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Ulcerative Colitis and Heartburn

Ulcerative colitis comes with a wide range of symptoms, and sometimes, you may wonder if it’s behind a particular symptom, such as heartburn.

Heartburn refers to a burning sensation in the chest and upper abdomen. It’s a relatively common complaint — around 15 to 30% of US citizens suffer from it and you’re more likely to experience heartburn as you age.

So can ulcerative colitis cause heartburn? Let’s find out.

Is heartburn a symptom of ulcerative colitis?

No, heartburn is not a classic symptom of ulcerative colitis.

Heartburn occurs when an injurious substance (like stomach acid) comes into contact with your esophagus, the tube that carries food from your mouth to your stomach. Ulcerative colitis affects your gut far away from the esophagus — it usually begins in the rectum (the terminal part of the gut) and extends up to the cecum (which is where the large intestine begins).

Importantly, ulcerative colitis does not extend above the cecum. It does not involve the small intestine, the stomach, the esophagus, or the oral cavity. And this is why it’s not usually associated with heartburn.

If you have ulcerative colitis, you may experience the following symptoms:

 

  • Bloody diarrhea
  • Belly pain
  • A sensation of incomplete emptying after you pass stool
  • A sudden urge to pass stool
  • Fever
  • Fatigue
  • Weight loss
  • Extraintestinal symptoms like joint pain, inflamed eyes, liver disease, and a variety of skin conditions

So if it’s not ulcerative colitis, what could be causing your heartburn? There are two main possibilities.

Is heartburn a sign of Crohn’s disease?

Yes, one possible cause of heartburn is Crohn’s disease, which is closely related to ulcerative colitis.

Crohn’s disease can affect any part of the GI tract from your mouth to the anus. If it affects your esophagus, you may experience heartburn.

If your heartburn is associated with the following symptoms, you may have Crohn’s disease:

  • Long-term, non-bloody diarrhea
  • Abdominal pain, particularly in the right lower area of your belly
  • Fat malabsorption — if your diarrhea is greasy, smelly, and difficult to flush, you have fat malabsorption
  • Fistulae and abscesses in your anal area — these are often the first signs of the disease
  • Skin rashes, eye inflammation, and painful joints

Because the symptoms of Crohn’s disease and ulcerative colitis are similar, you’ll need to work with a gastroenterologist to figure out your condition.

Gastrointestinal reflux disease (GERD) is the classic cause of heartburn

If your heartburn occurs without any of the symptoms described above, you may have GERD. GERD is a different medical condition, and compared to ulcerative colitis, it’s milder and easier to treat.

What is GERD?

GERD stands for gastrointestinal reflux disease and it occurs when stomach acid comes into contact with your esophagus.

Between your esophagus and stomach is a circular ring of muscle called the lower esophageal sphincter (LES). LES relaxes when you swallow food to allow it to enter the stomach, but otherwise it stays contracted to prevent acid reflux.

People with GERD have a dysfunctional LES. Prolonged relaxation of the LES allows acid to reflux into the esophagus and cause a burning sensation in the chest (or heartburn).

Certain risk factors increase your risk of experiencing heartburn. They are:  

  • Cigarette smoking
  • Drinking alcohol
  • Obesity
  • Pregnancy
  • Stress
  • Lack of saliva
  • Reduced peristalsis (rhythmic contractions) in the esophagus
  • Sliding hiatal hernia, which is when part of the stomach herniates into the chest
  • Gastric cancer
  • Asthma

If you have any of these risk factors and are experiencing heartburn, you may very well have GERD.

What are the symptoms of GERD?

The classic symptoms of GERD include heartburn, increased saliva in your mouth, and difficulty or pain while swallowing food.

However, some people experience other symptoms as well. These include chest pain, nausea, bad breath, and bloating.

If your heartburn is severe, you may develop a chronic cough, dental erosions, hoarse voice, and adult-onset asthma.

How is heartburn diagnosed?

Heartburn is diagnosed by careful history-taking and investigations.

If you present with the classical signs of heartburn, your doctor might start you on a class of drugs called proton pump inhibitors (PPIs). If your heartburn goes away when you take PPIs, a diagnosis of GERD is confirmed.

However, if you show alarm symptoms, like anemia, persistent vomiting, early satiety, difficulty in swallowing, or weight loss, your doctor might perform an endoscopy to rule out a serious underlying disease like cancer.

Sometimes, esophageal pH monitoring is used to confirm the diagnosis, where the doctor measures the esophageal pH over 24-48 hours via a catheter or capsule.

For what you can do about your heartburn, read the next section.

Can you take antacids with ulcerative colitis?

Yes, you can take antacids if you develop heartburn with ulcerative colitis. But you should understand that antacids won’t help your ulcerative colitis — they will only relieve your heartburn.

These days, doctors prefer PPIs over antacids in the treatment of heartburn. This is why it’s a good idea to seek medical treatment for heartburn instead of relying on over-the-counter antacids.

If you still want to take antacids, ask your doctor first about any potential drug interaction between antacids and your ulcerative colitis medications.

Finally, lifestyle changes are another major arm of heartburn treatment. Here are some changes your doctor might recommend you: 

  • Eating smaller meals
  • Avoiding eating close to bedtime
  • Avoiding foods/beverages that trigger heartburn — these include chocolate, spicy food, and coffee
  • Losing weight
  • Elevating the head of your bed while sleeping
  • Avoiding medications that trigger symptoms (like certain hypertension drugs)

If medical treatment and lifestyle changes fail to improve your heartburn, you can opt for a surgical procedure called fundoplication, which is where the surgeon wraps the upper portion of your stomach around the esophagus to prevent acid reflux.

Takeaway

Although heartburn and ulcerative colitis can occur together, heartburn is not a symptom of ulcerative colitis.

If you experience ulcerative colitis symptoms with heartburn, you may actually have Crohn’s disease, which is closely related to ulcerative colitis.

Finally, GERD is another major cause of heartburn around the globe, and your doctor will consider it while working up your symptoms.

 

Medically Reviewed by Onikepe Adegbola, MD PhD 


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