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HEARTBURN

Heartburn is the feeling of burning and pain in the chest, behind the breastbone. It occurs when the stomach acid or stomach contents backs up into the esophagus (a tube that connects mouth and stomach). This condition is mostly experienced after eating spicy foods or taking acidic beverages, it is commonly observed during pregnancy. Heartburn is the main symptom of gastro-esophageal reflux disease (GERD), a condition caused by acid refluxing into the esophagus.

Most of the people usually ignore heartburn, or just take few OTC pills for temporary relief. If heartburn is not treated effectively, it can cause erosions or ulcers in the esophageal lining and affects daily routine due to severe discomfort. Therefore, early diagnosis and appropriate treatment are highly recommended.

Symptoms

A burning pain in the chest, especially after eating or while sleeping is the common symptom of heartburn. Other symptoms include:

  • Frequent coughing
  • Worsening chest pain while lying down
  • Hoarseness in voice
  • Difficulty in swallowing
  • A persistent sore throat
  • Pain in the upper abdomen
  • Inflammation in the voice box

Causes

Heartburn mainly occurs when stomach acid backs up into the esophagus. It is a symptom of other underlying conditions which may be caused by:

  • Weakening of lower esophageal sphincter
  • Smoking- Habit of smoking can affect the function of your lower esophageal sphincter (LES), leading to the relaxation of the sphincter, that lets the acid reflux into the esophagus from the stomach.
  • A hiatal hernia- This condition makes your LES function ineffectively leading to the acid refluxes and finally the heartburn.
  • Pregnancy- Pregnancy creates pressure in the abdominal cavity affecting the LES and thus causes acid refluxes.
  • Obesity- Obesity predisposes acid reflux due to the increased pressure near the abdomen.

If heartburn is observed after taking certain foods, it is better to eliminate them from the diet.

Risk factors

The risk factors of heartburn include:

  • Alcohol consumption
  • Overeating of chocolates
  • Administration of aspirin, naproxen, ibuprofen
  • Consuming acid foods in diet (tomatoes, oranges, etc.)
  • Taking certain juices made of grape, orange, pineapple

Complications

Heartburn if persists for a longer time is considered as GERD, which requires appropriate treatment. If not, it may result in serious damage to esophagus and surrounding parts.

Diagnosis

To make a preliminary diagnosis, the doctor would take your medical history and performs a thorough physical examination. If any abnormality is suspected, the following tests are recommended:

  • Endoscopy: this test helps the doctor to understand the extent of damage and helps in ruling out the other possible reasons for the symptoms. If indicated, biopsies may also be ordered.
  • Upper GI series: to view the outline of your digestive system. The patient will be asked to drink a liquid that coats the inner side of the digestive tract and then the X-rays are taken.
  • Ambulatory pH testing: This test helps to measure the acidity of the esophagus. It is performed by inserting a small tube via nose to the stomach.

Based on the diagnostic results, the doctor would choose an appropriate treatment option.

Treatment

Heartburn can be managed by lifestyle modifications and medications. In rare situations, a surgical intervention may be recommended to help relieve from chronic heartburn or GERD.

Medications

  • Antacids: These medications assist in binding the excess acid and give protection to the esophagus by forming a coat. Antacids such as H2 antagonists are widely used, which helps decrease the acid production and alleviates the symptoms. Examples are cimetidine, ranitidine, famotidine.
  • Proton pump inhibitors (PPIs): These drugs help in blocking the production of acid by the stomach. Some of the examples of PPIs are omeprazole, rabeprazole, pantoprazole, lansoprazole, etc.
  • H2- receptor blockers- These drugs provide long-term relief and reduce acid production up to 12 hrs, ex: cimetidine, ranitidine, famotidine etc.

Surgery

Surgery is recommended if the symptoms are too severe, or if the patient develops any complication such as Barrett’s esophagus, severe pneumonia, or discomfort. There are different surgical approaches to heartburn such as Fundoliposuction, laparoscopic anti-reflux surgery, etc. The doctor suggests suitable surgery based on the patient’s condition and severity.

Prevention

There are several ways that help reduce your symptoms of heartburn.

  • Keeping track on weight because excess weight can increase pressure on the LES and may aggravate the symptoms of heartburn.
  • Quitting smoking and alcohol because smoking and alcohol consumption would interfere with the normal functioning of LES.
  • Avoiding foods that trigger the acids in your body, you must also never over eat.
  • Elevating the head of the bed while resting, this helps reduce the acid refluxes at nights while sleeping.
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