What causes heartburn?

To find out more our reporter Michael Slater pays a visit to Australian Gut Foundation president, Professor Terry Bolin.

"Well it's caused by acid and it's acid in the wrong place. So acid is produced in the stomach," says Professor Bolin.

Now if it stays in the stomach there's no problem as long as the small valve, the lower oesophageal sphincter, which connects the stomach with the oesophagus, is working properly. But if that valve is weakened the acid flows backwards, up into the oesophagus. This is what's known as reflux and it causes heartburn.

"It's a burning discomfort there and it can be very mild or it can be very severe, so it can mimic a heart attack," says Professor Bolin.

Heartburn is usually caused by what people put down their throats: "They've eaten rich or greasy food, too much fat, too much caffeine, stress, smoking, alcohol. Well, put them all together, you go out and have a big rich meal and you're going to get heartburn during the night," Professor Bolin says.

But for some people like Barbara Eneberg there seems to be no food-related reason for her chronic heartburn.

"It doesn't seem to be greatly associated, that I can figure out yet, to do with specific foods and I'm still trying to figure out what is causing it."

Antacid tablets weren't working so she asked Professor Bolin to look inside.

"Because she had breast cancer years ago, she's worried that there may be something sinister there, so it's important that we have a look," says the professor.

The professor proceeds to take photos and biopsies of inside Barbara's body.

"You see the oesophagus contracting and relaxing on the way down and it's about 40cm long. So there in the distance you can see a colour change of whitish pink to pink, so there's the junction of the oesophagus and the stomach," says Professor Bolin.

Also inside was a brown stain which is acid that's leaked back up into the oesophagus. Professor Bolin carefully checked this area for any indications of cancer. Heartburn and reflux are not life threatening conditions but chronic sufferers, like Barbara Eneberg, need to have it checked.

So what did Professor Bolin find? "No terrible things down there, no hiatus hernia, no inflammation, no cancer, nothing."

Barbara: "Yippee!"
Professor Bolin: "We'll be able to fix you easily."

Barbara was able to find relief with new medication but other sufferers like Glenda Hatch are not so lucky.

"I've had reflux since I was a teenager and I'm 66 now, so it's a long time," she says.

Like Barbara, Glenda had it checked and discovered she had a condition called Barrett's oesophagus.

"It's where the lining of the stomach spreads upwards into the oesophagus and we think it's due to long-term acid reflux and it might affect one in 10 of those with reflux and it's important because it's one cause of cancer of the oesophagus," says the professor.

Do nothing and you run the risk of developing oesophageal cancer.

Professor Bolin: "The big rising cancer in the Western world is oesophageal cancer in men, so we think it's important to treat the reflux properly and treat it long term. Because if you've got it you're going to have it indefinitely."
Michael: "So get to your doc quickly?"
Professor Bolin: "Exactly."

That's what Glenda did and she hasn't looked back: "After Professor Bolin put me onto this medication, I must tell you the result was almost instantaneous. That to me has been brilliant, absolutely brilliant."

So there it is, but if you've got things bubbling up from down below, what preventative steps can you take?

• Reduce portion sizes when eating
• Stay clear of fatty foods like burgers, fried chicken and chips.
• Stay clear of spicy foods too.
• Avoid coffee after dinner — caffeine is often a trigger.
• Don't rush — chew your food properly and your digestive tract will thank you for it.

Fast facts

• Milk is an old favourite for relieving heartburn, but does it work? Yes and no. It is an antacid, but it will only give temporary relief. The calcium and protein found in milk stimulate acid production, so half an hour later, you can find yourself suffering even more.