We often speak of heartburn and reflux of the stomach acid together, although the two don’t have the same meaning. Heartburn is a burning sensation in the stomach and esophagus. Reflux or gastro-oesophageal reflux disease (GERB) on the other hand means swallowing of the acid from the stomach up the esophagus and not always causing burning pain. Our stomach is like a bag with two one-way valves. This means that when everything is fine things can go only in one direction. The first valve that separates the stomach from the esophagus is called an esophageal valve and is actually a muscle that closes the passage at the end of the esophagus to the stomach. You do not have control over this muscle, but it opens itself together with the swallowing reflex and prevents anything from returning from the stomach. Of course, when everything works like it should. If you get poisoned, this valve can also open in the opposite direction and you will vomit, but if you are heartburning, your stomach juices are going up the esophagus.

Is heartburn caused by excessive or insufficient amounts of stomach acid?

First of all, you have to realize that there are very few cases of excessive stomach acid. The stomach is surrounded by a protective gastric mucosa that protects it against stomach or hydrochloric acid. When problems with the gastric mucosa or any other acid occur it may lead to gastric damage such as gastritis (inflammation of the stomach) and ulcers (wounds), both of which may cause pain. In most cases heartburn and reflux is caused by insufficient amounts of stomach acid. This means you will digest your food slower and it will linger in the stomach for longer where it can damage the gastric mucosa or it can start to boil and secrete harmful substances. This is why you can also experience a bad breath. Insufficient amounts of stomach acid can be caused by:
  • Stress
  • Poor thyroid function
  • Infection with helicobacter pillory bacteria (HP)
  • Lack of vitamins and minerals (especially chlorine, sodium, potassium, zinc and iodine)
  • Pernicious anemia
  • Gastritis or gastric cancer
  • Gastric bypass
  • Pellagra or lack of niacin (vitamin B3)

Heartburn, reflux and sphincter damage

Gastric acid reflux may also cause damage or malfunction of the gastro-oesophageal sphincter. Injuries can be either physical or neurological, and as a consequence the swelling of gastric juices into the esophagus can occur, especially when lying down.

Sibo – another candidate for heartburn

Increasingly, heartburn also occurs as a result of bacterial growth in the small intestine (SIBO) or stomach. The stomach and small intestine are relatively sterile and contain only a little bacterial flora under normal conditions. However, when the intestines aren’t healthy colonic bacteria can move higher into the digestive tract, where they come into contact with undigested foods and begin to ferment them immediately. This forms gases that can be pressed against the stomach and thus on the gastro-oesophageal sphincter, which opens and releases the gastric acid back to the esophagus causing a burning sensation and pain. As you can see, there are many causes of heartburn and reflux and excessive amounts of stomach acid is not a common cause. So if you want a lasting and healthy solution to your stomach problems, you will need to investigate the origin of your problem further. While your medication reduces all acid in the stomach to prevent unpleasant pain and burning symptoms, it also destroys your digestion and exposes you to a higher risk of infection and a lack of vitamins and minerals. This cannot be a proper and healthy permanent solution.

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