What REALLY Causes Heartburn?

Every day on television and other media we are barraged with ads about heartburn and acid reflux, which seem to tell us that stomach acid is the culprit causing our pain. If we take the patent medicine recommended in the commercial, our stomach problems will disappear. And how do those medicines propose to “fix” the problem? They lower the level of stomach acidity by either neutralizing stomach acid (these are antacids) or by shutting down the stomach’s ability to produce acid (proton pump inhibitors, or PPIs).

But it’s not really the level of acid in the stomach that causes the discomfort we call heartburn. Heartburn is caused when acid that is supposed to be in the stomach aiding digestion backs up into the esophagus, whose lining is not capable of withstanding the acidity and is chemically burned by it. If we take the advertised patent medicine, it will reduce the level of acid in the stomach, and so if comes up into the esophagus, its acidity will be less there as well, reducing or eliminating the burning sensation. But is this really a heartburn cure, or just temporary symptom relief? And do people really have too much acid in their stomach? Most importantly, is it healthy to reduce stomach acid?

Are Antacids and PPIs Really a Heartburn Cure?

Antacids and PPIs do reduce stomach acid, so when acid comes back into the throat, it does not burn as much. But antacids do not stop acid from going where it doesn’t belong in the first place. Why does acid come up into the throat? There is a valve at the bottom of the esophagus, just before the stomach, called the lower esophageal sphincter (LES). It allows food to pass into the stomach, but is supposed to prohibit stomach contents from going in the other direction. When there is food present in the stomach, that valve is supposed to be shut tight, but sometimes it relaxes when it should not. In some cases, the LES malfunctions because of food allergies and sensitivities, caffeine, alcohol, or nicotine. But it also happens when none of these is present. Doctors are not sure why, but some theorize that more acid, not less, is needed to keep the valve firmly shut, and that the valve relaxes in the presence of low stomach acid. If that is so, taking antacids could actually make the problem worse, not better.

Read the full article at TahomaClinicBlog.com.