Heartburn
Heartburn is the most common symptom of a condition
called gastroesophageal
reflux or acid
reflux.
A muscle (lower esophageal sphincter) located
between the esophagus (swallowing tube) and stomach normally opens after
swallowing. This allows food to pass into the stomach. The lower esophageal
sphincter muscle then closes quickly to prevent the return (reflux) of food
and stomach juices back into the esophagus.
When the lower esophageal sphincter muscle either
relaxes inappropriately or is very weak, the acidic contents of the stomach
can back up, or reflux, into the esophagus. This is called gastroesophageal
reflux. In addition to heartburn, symptoms may include persistent sore
throat, hoarseness, chronic cough, asthma, heart-like chest pain, and a
feeling of a lump in the throat. When the acid contents from the stomach
regularly back up into the esophagus, a chronic condition called
gastroesophageal reflux disease or GERD occurs. |
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There are several factors that influence
the occurrence and severity of gastroesophageal reflux and heartburn:
- The ability of the lower
gastroesophageal sphincter muscle to open and close properly
- The type and amount of stomach juices
that are backed up into the esophagus
- The clearing action of the esophagus
- The neutralizing effect of saliva and
other factors
People experience gastroesophageal
reflux and heartburn in a variety of ways. Heartburn usually begins as a burning
pain that starts behind the breastbone and radiates upward to the neck. Often
there is a sensation of food coming back into the mouth, accompanied by an acid
or bitter taste. Heartburn is sometimes called acid indigestion and usually
occurs after meals.
What are the
Symptoms of Heartburn?
- Burning pain behind the breastbone
area
- Burning pain or regurgitation that is
worse when lying down or bending over
What if Symptoms
Persist?
People with severe esophageal reflux or
with heartburn symptoms unresponsive to the measures described above may need
more complete diagnostic evaluation. A variety of tests and procedures are
currently used to further evaluate the patient with heartburn:
- Endoscopy - a
procedure where a flexible tube is placed into the esophagus whereby your
physician will see the tissue lining of the esophagus.
- Biopsy - the removal
of a small sample of tissue of the lining of the esophagus to better determine
the causes of underlying disease.
- Esophageal manometric studies
- pressure measurements of the esophagus, which identify critically low
pressure in the lower esophageal sphincter muscle and determine other
disorders of the esophageal muscle function.
- Twenty-four hour pH
monitoring - done for those patients for whom the diagnosis is
difficult to make. Many physicians find it helpful to measure the acid levels
inside the esophagus. This is done by placing a thin tube in the esophagus.
How Common is
Heartburn?
Although heartburn is common in our
society, it is rarely life-threatening. However, heartburn can severely limit
daily activities and productivity. With proper understanding of the causes of
heartburn and a consistent approach to a treatment program, most people will
find relief.
Heartburn is not caused by hiatal
hernia, which is the pushing up of the stomach into the chest cavity through a
hole in the diaphragm.
However, hiatal hernias do predispose
individuals to heartburn. The majority of people over 60 years of age have
hiatal hernias and most do not have any symptoms related to the condition.
Can Heartburn Require
Surgery?
A small number of people with
heartburn may need surgery because of severe reflux disease and poor response to
medical treatment plans.
Fundoplication is a
surgical procedure that reduces reflux. Patients not wanting to take medication
to control their symptoms are also candidates for surgery.
What are the
Complications of Long-Term Reflux and Heartburn?
The reflux that causes heartburn can
result in serious complications. Esophagitis, an irritation of inflammation of
the esophagus, can occur as a result of the constant presence of stomach acid in
the esophagus. Esophagitis may result in esophageal bleeding or ulcers. In
addition, a narrowing or closure (stricture) of the esophagus may occur.
Some people develop a condition known as
Barrett’s esophagus, a change in the cells lining the esophagus that predisposes
the esophagus to the development of cancer. Individuals with Barrett’s esophagus
should be monitored with periodic surveillance endoscopies and biopsies.
Tips to Control
Heartburn
Avoid food, beverages, and medicines
that affect the lower esophageal sphincter muscle action or irritate the lining
of the esophagus such as:
- Fried or fatty foods
- Chocolate
- Peppermint
- Alcohol
- Coffee
- Carbonated beverages
- Citrus fruits or juices
- Tomato Sauce
- Ketchup and mustard
- Vinegar
- Aspirin and other pain medicine other
than acetaminophen
Also,
- Decrease the size of portions at
mealtimes.
- Meals should be eaten two to three
hours before lying down to lessen the chance of reflux.
- Elevate the head of the bed four to
six inches.
- Lose weight, if overweight.
- Take over-the-counter medicines as
directed for relief of heartburn. Ask your pharmacist for a recommendation.
- Stop or decrease smoking, as
cigarettes decrease the ability of the lower esophageal sphincter muscle to
work properly.
Caution!
Any chest pain requires prompt medical evaluation.
Other causes, such as heart disease, must be considered.
For occasional heartburn, over-the-counter medicines
taken as directed can be helpful in reducing symptoms. If prolonged or frequent
use of nonprescription medicines (more than directed on the product) becomes
necessary, or if they do not completely control symptoms, a physician should be
consulted.
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