Heartburn is a burning sensation or pain in the esophagus, just below the sternum.
It is caused by the regurgitation of gastric acid. The mouth and stomach are connected by a tube called the esophagus. It is made of muscles that work to push food into the stomach in rhythmic waves.
Once in the stomach, food is prevented from refluxing (return to the esophagus), by a special area of circular muscle located at the junction of the esophagus and stomach, called the lower esophageal sphincter (LES).
A pressure difference in the diaphragm, the flat muscle that separates the thorax from the abdomen, also tends to keep the stomach contents in the stomach.
The stomach combines food, acids and enzymes to begin digestion. There are special protective cells that cover the stomach to prevent the acid from causing inflammation.
The esophagus does not have this same protection, and if stomach acid and digestive juices return to the esophagus, they can cause inflammation and damage to its unprotected lining.
Heartburn is actually a symptom of GERD (gastroesophageal reflux disease) and is caused by acid reflux 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 the increase of stomach acid secretion by setting the stage for heartburn. Over-the-counter medications can also precipitate heartburn.
Examples of these irritants include:
- Aspirin (Bayer, etc.).
- Ibuprofeno (Motrin, Advil, Nuprin, etc.).
- Naproxen (Naprosyn, Aleve).
- Carbonated drinks.
- Acid juices (lemon, orange, pineapple).
- Acid foods (tomatoes and oranges).
Smoking and the consumption of high-fat foods tend to affect the function of the lower esophageal sphincter (LES), causing it to relax from the stomach and allow the acid to flow back into the esophagus.
A hiatal hernia where a portion of the stomach is located inside the chest instead of in the abdomen, can affect how the LES works and is a risk factor for reflux.
Hiatal hernias by themselves do not cause symptoms. Only when the LES fails does acidity occur.
Pregnancy can cause increased pressure within the abdominal cavity and affect the function of SLE and predispose it to reflux.
Obesity can also cause an increase in pressure in the abdomen and, therefore, reflux in the same way.
Symptoms of heartburn
Disease gastroesophageal reflux (GERD) is a condition in which heartburn is a symptom. Stomach acid refluxes into the esophagus and causes pain.
This pain may feel like a burning sensation behind the sternum, either as a spasm or a sharp pain. Many times, the pain of acid reflux can be confused with the pain of a heart attack.
The pain of acid reflux (heartburn) may remain in the lower chest or may radiate to the back of the throat and be associated with a bitter taste in that part.
If there is acid reflux near the larynx in the throat, it can cause episodes of coughing or hoarseness. Refluxing for extended periods of time can be so severe that the acid wears out the enamel of the teeth and causes the decomposition.
Symptoms often get worse after heavy meals, leaning forward or lying down. Those affected can often wake up from sleep with heartburn.
Heartburn is not without complications. If ignored, recurrent irritation and inflammation of the esophagus can cause ulcers, which are small areas of tissue breakage. These can cause serious bleeding.
In addition, scarring and stenosis are other major complications of GERD.
Changes in the type of cells lining the esophagus can be the result of acid reflux, which causes a condition known as Barrett’s esophagus, which is associated with an increased risk of esophageal cancer.
Diagnosis of heartburn
Heartburn is a common complaint, although it can be confused with other diseases related to the chest, which include:
- Heart attack.
- Pulmonary embolism.
- Pain in the chest wall.
The diagnosis begins with a complete history and a physical examination. In many cases, this provides enough information for the health professional to make the diagnosis and start a treatment plan.
In some cases, more tests may be required:
X-ray: The patient may be asked to take barium or gastrografin (two types of contrast materials) while a radiologist, using an X-ray machine or fluoroscopy, observes how the contrast material travels through the esophagus and enters the stomach.
In addition to looking for irregularities or inflammation within the esophagus and esophageal walls, this test can determine if the muscles of the esophagus function correctly in a rhythmic manner to push the material into the stomach.
Endoscopy: In this test, a gastroenterologist uses a flexible endoscope and a fiber optic camera to look at the lining of the esophagus and stomach.
Inflammations and ulcers can be identified. Biopsies and small pieces of tissue can be obtained to look for cancer or precancerous cells.
Manometry and pH tests : Less frequently, when conventional therapy has not been able to confirm the diagnosis or when the symptoms are atypical, the use of pressure monitors and acid measurements within the esophagus may be useful in making the diagnosis.
Changes in lifestyle
- Eat food in fewer and more frequent portions.
- Avoid eating before going to bed.
- Avoid alcohol, aspirin, ibuprofen and caffeine.
- Stop smoking.
- Raise the head of the bed (or use two or three pillows) to allow gravity to hold the acid in the stomach and prevent acid reflux.
Antacids can be taken after meals, at bedtime or when necessary, to bind excess stomach acid and to cover the esophagus.
Antagonists Histamine H2 are drugs that block the action of histamine (a chemical that stimulates the stomach cells to produce acid) in the stomach’s acid-producing cells.
This decreases the production of acid in order to reduce symptoms. Examples include:
Some H2 blockers are available without a prescription. However, there may be potential interactions with some prescription medications.
Consult your health professional or pharmacist for advice on its safe use.
Proton pump inhibitors (PPIs) are another class of drugs that block the production of acid in the stomach.
- Omeprazol (Prilosec, Rapinex).
- Rabeprazol (Aciphex).
- Pantoprazole (Protonix).
- Lansoprazol (Prevacid).
Surgery is an option for:
- Those who undergo intensive medical therapy do not provide adequate relief.
- People with Barrett’s esophagus.
- People with reflux so severe that it causes hoarseness, pneumonia or wheezing.
Different surgical approaches for esophageal reflux are available. In fundoplication, the stomach is wrapped around the lower esophagus, creating in effect a new physiological valve to take the place of the lower esophageal sphincter.
Recently new devices were approved that can be wrapped around the lower esophagus that act by linking the LES. The specific procedure will be recommended depending on the patient’s situation.