Burning After a Meal, Burning on an Empty Stomach

"My stomach burns."

When I hear this, I ask one thing first. When does it burn? Soon after eating, or when the stomach is empty?

People arrive using the same word, but the place to look is different for the two.

It does not burn only because there is too much acid

The inside of the stomach is acidic to begin with. The reason it does not burn all day is that the stomach wall covers itself. A layer of mucus lies over it, and bicarbonate seeps out beneath that layer and neutralizes acid. Thin as they are, these two layers work all day.

So burning does not only come when acid rises. It also comes when the cover thins. The same concentration of acid reaches a person with an intact cover differently than it reaches a person whose cover has worn.

One more thing sits on top of that: the sensing side, the nerves in the lining, may have become sharpened. Some people describe it less as burning than as a queasiness, and I read those cases as sharpened sensation rather than excess secretion. A place stimulated over and over has a lower threshold.

The hour tells you where to look

Burning about 30 minutes after eating. Food coming in raises acid secretion along with it. People who burn at that point usually have the rising phase of secretion overlapping with a swollen lining.

Burning on an empty stomach — two or more hours after a meal, or before dawn. Here there is no food to take the edge off, and acid meets the lining directly. In these cases I suspect a thinned cover more.

Uncomfortable whether one eats or not. I take these as the first two overlapping.

Asking about the hour is no great examination. It only splits the same "burning" into three, and that changes where to start.

Too little acid also causes trouble

Say "burning" and it is easy to picture only an overflow of acid. There is the other side too.

Stomach acid does not only digest. It also screens what comes in. If the acidity is not low enough, things pass through unscreened. Some long-standing stomach complaints are on this side.

So the picture where "burning means simply reduce acid" does not fit everyone. Medication that suppresses acid does its work where acid is the problem. If the trouble is on the cover side or the sensing side, the place to work is different. (When fullness and indigestion come back but the scope is clean)

Three things I separate when it burns

I separate three things in these patients. Is the cover thin, is the pressure high, is the sensation sharpened?

I use herbal medicine as though those three sit in different layers. Some herbs help along the side that secretes mucus and bicarbonate (Atractylodes rhizome, licorice); some help the stomach stretch smoothly as it receives food (Magnolia bark, tangerine peel); some are read as settling the signal from a sharpened lining (Scutellaria root, Pinellia). It is not one thing switching acid off, but several pushing a little each, from different places.

What I find interesting is that the opposite direction has to be watched as well. Ginger is a herb often used when the stomach turns, yet where the lining is already worn and the local tissue has tilted acidic, the same compound can increase the burning. So in those places it is not used alone, and a herb that buffers the local acidity goes with it. The same herb works in opposite directions depending on conditions. That is why this is not medicine one can use by memorizing a list of compounds.

When to have it checked first

If stools come out black like tar, if a sense of catching appears on swallowing, if weight drops, or if vomiting repeats — then looking inside comes first.

---

Saying the stomach burns does not point to one state.

So I ask about the hour. When it burns tells me, often enough, where things have loosened.

Sources

• When tests are normal but the stomach burns, a fasting endoscopy often will not catch it, and most such cases come from the rhythm of the digestive tract being out of step — Asan Medical Center, Family Medicine
• The same symptoms arise when the stomach's ability to move food out declines, or when the stomach itself responds with heightened sensitivity — Asan Medical Center, Disease Encyclopedia

Written by Dr. Heo Ji-young (Ph.D. in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)