IBS and heartburn: What is the link?

 Key Takeaways

• Heartburn is a primary symptom of gastroesophageal reflux disorder (GERD) but can also occur in people with IBS.
• Experts are not sure if IBS causes heartburn, but they know that there is a link between IBS and heartburn because some people with IBS also experience heartburn.
• The treatment for IBS and GERD includes medications, dietary, and lifestyle changes. 

Acid reflux, also called gastroesophageal reflux (GER) is a health condition where stomach acid goes back up (reflux) into the esophagus. This may cause a burning sensation in the chest area called heartburn. 

When acid reflux occurs frequently, doctors may diagnose it as gastroesophageal reflux disease (GERD). 

Researchers have carried out studies that indicate there is a link between GERD and irritable bowel disease (IBS), another gastrointestinal tract disease. IBS can cause abdominal discomfort and a range of other symptoms such as diarrhoea and constipation. 

But, is heartburn also associated with IBS? We will find out in this article. This article will discuss IBS, heartburn, and acid reflux. It will discuss the causes of heartburn and how this symptom is linked to IBS.

 What is IBS?

Irritable bowel syndrome (IBS) is a chronic disease that affects the functioning or physiology of the gastrointestinal system. This medical condition includes a group of symptoms like constipation, diarrhea, bloating, abdominal pain, bowel movement, and gas.

The cause of this condition is unknown, but several studies suggest psychological and dietary factors in the development and worsening of the symptoms. 

Two symptoms that are predominant in IBS are constipation and diarrhea. Constipation occurs when water is largely absorbed from waste products as they move through the large intestines, causing difficult bowel movements and hard stools. On the other hand, waste products moving through the large intestines in a fast manner can cause an incomplete absorption of water to produce watery stool in a condition called diarrhea.

 Is heartburn common in people with IBS?

IBS often affects the lower gastrointestinal tract and while heartburn is a common symptom of conditions like GERD which affects the upper gastrointestinal tract. However, some people with IBS may also experience heartburn.

Because GERD and IBS both affect the gastrointestinal tracts, they share some similar symptoms, including heartburn. A 2019 study that assessed 1489 people with IBS found that about 66% had other overlapping GERD symptoms like heartburn. This indicates that heartburn may also be common in people with IBS.

 What is the link between heartburn (acid reflux) and IBS?

Over the years, there have been suggestions about a strong link between heartburn which is a symptom of GERD, and IBS. An older systematic review article showed that IBS patients were 4.17 times more likely to have reflux symptoms in comparison to people without IBS.

Another article published by the World Journal of Gastroenterology indicated that the link between IBS and GERD lies in their overlapping symptoms after studying 6, 476 patients. The process of this study followed people with IBS, GERD, or both filling out a questionnaire about their symptoms and severity, and the gastroenterologists involved in this study defined GERD as the presence of heartburn, regurgitation, and dysphagia. Among the 1419 patients diagnosed with IBS, 902 had GERD as shown by the presence of the 3 major symptoms, while about 33.9% of the patients with GERD also had IBS.

Researchers are not sure how or why IBS  causes heartburn, but they believe it could be linked to GERD and IBS sharing some similar triggers, such as stress and dietary factors. The link between these conditions and their overlapping symptoms suggest that while the upper and lower gastrointestinal region are somewhat apart, they have some symptoms in common. 

 Causes of heartburn

The primary cause of heartburn is acid reflux. Acid reflux is caused by the lower esophageal sphincter (LES) relaxing which leads to stomach acid coming back up into the esophagus. As explained earlier, when acid reflux occurs frequently, doctors may diagnose it as GERD.  Below are some factors that can cause the LES to become relaxed, eventually leading to heartburn:

• Inhaling smoke or smoking: Frequent smoking can cause the lower esophageal sphincter (LES) to become relaxed which causes acid reflux and eventually heartburn. 
• Hiatal hernia: This is a condition where your stomach pushes and protrudes through a structure called a diaphragm. The diaphragm is a muscular membrane that separates the contents of the abdomen (such as the stomach) from the chest region. 
• Acidic bubbles: Gas which is a symptom of indigestion can cause acidic bubbles from the stomach to rise to your upper gastrointestinal tract. This can weaken the LES.
• Certain types of food: According to research published in 2019 Some food substances can worsen the symptoms of GERD including heartburn. These foods include tomato-based sauces, peppermint, caffeine, chocolate, alcohol, fatty foods, fried foods, chocolate, citrus, spices, and carbonated drinks. 
• Consuming certain medications: The use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, sedatives, and aspirin can cause gastrointestinal diseases like GERD which leads to heartburn.
• The body‘s position: Lying down immediately after eating may worsen GERD symptoms because when lying down, the LES may relax in some people causing acid reflux. This may explain why some people with GERD may experience worse symptoms at night.

 Difference between GERD and heartburn

GERD and heartburn are both terms related to the gastrointestinal tract, but they mean different things.

GERD is a gastrointestinal disorder that occurs when the lower esophageal sphincter (LES) becomes relaxed or weakened which leads to constant acid reflux. GERD is also known as chronic acid reflux because it occurs when you experience acid reflux multiple times a week.

Heartburn, on the other hand, is a primary symptom of GERD. When stomach acid flows back into your esophagus, it causes the heartburn pain in your middle chest region.   

Some people use the two medical terms interchangeably because they are linked. But it is important to know the difference between the two.  

 Treatment for GERD and IBS

The treatment of IBS is not limited to medication but extends to dietary and lifestyle changes to help quicken your recovery by reducing the various symptoms. The approaches taken towards treating IBS include:

• Medications
• Dietary changes
• Psychotherapy

 Medications

Your doctor may prescribe any of the following medications to help relieve the symptoms of IBS.

• Antidiarrheal: This kind of drug helps relieve diarrhea which may be a subtype in your situation or a regular symptom. Some drugs in this category include loperamide, alosetron, eluxadoline, and rifaximin.
• Anti-constipation: Drugs under this category help to relieve constipation and improve the consistency of stool. Some examples of these drugs your doctor may prescribe to you include laxatives, fiber supplements, linaclotide, lubiprostone, and plecanatide.
• For abdominal pain: Drugs like antispasmodics and peppermint oil capsules can help reduce abdominal pain and cramping. 

 Dietary changes

In addition to medications prescribed by your doctor, you need to make dietary changes to improve the symptoms of IBS. For treatment, medical experts recommend that you avoid fatty, spicy, caffeine, processed foods, alcoholic beverages, and certain vegetables like cauliflower, broccoli, and cabbage that are hard to digest.

 Psychotherapy

A recent 2023 study suggests there is a link between the brain and the gastrointestinal system called the gut-brain axis, as the gut microbiota can control some psychological processes. This indicates that psychological stress may also affect the gastrointestinal system.

Try destressing and avoiding your stress triggers as this may help relieve IBS symptoms. Medical experts recommend cognitive behavioral therapy where you talk to a psychological expert or therapist. Your doctor may also suggest that you consider hypnotherapy to help improve IBS symptoms. 

 Treatment for GERD

Similar to IBS, your doctor will recommend medications, dietary, and lifestyle changes to effectively treat GERD and reduces its symptoms. 

 Medications

• Antacids: This type of drug works by neutralizing stomach acid and your doctor may prescribe it to treat mild heartburn and other GERD symptoms. 
• Proton pump inhibitors (PPIs): PPIs reduce the amount of acid in your stomach and they are recommended by a medical professional to not only relieve the symptoms of GERD but to repair the esophageal lining as well.
• H2 blockers: H2 blockers have a similar function to PPIs as they reduce the amount of acid your stomach produces and heal the esophageal lining, however, they are not as effective as PPIs.

 Dietary and lifestyle changes

If you have GERD, it may be best to avoid foods like citrus and tomato-based products that increase stomach acid. You may also want to keep away from peppermint, alcohol, and fatty foods that tend to relax the lower esophageal sphincter. Avoid large meals and try to sit up for a while after eating, so that gravity can help your food go down the digestive tract before you lie down.

Losing weight for those who are overweight and quitting smoking for those who smoke may help with GERD.

 Surgery

Your doctor might suggest undergoing surgery if you have taken over-the-counter medications and made lifestyle and dietary changes with no improvement in the symptoms of IBS. The primary goal of surgery is to strengthen the anti-reflux barrier. Depending on your condition, your doctor may recommend other approaches like endoscopy and bariatric surgery to reduce weight and improve GERD symptoms.

 Conclusion

This article explores the link between IBS and heartburn using credible sources and it also addresses one major misinterpretation of the similarities between GERD and heartburn.

Acid reflux is when stomach acid comes back up to the oesophagus and GERD is a health condition used to refer to chronic acid reflux. Heartburn is simply the thoracic pain felt from acid reflux and while it is common in people with GERD, it can also occur in those with IBS.