Heartburn!

Heartburn or pyrosis is a painful or burning sensation in the esophagus, just below the breastbone caused by regurgitation of gastric acid. The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn is also identified as one of the causes of chronic cough, and may even mimick asthma.

Heartburn actually has nothing to do with the heart; it is so called because of a burning sensation of the breastbone, although some heart problems have a similar sensation to heartburn.

Heartburn Pathophysiology

The sensation of heartburn is caused by exposure of the lower esophagus to the acidic contents of the stomach. Normally, the lower esophageal sphincter (LES) separating the stomach from the esophagus is supposed to contract to prevent this situation. If the sphincter relaxes for any reason (as normally occurs during swallowing), stomach contents, mixed with gastric acid, can return into the esophagus. This return is also known as reflux, and may progress to gastroesophageal reflux disease (GERD) if it occurs frequently. Peristalsis, the rhythmic wave of muscular contraction in the esophagus, normally moves food down and past the LES and is responsible for ultimately clearing refluxed stomach contents. In addition, gastric acid can be neutralized by buffers present in saliva.

Heartburn Causes

Foods that may cause heartburn

Heartburn and Alcohol

Coffee, tea, cola, and other caffeinated and carbonated beverages

Chocolate

Citrus fruits and juices

Tomatoes and tomato sauces (such as Pizza and Pasta sauce)

Spicy foods and fatty foods (including full-fat dairy products)

Peppermint and spearmint

Dry foods such as peanuts

Fatty foods such as ice cream

It can also be psychosomatic, primarily in relation to stress.

Heartburn Diagnosis

Physicians typically diagnose gastroesophageal reflux disease (GERD) based on symptoms alone. When the clinical presentation is unclear, other tests can be performed to confirm the diagnosis or exclude other disorders. Confirmatory tests include:

Heartburn Ambulatory pH Monitoring

A probe can be placed via the nose into the esophagus to record the level of acidity in the lower esophagus. Because some degree of variation in acidity is normal, and small reflux events are relatively common, such monitors must be left in place for at least a 24-hour period to confirm the diagnosis of GERD. The test is particularly useful when the patient's symptoms can be correlated to episodes of increased esophageal acidity.

Heartburn Upper Gastrointestinal GI Series

A series of x-rays of the upper digestive system are taken after drinking a barium solution. These can demonstrate reflux of barium into the esophagus, which suggests the possibility of gastroesophageal reflux disease. More accurately, fluoroscopy can be used to document reflux in real-time.

Heartburn Manometry

In this test, a pressure sensor (manometer) is passed through the mouth into the esophagus and measures the pressure of the lower esophageal sphincter directly.

Heartburn Endoscopy

The esophageal mucosa can be visualized directly by passing a thin, lighted tube with a tiny camera attached (an endoscope) through the mouth to examine the esophagus and stomach. In this way, evidence of esophageal inflammation can be detected, and biopsies taken if necessary:

Heartburn Biopsy

A small sample of tissue from the esophagus is removed. It is then studied to check for inflammation, cancer, or other problems.

Heartburn Treatment

Heartburn Prevention

If heartburn occurs when lying down, raising the head with pillows or sitting up frequently provides relief although care must be taken to avoid placing continuous strain on the neck. Avoidance of certain foods shortly before bedtime is frequently advised to avoid future attacks.

Heartburn Medications

Antacids, H2-receptor antagonists and proton pump inhibitors are used (in that order) to treat heartburn.

Heartburn Antacids

Daily treatment with Antacids is effective for 25-30% of people with GERD. Acid-blocking medications are the most effective for mild forms of the condition.

Heartburn and Water

Some have suggested that drinking a large glass of water dilutes the high pH levels in the stomach (since pure water has a neutral pH of 7) and allows the pain to temporarily subside. However, because pH is measured on a logarithmic scale (a shift of 1 on the pH scale corresponds to a change by a factor of 10), to substantially dilute the pH of stomach acid would mean drinking at least 10 times as much pure water as the volume of acid.

Heartburn H2-receptor antagonists

With the advent of proton-pump inhibitors, H2-receptor antagonists are not widely used.

Heartburn Proton-pump Inhibitors

Proton pump inhibitors are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors directly block acid production in the stomach cells and provide more effective relief than less powerful medications. In order to prevent heartburn the medication disfigures and disables the proteins (proton pumps) that control the pH of the stomach, allowing the body to digest them.

Heartburn Restricting

Restricting is very important, since 90-95% of sufferers of heartburn or esophageal disorder can link their symptoms to specific foods. Therefore, it is important that heartburn sufferers manage their s as a way to treat their heartburn. Sufferers should choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers. .