Heartburn; Types, Causes, Symptoms, Diagnosis, Treatment

Heartburn








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Heartburn is a sensation of burning in the chest caused by stomach acid backing up into the esophagus (food pipe). It is also known as acid indigestion, is a burning sensation in the central chest or upper central abdomen. The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw.  The burning is usually in the central part of the chest, just behind the sternum (breastbone). The burning can worsen or can be brought on by lying flat or on the right side. Pregnancy tends to aggravate heartburn.

Causes of Heartburn

Heartburn is actually a symptom of GERD (gastroesophageal reflux disease), and is caused by acid refluxing back into the esophagus. Risk factors include those that increase the production of acid in the stomach, as well as structural problems that allow acid reflux into the esophagus.

  • Some common foods that we eat and drink, stimulate increased stomach acid secretion setting the stage for heartburn. Over-the-counter medications also may precipitate heartburn. Examples of these irritants include:
    • caffeine,
    • aspirin
    • buprofen
    • Naproxen
    • carbonated beverages,
    • acidic juices (grapefruit, orange, pineapple)
    • acidic foods (tomatoes, grapefruit, and oranges)
  • Smoking and the consumption of high-fat content foods tend to affect function of the lower esophageal sphincter (LES), causing it to relax from the stomach and allow acid to reflux into the esophagus.
  • A hiatal hernia where a portion of the stomach lies within the chest instead of the in abdomen, can affect the way the LES works and is a risk factor for reflux. Hiatal hernias by themselves cause no symptoms. It is only when the LES fails that heartburn occurs.
  • Pregnancy can cause increased pressure within theabdominal cavity and affect LES function and predispose it to reflux.
  • Obesity may also cause increased pressure in the abdomen, and thus reflux in the same way.
  • Primary diseases of the esophagus can also present with heartburn as a symptom. These include, among others, scleroderma and sarcoidosis.
  • Some types of food aggravate heartburn, including:
    • Alcohol, which relaxes the oesophageal sphincter
    • Coffee and chocolate
    • Orange juice and other acidic juices
    • Acidic foods, such as tomatoes, oranges, and grapefruits
    • Fatty or fried foods
    • Black pepper, mustard, and spicy foods
    • Large meals or portion sizes.
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Symptoms of Heartburn

Diagnosis of Heartburn

To evaluate if there is any damage and how severe your heartburn is, the doctor my suggest some of the following tests:

  • Endoscopy – A flexible scope is passed down the esophagus to examine the esophagus as well as the stomach. Biopsies can be taken if indicated. This lets the doctor see if there is any obvious damage, and also eliminate other reasons for the patient’s symptoms (foreign body, malignancy).
  • Upper GI series (upper GI series) – After drinking a liquid that coats the inside of the digestive tract, X-ray sare taken. These X-rays will show the outline of the digestive system.
  • Ambulatory pH testing – This test measures the acidity in the esophagus via a small tube that goes through the nose into the stomach.
  • Manometry and pH testing – Less commonly, when conventional therapy has failed to confirm the diagnosis, or when symptoms are atypical, use of pressure monitors and acid measurements from within the esophagus may be helpful in making the diagnosis.

Treatment of Heartburn

Common OTC antacids such as Rolaids, Tums or Maalox are effective for some individuals;

Other people may do well with proton pump inhibitors (PPIs) such as

There are many over-the-counter and prescription medications available. These fall into three major categories

Medications that neutralize stomach acid (antacids) 

Antacids  provide quick relieve because they decrease the acid. These medications don’t heal existing damage to your esophagus nor prevent future episodes of heartburn.

Medications that reduce the production of acid 

These medications are named after the receptor they block (H-2 blockers) and are available as over-the-counter as well as prescription medications. Their symptom relief tends to last longer than antacids, but it also takes longer for them to start working.

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Others may need H2 receptor antagonists such as

Medications that block acid production  

Proton pump inhibitors (for example, omeprazole , lansoprazole  block the production of acid. This then allows healing of the damaged esophagus.

Prevention of Heartburn

Food and drink tips for night-time heartburn relief

  • Reduce heartburn risk by limiting acidic foods such as grapefruit, oranges, tomatoes, and vinegar.
  • Spicy foods giving you heartburn? Cut back on pepper and chillies.
  • Don’t lie down for at least three hours after you eat. When you are sitting up, gravity helps prevent food and stomach acid from going up into the gullet (oesophagus) and causing heartburn.
  • Enjoy lean meats and non-fatty foods. Greasy foods – such as chips and burgers – can trigger heartburn.
  • Avoid or reduce drinks that can trigger reflux such as alcohol, drinks with caffeine and fizzy drinks.
  • Size matters – eat smaller meals and you may avoid triggering heartburn symptoms.
  • Enjoy an after-work drink? You may want to turn teetotal – alcohol can relax the oesophageal sphincter, worsening heartburn.
  • Crazy about colas? It may be time to cut back. Colas can be related to reflux and to heartburn symptoms.
  • Avoid snacking at bedtime. Eating close to bedtime can trigger heartburn symptoms.

Lifestyle tips for night-time heartburn relief

  • Steer clear of tight clothes. Tight belts, waistbands and underwear can press on your stomach triggering heartburn.
  • Strive for a less stressful life. Stress may increase stomach acids, increasing heartburn symptoms.
  • Heavy? Try losing weight. The pressure of excess weight increases the chance stomach acid will reflux back up into the oesophagus causing heartburn.
  • Popping antacids more than once a week? You may have GORD and need specific treatment.
  • Try chewing gum at night. This can boost the production of saliva, which helps neutralise stomach acid.
  • Not all “trigger” foods cause heartburn symptoms in everyone. Keep track of your symptoms to find your personal triggers.
  • Pregnant? You may experience heartburn or GORD. Seek medical adviceabout finding relief.
  • Heartburn worse after exercise? Drink plenty of water. It helps with hydration and digestion.
  • Try keeping a diary or heartburn log to keep track of activities that might trigger attacks.
  • Wait for your work-out if you don’t want to trigger heartburn. Wait at least two hours after a meal before exercising.
  • Nicotine can cause your oesophageal sphincter to relax. If you smoke, stop smoking.
  • Some medicines can worsen reflux and heartburn. Seek medical advice about alternatives.
  • Use blocks or bricks under the bedpost to raise the head of your bed 15cm (6in) so you can sleep with head and chest elevated. You can also try a wedge pillow.
  • Bend with your knees. Bending over at the waist tends to increase reflux and heartburn symptoms.
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How can I reduce heartburn during pregnancy

Prevention is your best bet to reduce heartburn during your pregnancy. Though you may not be able to avoid the condition entirely, here are some ways to prevent it and minimize any discomfort:

  • Avoid food and drinks that upset your stomach – These include carbonated drinks, alcohol, caffeine, chocolate, citrus fruits and juices, tomatoes, mustard, vinegar, mint products, processed meats, and foods that are fatty, spicy, fried, or highly seasoned.
  • Eat small meals – Instead of three large meals, eat several small ones throughout the day. Take your time eating and chew thoroughly.
  • Drink water in between meals – It’s important to drink plenty of water daily during pregnancy, but too much liquid can distend your stomach. Stay hydrated by drinking most of your water in between meals.
  • Chew gum after eating – Chewing gum stimulates your salivary glands, and saliva can help neutralize acid.
  • Eat two or three hours before bedtime – This gives your body time to digest before you lie down.
  • Sleep propped up – Elevate your upper body by about 6 inches with several pillows or a wedge when you sleep. This helps stomach acid stay down and aids digestion.
  • Dress comfortably – Wear loose, relaxed clothing. Don’t wear clothes that are tight around your waist and tummy.
  • Ask your provider about heartburn medicines – An antacid that contains magnesium or calcium may ease discomfort. Check with your provider before taking one because some brands are high in sodium or contain aluminum or aspirin. You can also talk to your provider about prescription heartburn medications that are safe during pregnancy.
  • Don’t smoke – In addition to contributing to serious health problems, smoking boosts the acid in the stomach.

References

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