Why Persistent Heartburn is Not Just Acidity

Heartburn is often treated as simple acidity with antacids, but gastro-oesophageal reflux disease, known as GERD, is a distinct medical condition. It happens when stomach contents repeatedly move into the food pipe because the natural anti-reflux barrier stops working well. Experts note that GERD is not just about the body making too much acid. Some people with reflux show visible inflammation in the food pipe, while others have symptoms without any injury at all. GERD is widespread in India. A 2021 analysis of nine Indian studies involving 20,614 people found a pooled prevalence rate of 15.6 percent. The lower oesophageal sphincter acts as a valve between the food pipe and the stomach, but it can relax too soon and let stomach contents flow upward. A hiatal hernia can weaken this barrier by pushing part of the stomach above the diaphragm. Obesity, especially extra belly fat, increases pressure inside the abdomen, while delayed stomach emptying raises pressure inside the organ. The food pipe relies on protective mechanisms like saliva to clear refluxed material and alkaline mucus to limit acid damage. Dr. Vishnu Abishek Raju, a senior consultant in medical gastroenterology at Apollo Hospitals in Chennai, explains that the amount of reflux does not always match how severe the symptoms feel. Some individuals have increased nerve sensitivity in the food pipe, meaning even normal amounts of reflux can cause strong burning or chest pain. Dr. Arul Prakash, a clinical lead and senior consultant at SRM Prime Hospital in Chennai, points out that people with high nerve sensitivity may feel a burning sensation with almost anything they eat. Doctors use several methods to test and manage these issues. Endoscopy helps spot problems like oesophagitis, ulcers, and Barrett's oesophagus, especially when patients report red flags like trouble swallowing, bleeding, or unexplained weight loss. When an endoscopy is normal, doctors may use 24-hour pH-impedance monitoring or manometry to check pressure and movement in the food pipe. Lifestyle changes like losing weight, avoiding food for three hours before lying down, raising the head of the bed, and sleeping on the left side can help manage symptoms. If left unchecked, long-term GERD can lead to severe complications, including Barrett's oesophagus, which carries a higher risk of cancer.