Last Updated on October 28, 2023
Heartburn is a symptom of Gastroesophageal reflux disease. It is the painful burning sensation described by person having gastroesophageal reflux disease caused by stomach acid refluxes up into esophagus. This pain is felt behind the sternum or breastbone, either as a spasm or a sharp pain.
The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw.
Though the name implies otherwise, the heartburn has got nothing to do with the heart. Heartburn is often felt as a burning sensation in the middle of the lower to the middle part of the chest.
It is probably called heartburn because earlier it might have been perceived to origin from heart due the same location of the pain.
In fact, many times the pain of acid reflux can be mistaken for the pain of a heart attack.
The pain of acid reflux (heartburn) may be associated with waterbrash, a sour taste in the back of the throat. it may cause coughing episodes or hoarseness or teeth decay in chronic cases.
Symptoms are often worsened after heavy meals, leaning forward, or lying flat.
It may occur in the night and those affected may often awaken from sleep with heartburn.
Relevant Pathophysiology
The esophagus is a tube that connects the mouth to the stomach. It receives and prpels food toward the stomach. Once in the stomach, food is prevented from refluxing by a special area of circular muscle located at the junction of the esophagus and stomach, called the lower esophageal sphincter.
The stomach produces acid and enzymes to digest the food. Stomach is protected by a special lining of the cells to prevent the acid from causing inflammation.
The esophagus lcaks this protection and if stomach acid and digestive juices reflux back into the esophagus, they can cause inflammation and damage to its unprotected lining leading to pain and burning sensation.
Heartburn Causes
As hearburn is a symptom of gastroesophageal reflux disease caused by acid refluxing back into the esophagus.
Therefore the conditions which cause increased production of acid in the stomach and structural issues allowing acid reflux into the esophagus can cause heartburn.
In addition, the foods that directly irritate the stomach and esophagus are also responsible for heartburn.
Irritant Food
Foods that stimulate increased stomach acid secretion. These irritants include:
-
- Alcohol,
- Caffeine,
- Carbonated beverages,
- acidic juices (grapefruit, orange, pineapple)
- acidic foods (tomatoes, grapefruit, and oranges), and
- Chocolate
- high-fat content foods
Drugs
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- Aspirin and other NSAIDs
- Steroids
- Any drug causing gastritis
Smoking
Smoking causes allows acid to reflux into the esophagus.
Pregnancy
Pregnancy results in increased pressure within the abdominal cavity. It affects lower esophageal sphincter function and predisposes it to reflux.
Obesity
It causes increased pressure in the abdomen, and thus reflux .
GI Conditions
- Gastroparesis
- Occurs due to damage to the nerves going to the stomach resulting in slower gastric emptying
- Most common in people with long-standing diabetes.
- Achalasia
- a motility disorder
- LES does not close properly and reflux occurs
- Scleroderma
- Sarcoidosis.
- Gastroesophageal reflux disease
- Peptic ulcers
Diagnosis of Heartburn
Heartburn has typical presentation and waxes and wanes over a period. It can be confused with chest wall pain. Lung infection and heart attack.
The diagnosis is mainly clinical and based on complete history and physical examination.
Depending on the suspected causes following investigations may be undertaken
- Barium meal studies
- Endoscopy
- Endoscpoic biopsy
- Esophageal Manometry and pH testing
Treatment of Heartburn
Lifestyle Changes
Many lifestyle changes can help in mild to moderate degrees of heartburn. These changes could be
- Eating smaller, more frequent meals
- Avoid eating before bedtime
- Irritant foods
- Stop smoking
- Elevating the head of the bed to allow gravity to keep acid in the stomach and avoid acid reflux.
Drugs for Heartburn
Antacids bind excess acid in the stomach and to coat the esophagus. These may be taken after meals, at bedtime, or when needed.
Histamine receptors H2 antagonists like cimetidine, ranitidine and famotidine are commonly used.
Proton pump inhibitor is another class of drugs used for heartburn. The examples include omeprazole, rabeprazole amd pantoprazole.
