What Is Heartburn (Pyrosis)?

Nearly everybody has experienced heartburn—also called pyrosis or acid indigestion—at some point. Heartburn is a symptom of acid reflux, which is when stomach acids flow back into the esophagus (the tube that leads down to the stomach from the throat). Its name is attributed to the "burning" pain it causes in your throat or chest.

A range of diseases, disorders, and other risk factors can trigger pyrosis—as can eating certain foods. The symptoms depend on the underlying cause.

For most people, pyrosis only occurs once in a while and usually resolves on its own. But for others, it’s chronic and recurring. Treatments can vary based on how frequently you’re having problems and how severe they are. Luckily, there are effective ways to manage both occasional and chronic heartburn.   

Heartburn Symptoms 

Pyrosis symptoms are painful and uncomfortable and can vary from case to case. They typically begin or worsen after eating, drinking alcohol, or taking certain medications. They also get worse in the evenings, or if you lie down or bend over. Symptoms can last anywhere from several minutes to several hours.

The following are common signs of heartburn:

• Burning, sharp pain in the middle of your chest, behind the breastbone, or in the neck
• Rising burning and pain in the throat
• Acid reflux, a sour, acidic taste, or that of food you’ve eaten, in the back of the mouth
• Hoarseness
• Chronic, persistent cough
• An uncomfortable lump in the throat
• Difficulty swallowing (dysphagia) or pain when you swallow
• Nausea and/or vomiting

If you have frequently recurring pyrosis—which is defined as episodes that occur more than twice a week—you may have gastroesophageal reflux disease (GERD). GERD is a chronic condition characterized by regular occurrences of acid reflux.

What Causes Pyrosis? 

When you eat, your lower esophageal sphincter acts as a valve between your esophagus and stomach, letting things in but not out. Pyrosis occurs when this sphincter relaxes or doesn’t close all the way. This causes acid reflux: a backflow of stomach acid, bile, and food up into your esophagus. The tissues lining the esophagus and throat, unlike those of the stomach, aren’t acclimated to these digestive juices; therefore, they become irritated, causing heartburn.

Researchers aren’t certain why acid reflux occurs, but many factors can affect your lower esophageal sphincter. Occasional cases can be triggered by certain foods, alcohol, and medications. medications that may trigger acid reflux include benzodiazepines, calcium channel blockers, tricylcic antidepressants, iron supplements, and non-steroidal anti-inflammatory drugs (NSAIDs).

In addition, several conditions can have a lasting effect on your esophageal sphincter, triggering chronic pyrosis. These include:

• Gastroesophageal reflux disease (GERD), which is a weakness or disorder of the lower esophageal sphincter
• Hiatal hernia, which is when your stomach pushes into the chest cavity
• Esophageal motility disorders, in which food is unable to travel through your esophagus

Risk Factors

Many factors can increase your chances of experiencing heartburn, including:

• Pregnancy (as many as 45% of pregnant people experience heartburn)
• Having obesity
• Smoking or repeated exposure to second-hand smoke
• Experiencing chronic stress or anxiety
• Eating spicy, fatty, fried, or very acidic foods, as well as chocolate, onions, and peppermint
• Consuming alcohol, carbonated beverages, or coffee

Diagnosis

Most of the time, your healthcare provider will be able to diagnose pyrosis based on assessing of your symptoms. However, if you are persistently experiencing heartburn, they’ll need to confirm the cause; if they suspect GERD, they’ll work to rule out other potential causes of symptoms, including gastritis, Crohn’s disease, and others.

The following tests may assist in the diagnostic process:

• Upper gastrointestinal (GI) endoscopy: Using a specialized tube with a camera, or endoscope, your healthcare provider can examine the lining of your esophagus, stomach, and duodenum (the uppermost part of your small intestine).
• Biopsy: If you experience complications from chronic heartburn, your healthcare provider will take a small sample of tissue during the upper GI endoscopy. They'll evaluate the tissue under a microscope to look for signs of a condition that may be causing it.
• Catheter pH monitoring: This is when a catheter—a flexible tube—is inserted through your nose to measure stomach acid levels in your esophagus.
• Capsule pH monitoring: An endoscope is used to place a small capsule on your esophagus, which sends data about your acidity levels to a wearable device.
• X ray: X-ray imaging may be used to create images of the affected area in cases of suspected GERD.
• Esophageal motility tests (esophageal manometry): A sensor is placed in your esophagus to track how well you’re swallowing.     

Heartburn Treatment

The goals of treatment for pyrosis are two-fold: to ease symptoms and help manage any underlying cause of your symptoms. Depending on what’s causing your heartburn, this can involve everything from home or over-the-counter remedies to surgery.  

Medications

Medications can be used to help manage heartburn in both occasional and chronic cases. Common over-the-counter (OTC) and prescription medications include:

• Antacids, available OTC, include Tums (calcium carbonate) and Mylanta (aluminum hydroxide/magnesium hydroxide/simethicone)
• H2 blockers, which are available as prescription or OTC, include Pepcid AC (famotidine) or Axid (nizatidine)    
• Proton pump inhibitors (PPIs), which are available as prescription or OTC, include Protonix (pantoprazole), Prilosec (omeprazole), and Prevacid (lansoprazole)  

Surgery

In cases of GERD or chronic heartburn, several surgeries can repair the lower esophageal sphincter:

• Fundoplication: This is an open or laparoscopic (minimally-invasive) surgery where the upper part of your stomach is wrapped around your esophagus to reduce the amount of acid that can flow upward.
• Endoscopy: Using an endoscope (a flexible tube with a camera) to guide their work, surgeons perform fundoplication or targeted radio frequencies (RF) to the esophageal sphincter to reduce the size of the opening.
• Weight loss surgery: Since having obesity is a significant risk factor for chronic pyrosis, your healthcare provider may recommend weight loss surgeries, such as gastric band or gastric bypass.
• Hernia repair: Hernia repair surgeries tighten the hiatus—the opening in the tissue between the abdomen and chest cavity—to treat heartburn caused by hiatal hernia.

Prevention

Preventing pyrosis primarily involves making lifestyle changes and working to manage any conditions that make it worse or make attacks more likely. These strategies include managing your diet and alcohol intake, not smoking, and waiting to lie down after eating.

Diet Management

Citrus, fatty or fried foods, coffee, caffeinated beverages, spices, onions, and tomato sauce are among the acidic foods and drinks that can set off attacks. It can be helpful to keep a food diary and record when you experience symptoms to help you determine what may be contributing to it.

Alcohol can relax your lower gastroesophageal sphincter, so limiting or stopping use can help prevent heartburn.

In addition, making changes to your diet, improving your sleep, and boosting physical activity can help you manage and maintain your weight. Doing so can reduce pressure on your lower gastroesophageal sphincter.

Avoid Smoking

Smoking and using tobacco products are significant risk factors for pyrosis as well as many other health conditions. It is best to avoid smoking and secondhand smoke as much as possible. If you currently smoke, there are many resources available to help you quit.

Waiting To Lie Down

If your heartburn attacks usually happen at night, wait at least three hours after eating to lie down or go to bed. Doing so can also help existing heartburn from getting worse. If this interferes too much with your bedtime, you can also try propping yourself up slightly as you sleep to help keep you from lying directly on your back. This helps acid to continue flowing down into your stomach and not back up into your esophagus.

Complications of Pyrosis

If untreated, chronic pyrosis can cause serious complications, including:

• Esophagitis: Frequent exposure to stomach acids causes inflammation of the lining of the esophagus, which can lead to ulcers, bleeding, and further complications.
• Barret’s esophagus: This condition occurs when intestinal lining-like tissue replaces normal tissue in your esophagus. Having Barrett's esophagus increases your risk of developing esophageal cancer.
• Esophageal stricture: This is when the esophagus narrows due to inflammation of the lining, causing difficulty swallowing.
• Hoarseness: A husky, hoarse voice can also occur as your vocal cords are affected by stomach acid.
• Asthma: Breathing problems associated with pyrosis can develop into asthma, a chronic narrowing of the lungs’ airways.
• Laryngitis: Exposure to stomach acids can lead to laryngitis, which is characterized by inflammation of the vocal cords that can make you temporarily lose your voice.  
• Tooth damage: Your teeth can also be affected by chronic acid reflux; stomach acids and bile can eat away at their enamel, leading to decay and cavities.

A Quick Review

Pyrosis, or heartburn, is a common condition, characterized by burning and pain in your chest. It occurs when stomach acids and bile travel back up from your stomach to your esophagus due to a weakness or relaxation of the sphincter, or biological valve, meant to prevent this backflow. O

Although this condition is usually temporary, some people have recurring or chronic pyrosis, caused by conditions like gastroesophageal reflux disease (GERD) or hiatal hernia. Pregnancy, obesity, and smoking are among many risk factors.

Treatments for pyrosis depend on the underlying cause. They range from taking over-the-counter medications to surgeries. Lifestyle changes, such as modifying your diet to avoid food triggers, can help prevent attacks.