal sphincter muscle (LES) which is supposed to guide the stomach entrance, opens up to give way to the acid to flow up, causing heartburn.

This is caused generally by improper diet, poor lifestyle and obesity but other pathological or physiological conditions may be responsible too.

Heartburn is treated easily and is a common disorder, but its negligence leads to a chronic form which requires more attention and complex medications [1] .

Generally, chronic heartburn involves more complex, intense and long-lasting symptoms as opposed to those which are experienced in normal heartburn.

These include an increase in the frequency of the acid reflux, nausea, and vomiting, bitter taste in the mouth, difficulty in swallowing, cough, wheezing, inflammation and pain in the chest.

The symptoms of chronic heartburn occur more frequently than those of heartburn and cannot be treated by antacids or simple medications which provide only momentary relief [2].

Factors Associated with Chronic Heartburn

There are several factors involved with the occurrence of GERD or chronic heartburn, which indicate the presence of the disorder.

Absences of any symptoms do not necessarily mean that the disorder is not present.

Patients suspecting GERD must keep track of the duration of symptoms. patients with a long history of chronic heartburn should seek medical attention and get themselves checked for Barrett oesophagus, a condition in which the lining of oesophagus becomes similar to that of lower stomach and intestines due to excessive reflux of acid.

It is important to notice the occurrence of frequency symptoms particularly after meals, which increases in GERD.

Night time heartburn also becomes a common phenomenon in such situations.

These symptoms in chronic heartburn are only relived for a few hours when treated with antacids or normal heartburn medications, after which they show up again.

The symptoms occur most while lying flat and cause a painful sensation of nausea [3].

What to Avoid in Chronic Heartburn?

Diet and Lifestyle plays an important role in the occurrence of GERD or chronic heartburn and if a proper healthy way of living is followed regularly, significant relief from the symptoms can be provided.

It can also reduce the dependency of a person on anti-heartburn drugs, which have their own side effects.

There are a number of lifestyle and diet modifications which are necessary to provide long term relief from chronic heartburn and prevent its occurrence again [4] .

What Should People with Chronic Heartburn Do

Food items to be Avoided

Avoid Carbonated Beverages because they decrease the pH of the stomach and make it more acidic. More importantly, they also decrease the pressure of the LES and make reflux more probable [5].

Avoid Fatty Food because it takes a long time to digest. If anything is hard to digest, it stays in the stomach for a long period which decreases the LES pressure.

Also, due to the presence of food for a long time in the stomach, more acid is secreted to speed up its digestion. This excessive acid causes reflux.

Avoid spicy foods/garlic/raw onions/tomatoes because they relax the lower oesophageal sphincter making it easier for the acid to reflux back up and cause heartburn [6].

Avoid sweets/chocolates/spearmint as they also tend to relax the sphincter muscle and make the reflux of acid more probable.

Avoid Citrus Fruits because they already contain acid and once they reach the stomach, they make the gut pH even more acidic and more prone to reflux [7].

Avoid Caffeinated Beverages because they relax the sphincter and decrease its pressure at the same time, making the reflux more likely to occur [8].

Top Lifestyle Modifications

Avoid Alcohol Consumption especially red wine because it relaxes the LES particularly when taken with heavy meals [9].

Quit Smoking since smoking is one of the major factors that decrease the overall pressure of the lower oesophageal sphincter, causing it to open up and give way to the acid to flow up, causing heartburn [10].

Avoid Over-Eating especially at night because it causes the stomach to secrete more acids for digestion causing heartburn.

Overeating also causes obesity which is another major factor for the occurrence of heartburn.

Exercise Regularly to Manage Weight since obesity exerts extra pressure on the stomach, which causes the sphincter to open up and allow acid reflux [11].

Chin up while Sleeping by using a neck supporter or a bed elevator. The elevation can be of a few inches on the side of the head so that the upper portion of the body is fairly on the higher level than the lower part.

This causes gravity to exert a proper force and the food goes down its normal course while sleeping, instead of flowing back up [12].

Sleeping on the left helps reduce acid reflux because in this position, the stomach is placed below the oesophagus and the food flows down its course of gravity [13].

Walking after meals at a slow pace for 15-20 minutes is also helpful for reducing reflux because it increases the digestion and reduces the acid secretion in the stomach.

Also, avoid excessive physical activity after meals because it again slows down digestion and makes reflux more probable.

Avoid lying down immediately after meals because it slows down digestion and the acid that is being secreted in the stomach to digest the food is more prone to flow up, causing heartburn.

Acupuncture or its automated counterpart called electroacupuncture helps in many ways to reduce heartburns. It reduces the frequency of transient LES relaxations, increases gastric motility and stomach emptying rate.

It also helps in increasing the LES pressure and exerts protective effects on the gastric mucosa.

Massage and relaxation help a great deal in reducing heartburns. A majority of heartburn cases are intensified due to stress and tension.

Massage and relaxation methods such as yoga, meditation etc help the mind to relax and exert a positive effect on the gut so that the digestion is enhanced and incidences of heartburns are reduced.

Avoid tight-fitting clothes because they tend to put pressure on the stomach from the outside, making reflux more probable [14].

Foods to Consume during Heartburn

A variety of food items and natural herbs are known to relieve heartburn.

Some provide instant but short term relief; others might need regular consumption to show any long term signs of amelioration of the symptoms.

It is always advised to consult a dietician for a proper diet chart that includes food items that don’t trigger heartburn along with the inclusion of certain herbs in the diet which relieves acid reflux.

Given below are some of the foods that can be consumed during chronic heartburn.

Aloe Vera

It is one of the best herbal remedies for providing long term relief from heartburn, mostly without any side effects.

It is known to soothe the stomach lining by its cooling effects and cover the gut by a layer of protective mucous that prevents acid from damaging the cells.

It also inhibits inflammation and maintains the pH of the gut [15].

Fennel

A part of bitter herbs, fennel seeds are excellent to provide relief from digestive disorders.

It enhances digestion and prevents acid reflux. It can be taken as a whole or in the form of tea after meals [16].

Banana

Like aloe vera, banana is also full of mucous like polysaccharides which coat the gut and protect against acid attack.

Banana also helps proper digestion of food, inhibits inflammation and acid reflux [17].

Cucumber Juice

It is a very good coolant and helps soothe the stomach by reducing the pain. It also acts as a major anti-inflammatory agent [18].

Green Leafy Vegetables

Green leafy vegetables help in digestion and weight management. Apart from that, they are a good source of essential nutrients which help increase immunity, reduce inflammation and peptic ulceration.

Liquorice

It is an ancient Asian legume plant and its diglycirrhizinated form is widely available in the markets as heartburn medication. It works by reducing ulcers and inflammation besides improving digestion [19].

Greater Celandine

It is a bitter herb and helps to tone the stomach muscles. It increases digestion and reduces inflammation in heartburn. It is generally consumed as a tea [20].

Papaya

Papaya has long been considered good for digestive disorders. Its high papain enzyme content helps improve digestion and reduce constipation.

Besides, its leaves are also known to reduce inflammation and maintain the pH of the stomach, which helps in heartburn [21].

Chamomile

It belongs to the daisy family of plants and is known as a very good herbal antacid. It helps maintain the pH of the stomach, reduce inflammation and ulceration to alleviate heartburn [22].

Wormwood

Also known as absinthe, it is taken as tea or tincture and is an excellent medication for digestion disorders.

It enhances the digestive capacity of the stomach and reduces inflammation, ulceration, and pain.

It also increases the amount of gastric enzyme secretion where heartburn is caused not by excess of acid but by the absence of the same, causing improper digestion [23].

Probiotics

Probiotics are natural substances that contain or promote digestion-friendly micro-organisms.

These help in increased digestion and reduction in acid reflux. Examples of probiotics are curd, yogurt, cheese and other fermented foods [24].

Red Rice Yeast

It is the rice fermented with a fungus called Monascus purpureus. It is a very good probiotic and improves digestion.

It also acts as an anti-oxidant to protect the gut wall from damaging effects of the acid [25].

Medications and Conditions that may Cause Chronic Heartburn

There are several risk factors and physiological conditions that may enhance or initiate heartburn. These include:

  • Pregnancy
  • Hiatal hernia
  • Stress
  • Increased body mass index (BMI) [26]

Apart from these conditions several other conditions may possibly trigger or exacerbate heartburn which would be indicated by the doctor and if not, medical attention should be given immediately.

Several drugs that may increase the symptoms of chronic heartburn are:

Beta Blockers

They are the medications given for high blood pressure.

They work by reducing the nerve impulses in the muscles and blood vessels of the body and relaxing them so that the blood vessels can be dilated and blood pressure is reduced.

However, they can also affect gut muscles in the process and cause chronic heartburn[27] .

Calcium Channel Blockers

They work in a similar manner as that of beta blockers and are also used to treat blood pressure and heart disorders. They relax the muscles of the body, including LES, causing heartburn [28].

Anticholinergics

They are the neuromuscular blockers and are taken for relaxation of the muscles in case of diseases like depression, dementia, fits, and schizophrenia.

They also sometimes act on the gut muscles including LES and relax them, causing heartburn [29].

NSAIDS

Non-steroidal anti-inflammatory drugs or NSAIDs are over the counter available pain relief medications. They relax the muscles of the body and the effects also can be seen on LES, the relaxation of which causes heartburn [30].

Aspirin

It is a pain relief agent used for headaches and dilating the blood vessels. But it is a known culprit for damaging the mucosal linings of the gut.

Excessive intake of aspirin causes thinning of the mucosal layer of the gastrointestinal tract, making it more sensitive to acid attack and ulceration [31].

When to Contact a Medical Professional?

Though heartburn is a common disorder and can be treated by simple medications, chronic heartburn is not that easy to treat. Its symptoms and effects last longer and are more complicated.

They can also cause further problems if proper care is not provided. It is important to know when to contact a doctor so that a proper diagnosis of the severity of the disorder can be done and medications are started accordingly.

Contact the hospital immediately if

Heartburn lasts longer than a few days

If heartburn and pain do not subside for more than a few days, specifically 4-7 days, it is best to contact a doctor and get the condition checked before taking any herbal preparations or medications.

Difficulty in swallowing is experienced

Chronic heartburn is marked by difficulty in swallowing, nausea and bitter taste in the mouth. If these symptoms are experienced for a longer time, it is better to get diagnosed.

You or a Family Member has a history of Barrett’s Oesophagus

Chronic heartburn can lead to Barrett’s oesophagus, but Barrett’s oesophagus can also lead to chronic heartburn.

Those with a history of this disorder should keep on checking with the practitioner for incidences of occurrence of heartburn or GERD and keep the diet accordingly to avoid any symptoms of heartburn [32].

Precautions to be taken when Suffering from Chronic Heartburn

Chronic heartburn is not as easily manageable as normal heartburn which is why extra precautions are to be taken for treatment of this disorder to avoid any other unpleasant effects.

Never opt for any medications or home remedies before actually getting diagnosed with chronic heartburn. The pain and symptoms of some diseases may look similar to those of heartburn but the treatment could be different.

Never opt for any herb or home remedy without the consultation of a pharmacist or a registered practitioner if taking it for the first time.

Alternatively, start with the lowest dose of the herb to check for any allergic reactions, if taking it for the first time.

Always follow the instructions of registered practitioner/pharmacist or the drug label before consuming any food, herb or drug without a prescription.

Always read the drug labels or information on herbal remedies to fully understand their effects and/or any side effects that they might cause normally.

In case of occurrence of any unusual or odd symptoms such as bleeding, unconsciousness, fits, seizures, etc., call for medical help immediately and cease the consumption of the drug/herb.

People suffering from any other unrelated physiological conditions such as diabetes, kidney disorders, liver problems, heart problems, etc. along with heartburn, should never take the heartburn medications/drugs or diet without a doctor’s prescription.

Also, the doctor should always be informed of all the conditions being suffered from. This is because some medications may interact amongst themselves and increase or decrease each others’ effects [33].

Summary

Chronic heartburn is a more severe form of normal acid reflux and is a complex disorder.

It takes efforts and persistence of maintenance of a healthy diet and lifestyle with or without drugs to cure it completely or to a point where it no more poses frequent problems.

Also, its treatment is necessary because it may increase in its intensity with time and cause diseases like cancers and Barrett’s oesophagus.

Several diet modifications, a lifestyle change, herbal remedies work wonders if taken regularly with care in the early stages of the disorder.

Proper precautions should always be taken to avoid any unwanted discomforts and side effects.

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