Heartburn is a burning sensation in the chest that can extend to the neck,
throat, and face; it is worsened by bending or lying down. It is the primary
gastroesophageal reflux, which is the movement of stomach acid into the
esophagus. Heartburn is generally related to
posture. On rare
occasions, it is due to gastritis (stomach lining inflammation).
What causes Heartburn?
Understanding heartburn depends on understanding the structure and
action of the esophagus. The esophagus is a tube connecting the throat to the
stomach. The esophagus carries food and liquid into the stomach. At the lower
end of the esophagus where it enters the stomach, there is a strong muscular
ring called the lower esophageal sphincter (LES). The LES should remain tightly
closed, except to allow food and liquid to pass into the stomach. Reflux occurs
LES is not working properly. It may relax for periods of time throughout
the day and night, or it may be constantly too weak to function effectively.
This allows the stomach's acid juices to flow into the esophagus.
Heartburn and reflux are extremely common, with 10 percent of the
population experiencing them daily. Twenty-five percent of
women have heartburn. Even though heartburn is common, it is rarely life
Thus, if the LES opens inappropriately or fails to close completely, and stomach
contents leak into the esophagus, the esophagus can be burned by acid. The
resulting burning sensation is called heartburn. How severe the disease becomes
depends on how weakened the LES is, and the amount and duration of acid refluxed
into the esophagus.
Factors contributing to Heartburn :
A number of different factors may contribute to LES malfunction with its
consequent gastroesophageal acid reflux:
The eating of large meals that distend the stomach can cause the LES to open
Lying down within two to three hours of eating can cause the LES to
and tight clothing can impair the ability of the LES to stay closed by
putting pressure on the abdomen.
Certain drugs, notably nicotine, alcohol, diazepam (Valium), meperidine
(Demerol), theophylline, morphine, prostaglandins, calcium channel blockers
(medicines that slow the movement of calcium into the cells of the heart and
blood vessels.), nitrate heart medications, anticholinergic and adrenergic
(drugs that limit nerve reactions), including dopamine, can relax the LES.
Progesterone is thought to relax the LES.
Greasy foods and some other foods such as chocolate, coffee, and peppermint
can relax the LES.
scleroderma can cause the LES to malfunction.
A burning feeling in the chest just behind the breastbone that occurs
eating and lasts a few minutes to several hours.
Chest pain, especially after bending over, lying down, or eating.
Burning in the throat -- or hot, sour, acidic, or salty-tasting fluid at the
back of the throat.
Feeling of food "sticking" in the middle of the chest or throat
Other symptoms include:
Chronic sore throat
Difficulty or pain when swallowing
Waterbrash (sudden excess of saliva)
Sour taste in the mouth
Inflammation of the gums
Erosion of tooth enamel (the surface of the teeth)
NOTE: chest pain is also a symptom of heartburn. However, it is often
difficult to differentiate
chest pain due to heartburn/GERD and chest pain due to
heart disease. Therefore, be sure to get all chest pain evaluated
IMMEDIATELY by a health care professional
Heartburn Diagnosis :
The primary tests used to diagnose heartburn symptoms are:
GI Endoscopy- The patient is mildly sedated and a flexible
videoscope is inserted into the esophagus to visually inspect it and the
Upper GI Series- The patient drinks liquid barium and x-rays are
taken of the esophagus and stomach showing how they function..
Esophageal manometry- The primary benefit of the exam is that the
physician has clear documentation of the muscle function of the esophagus.
With this information, a specific treatment program can be outlined or
reassurance provided if the exam is normal. There are really no serious
problems associated with manometry. Slight gagging is normal during the
exam, and a temporary sore throat may be present afterward.
24 hour Ambulatory pH (acid) Monitoring- Ambulatory pH (acid)
monitoring is considered the gold standard for objectively assessing acid
reflux activity and can confirm significant gastroesophageal reflux disease.
pH monitoring is usually performed prior to any antireflux procedure.
Traditionally, a tiny tube is placed through the nose and into the esophagus
(food tube) above the lower esophageal sphincter. The test runs for 24 hours
and measures the number of times acid enters the esophagus. A newer
technology is now available called The BRAVO System. It is a wireless
transmitting capsule which is placed usually following endoscopy. It is
introduced through the mouth and attached to the esophagus by way of a
clipping system. It will measure acid reflux activity for 48 hours and the
capsule will usually fall off within 3 to 5 days and is passed.
Lifestyle Changes- may include daily
dietary changes combined with day to day living.
usually recommend their patients try raising the head of the bed (about six
inches) or sleep on a specially designed wedge. If you cannot raise the head
of your bed, you can also slide blocks or books under the legs at the head
of the bed. Raising the head of the bed and avoiding heavy lifting
reduces heartburn by allowing gravity to minimize reflux of the stomach's
contents into the esophagus.
Taking off any
extra weight is
advisable. You also may want to loosen your belt and avoid wearing tight
is usually recommended to help keep weight off and increase overall fitness.
lifting heavy objects or bending forward if possible.
is also recommended because both weaken the LES, (lower esophageal
sphincter) and increase stomach acid production and irritation.
Avoid foods and beverages that can weaken or take pressure off the LES
. It is important to avoid food close to bedtime (usually 2-3
Eat more slowly. Downing a lot of food in a hurry can cause the stomach to
produce extra digestive acids.
Eat smaller and more frequent meals. After eating, don't bend over, lie
down, or go to sleep for two to four hours.
Eat more healthy including
fiber in your diet
Foods to be avoided:
Citrus and tomato products
Drinks that contain caffeine (coffee, tea, chocolate and some sodas)
drinks, (diet and non-diet)
Over-the-counter (non-prescription) remedies such as antacids may also
offer some comfort. They are usually taken after meals or at bedtime.
Antacids, if taken regularly, can neutralize acid in the esophagus and
stomach and stop heartburn. Antacids usually provide at least temporary or
partial relief. Antacids can also be combined with a foaming agent such as
alginic acid to bring relief. These compounds are believed to form a foam
barrier on top of the stomach that prevents acid reflux from occurring. If
an antacid has not provided relief in several weeks, it probably won't.
Long-term use of antacids can result in side effects, including diarrhea,
constipation, changes in the way your calcium metabolizes, and a build-up of
magnesium in the body. Persons with kidney disease should be especially
careful not to get too much
magnesium; if antacids are needed for more than 3 weeks, a doctor should
be consulted. Persons with high
blood pressure should also check with their doctor before taking
antacids, since they can be high in sodium.
If the symptoms continue, your doctor may prescribe medicine that can cut down
on stomach acid production or speed up digestion.(H-2 blockers) These could
(Some of these medications are now available at lower dosage without a
Other medical approaches include increasing the strength of the LES and
quicken emptying of stomach contents with motility drugs that act on the
upper gastrointestinal tract. These drugs include cisapride, bethanechol and
Propulsid (cisapride), Reglan (metoclopramide) and bethanechol chloride are
usually used along with H-2 blockers. They strengthen the squeezing action
of the esophagus and tighten the LES to relieve GERD. Metoclopramide has the
added benefit of making the stomach empty faster.
Cisapride may cause some side effects including abdominal cramps,
constipation, diarrhea and increased nervousness. Metoclopramide can cause
fatigue, as well as other more serious side effects. Bethanechol chloride
can cause nausea and vomiting especially if it is taken too soon after
Another type of drug, the proton pump (or acid pump) inhibitor omeprazole
inhibits an enzyme ( protein in the acid-producing cells of the stomach)
necessary for acid secretion, and thus stops stomach acid production. The
acid pump inhibitor lansoprazole is being investigated as a new treatment
for GERD. These drugs are usually prescribed for short-term use. They may
cause side effects including stomach or abdominal pain, diarrhea and nausea.
Frequently, combinations of drugs are prescribed to relieve your symptoms.
Aspirin and anti-inflammatory drugs like ibuprofen reduce the protective
lining of your stomach, which can lead to more irritation. Be sure to check
with your doctor or pharmacist before taking any new medicine to discuss
other medicines you may be taking and how these new medications might
interact with them.
you are having trouble swallowing, your doctor may recommend that your
esophagus be stretched by a medical procedure. The procedure may need to be
repeated over a period of a few days until your esophagus is wide enough to
pass solid food again. Larger tubes may be used to stretch the esophagus and
make the passageway wider if you continue having trouble swallowing. While
many patient report relief with this less invasive treatment, it is not a
cure and quite often symptoms reoccur.
Surgery may be an option:
If symptoms do not improve with medications or return after medication is
If lifelong medication is needed.
If you are unwilling or unable to take medication regularly for prolonged
If reflux has severely damaged the esophagus.
the procedure to relieve esophageal reflux disease can be performed through
the traditional open technique or through minimally invasive surgery, also
known as laparoscopy or laparoscopic fundoplication. Both surgical
procedures increase pressure in the lower esophagus by tightening or
rebuilding the gastro-esophageal valve. This surgery restores the stomach to
its original position and strengthens the area around the valve opening.
Laparoscopic surgery is performed through several small incisions instead of a
single long one, as in the traditional open procedure. As a result, there is
less pain, a quicker recovery time, a shorter hospital stay, and a lower
risk of infection.
Another treatment offered is a nonsurgical, minimally invasive
radiofrequency procedure that is done on an outpatient basis. Patients go
home the same day.
The treatment is delivered via an endoscope. A balloon-tipped catheter is
inserted into the esophagus. The miniature balloon has tiny needle
electrodes on its surface. The electrodes deliver a controlled amount of
radiofrequency energy to spots above and below the junction of the stomach
and esophagus. The radiofrequency energy causes tiny burns that heal and
form scar tissue. The scar tissue actually tightens the weak valve.
Dated 05 February 2014