Cause

• The lower esophageal sphincter is a bundle of muscles at the low end of the esophagus, where it meets the stomach. When the lower esophageal sphincter is closed, it prevents acid and stomach contents from traveling backwards from the stomach

The following below will either:

• Relax the ‘lower esophageal sphincter’  causing acid to enter the esophagus from the stomach to the throat (heartburn)
• Put pressure on the ‘lower esophageal sphincter’ by slowing digestion process.

• Smoking  (Smoking causes slowness of digestion , slow the production of saliva which acts as a defence to acid, slows the production of bicarbonate to help neutralise acid in our stomach, promote bile acid into the stomach- all these factors lead to heartburn).

Food and drink

• Alcohol (this helps to relax the ‘lower oesophageal sphincter’ tissue  (that stops acid entering the throat and alcohol triggers stomach acid production)
• Caffeinated drinks and tea (this helps to relax the ‘lower esophageal sphincter’ tissue and this causes acid to enter the throat as well as irritate the stomach lining)
• Fatty, fried and/or greasy foods (this slows down digestion putting pressure on the ‘lower esophageal sphincter’ tissue and this causes acid to enter the throat)
• Citrus fruits (increase stomach acid production)
• Tomatoes (increase stomach acid production)
• Spicy foods (increase stomach acid production)
• Black pepper (increase stomach acid production)
• Peppermint tea.

Eating Habits

• Large meals -A full stomach can put extra pressure on the ‘lower oesophageal sphincter’ tissue  and this causes acid to enter the throat)
• Eating two to three hours prior to bedtime
• Lying down with a full stomach (puts pressure on the ‘lower esophageal sphincter’ tissue  and this causes acid to enter the throat)

Abdominal pressure

• Overweight
• Wearing tight fitting clothes
• Exercise straight after eating (High-impact exercises that involve jumping, as well as exercises such as crunches)

Medication

• See Medtick ‘Medication’

In babies under the age of two years old:

(The risk of heartburn is greater when)

• Premature birth;
• Parental history of heartburn or acid regurgitation;
• Obesity (overweight);
• Hiatus hernia;
• History of congenital diaphragmatic hernia (repaired);
• History of congenital oesophageal atresia (repaired) – rare birth defect that affects a baby’s oesophagus (the tube through which food passes from the mouth to the stomach). The upper part of the oesophagus doesn’t connect with the lower oesophagus and stomach. It usually ends in a pouch, which means food can’t reach the stomach;
• Underlying neurodisability;

Cause by other infancy related conditions:

• Overfeeding
• Cow’s-milk protein allergy
• Pyloric stenosis- problem that affects babies between birth and 6 months of age and causes forceful vomiting that can lead to dehydration.
• Bronchopulmonary dysplasia (BPD)- a breathing disorder where an infant’s lungs become irritated and do not develop normally.
• Malrotation -a birth defect link that occurs when the intestines do not correctly or completely rotate into their normal final position during development.
• Tracheo-oesophageal fistula- an abnormal connection between these two tubes. As a result, swallowed liquids or food can be aspirated (inhaled) into your child’s lungs.
• Constipation

The Pharmaceutical Journal, PJ, May 2022, Vol 308, No 7961;308(7961):
DOI:10.1211/PJ.2022.1.141848

Other condition to consider in babies:

Reflux and Regurgitation (when babies bring up feeds and food):

• Gastro-oesophageal reflux is very common (it affects at least 40% of infants);
• It usually begins before the infant is eight weeks old;
• May be frequent (5% of those affected have 6 or more episodes each day);
• Usually becomes less frequent with time (it resolves in 90% of affected infants before they are 1 year old);

The Pharmaceutical Journal, PJ, May 2022, Vol 308, No 7961;308(7961):
DOI:10.1211/PJ.2022.1.141848

Many young babies have bouts of acid reflux because their muscular valve keeping the food in the stomach has not properly developed yet.

Symptoms

• Bringing up milk or being sick during or shortly after feeding?
• Coughing when feeding?
• Hiccups when feeding?
• Unsettled and/or crying during feeding?
• Swallowing and/or gulping after burping?
• Swallowing and/or gulping after feeding?
• Not gaining weight (due to not keeping food down)?

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