Acid Reflux and Heartburn: What’s the Difference?

You probably think that acid reflux and heartburn mean the same thing. But this is not the case. Granted, both are closely related and affect the upper parts of the digestive system, still there are differences between the two. But how are they different?

To answer this question we need to understand what each of the two terms means. How they are related and why they are different.

What Is Acid Reflux?

Acid reflux is the tendency for stomach acid to flow upwards into the esophagus. This causes a burning pain in the lower part of the chest. 

This tendency occurs when the lower esophageal sphincter (LES) opens in the wrong direction. Normally, the LES opens one-way to let food or drink through into the stomach. After food or drink passes through, the LES closes. This helps to keep the food you have eaten and other stomach contents including stomach acid, from flowing back into the esophagus. 

Why Acid Reflux Occurs

A problem such as the inability of the lower esophageal sphincter to close tightly enough, or sphincter muscle weakness, can lead to the flow of stomach contents upwards into the esophagus. Hiatal hernia, a condition in which the lower esophageal sphincter and part of the stomach are above the diaphragm can also make it easier for acid to flow upwards into the esophagus.1)

Physical exertion including bending over or working out, soon after a meal can lead to this problem. Similar pressure can be caused by being overweight or obese, and being constipated. 

Most often, acid reflux occurs after a meal, especially a heavy meal. It is also more common in pregnant women and for older people.  

What May Worsen Acid Reflux?

As stated above, some foods and drinks are associated with acid reflux. These include alcohol and caffeinated drinks, chocolate, tomatoes, citrus fruits, onions and garlic. If you frequently suffer from this condition, making lifestyle changes that include reducing or cutting out these foods and drinks may reduce the frequency of acid reflux. 

Smoking may also trigger or worsen the symptoms. For this reason, people who frequently suffer from acid reflux can benefit by quitting smoking.

Symptoms of Acid Reflux

Acid reflux means that stomach acid gets into the esophagus or even the throat, causing irritation in these sensitive tissues. The irritation can lead to a number of issues or symptoms. These include sore throat, coughing, sour or bitter taste in the throat or mouth, and a burning pain in the chest otherwise called heartburn.

While an occasional episode is normal, if it occurs more than twice a week, it is said to be chronic and may lead to gastroesophageal reflux disease or GERD. In fact, recurrent acid reflux is a major symptom of GERD.

Complications of Acid Reflux

Many people may consider acid reflux as a minor condition and disregard the need for its treatment. However, left untreated, it can lead to serious complications. As stated elsewhere, when stomach acid gets into the esophagus, it causes irritation that presents with various symptoms including heartburn and pain.

If the resultant irritation of tissue becomes chronic, it can lead to chronic inflammation. 

What Is Heartburn?

Although the name may suggest that heartburn has something to do with the heart, the truth is that heartburn does not affect or involve the heart. The term heartburn is used because the burning feeling occurs in the same general area where the heart is located.

Heartburn may also present with some symptoms that are similar to those of heart disease or even a heart attack. 

Causes of Heartburn

Heartburn affects the upper part of the digestive tract called the esophagus. The feeling of irritation occurs as a result of acid reflux. This is the flow of stomach acid through the lower esophageal sphincter into the esophagus. 

Esophagus is the food tube that connects the throat to the stomach. If for some reason, the lower esophageal sphincter opens upwards, stomach acid can escape and get into the esophagus leading to the burning feeling commonly called heartburn.

The lower esophageal sphincter is located off-center, towards the left side of the body, immediately below the ribcage. This is the general area where the heart is located, hence the reference of this feeling as heartburn.

Symptoms of Heartburn

Heartburn can present with a burning pain in the chest or throat. The condition can be brought about by some foods or drinks. In one study of a group of people with heartburn, 67 percent of 382 individuals suffered heartburn after taking orange juice.2)

Some medications and conditions like pregnancy may also increase the incidences of heartburn.

The burning pain occurs because unlike the stomach which can withstand the corrosive digestive acid, the esophagus does not have acid-resistant tissues. The pain arises when the acid irritates the more sensitive esophageal tissues.

Just as acid reflux leads to heartburn, heartburn is a sign of acid reflux. The condition is quite common. According to the American College of Gastroenterology, about 60 million Americans get heartburn at least once in a month. The condition is more common in pregnant women and older people.3)

Complications of Heartburn

Although many people consider acid reflux a minor problem and never seek for treatment, this digestive system issue can lead to serious complications.  Studies suggest that chronic inflammation in the esophagus can end up damaging the lining of the sensitive tissue leading to bleeding.

It can also cause scarring which can lead to narrowing of the esophagus. When this happens, you may experience difficulty when swallowing. When this happens, you may feel like food gets stuck in the throat. Chronic inflammation within the esophagus can also lead to changes in the cells of the lining of the esophagus which may ultimately lead to cancer of the esophagus.

Final Considerations

The above discussion points to the main difference between acid reflux and heartburn. That acid reflux leads to the irritation of the esophageal tissues, a condition called heartburn. This indicates that heartburn is just a symptom. This suggests that treating heartburn does not offer a lasting solution. This is because heartburn is a sign of the underlying problem called acid reflux.

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