What causes heartburn and back spasms together?

Heartburn and back spasms can occur together due to several interconnected factors. Heartburn, often caused by acid reflux, can lead to irritation and inflammation in the esophagus, which may trigger referred pain in the back. Additionally, stress or anxiety can contribute to both gastrointestinal issues and muscle tension, resulting in spasms. Conditions like a hiatal hernia may also link these symptoms by affecting the surrounding muscles and nerves.