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What is Heart Burn ?
An uncomfortable, burning sensation
felt behind the breastbone is usually referred to as heartburn.
It is medically known as pyrosis. The pain often rises in the
chest and may radiate to the neck or throat. It is a burning
sensation or a gnawing pain experienced in the area of the chest
over the heart, or beneath the sternum and near the heart.
Although, it is termed as heartburn, it is not related to any
heart disorder, and is instead a digestive disorder. It is
actually a non-cardiac chest pain.
Symptoms of heartburn
Heartburn itself is a symptom. Heartburn can be a
once-in-a-while irritation or it can occur frequently, requiring
sufferers to take daily medication.
People with heartburn often describe one or more of the
following symptoms:
• A burning chest pain that begins at the breastbone and moves
up towards the throat, that occurs after eating and can last a
few minutes to several hours.
• Lying down, bending over and eating food often makes symptoms
worse.
• A sensation of food coming up into the throat or mouth
(regurgitation).
• Burning sensation in the throat.
• Sour or bitter taste in the mouth.
• Belching caused by the noisy stomach gases coming through the
mouth.
• Chronic coughing, hoarseness may be present.
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• Sometimes, breathing becomes noisy
and high-pitched.
• The symptoms of a heart attack can closely mimic the symptoms
of heartburn and indigestion, especially among women. The chest
pain can be confused with angina, but the heart has nothing to
do with it. It is purely a digestive problem.
• Heartburn is a problem closely
associated with pregnancy.
• Feeling of food "sticking" in the middle of the chest or
throat, and difficulty in swallowing.
• Heartburn can be a once-in-a-while irritation or it can occur
frequently, requiring sufferers to take daily medication.
Chronic heartburn (regular heartburn) may lead to a medical
condition called GERD or Gastro esophageal Reflux Disease.
Heartburn that occurs more than twice a week may be considered
GERD, and it can eventually lead to more serious health
problems. The main symptoms are persistent heartburn and acid
regurgitation.
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Causes
of heartburn
Stomach juices are secreted by the stomach as an aid to
digestion. Juices contain powerful acid, hydrochloric acid.
Heartburn occurs when small amounts of this acid rise up into
the gullet (esophagus) - the tube which carries food from the
mouth to the stomach. This is called reflux. While the stomach
is naturally protected from this potent acid, the esophagus does
not share the same protective qualities as the stomach. Lower
esophageal sphincter (LES) is a natural valve that keeps stomach
acid in the stomach, out of esophagus. The LES is a ring of
muscle at the bottom of the esophagus that acts like a valve
between the esophagus and stomach. Heartburn results when this
valve does not work properly, LES relaxes allowing the harsh
stomach juices to flow upward and come in contact with and
irritate the delicate lining of the esophagus. Heartburn may
also occur in people with a normal LES. Increases in the
pressure in the abdomen can overcome the strength of a normal
valve.
Factors contributing to heartburn
are
• Eating foods such as citrus fruits, chocolate, peppermint,
spearmint, tomatoes or tomato-based products, raw onions,
garlic, black pepper, vinegar and fatty or spicy foods (such
foods puts more pressure on LES, allowing reflux of stomach
contents). Drinking beverages such as coffee, citrus juices, and
caffeinated, carbonated or alcoholic beverages (relaxes LES).
• Eating large meals and lying down shortly after eating are
activities that put extra pressure on the lower esophageal
sphincter which will increase the chance that some of this food
will reflux into the esophagus.
• Bending, lifting, or performing other vigorous physical
activities shortly after eating may also lead to heartburn.
• Being overweight, smoking, hectic lifestyle, or wearing
restrictive clothing also contributes to heartburn.
• Medicines, such as aspirin, ibuprofen, prednisone, iron,
potassium, or antihistamines.
Possible underlying causes of
heartburn includes
1) Gastroesophageal Reflux Disease (GERD) It is also known as
acid reflux and is a condition in which stomach acid refluxes or
backs up into the esophagus and sometimes into the mouth, causes
a burning sensation in the chest or throat called heartburn.
Heartburn that occurs more than twice a week may be considered
GERD, and it can eventually lead to more serious health
problems.
2) Hiatal hernia Hiatal hernia is a condition in which the upper
portion of the stomach protrudes into the chest cavity through
an opening of the diaphragm, the muscle that separates the
abdomen from the chest. This causes food and acid to back up
into the esophagus leading to heartburn.
3) Peptic ulcer Peptic ulcers are an inflammation of the stomach
or duodenal lining. Peptic ulcers occur when stomach acid and
digestive juices eat away the protective lining, causing
heartburn.
4) Gastrointestinal motility disorders
5) Certain medications are likely to contribute to heartburn
like
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• Medications used to treat asthma
and breathing difficulties like theophylline
• Medications used to treat heart and blood pressure, like
calcium channel blockers, e.g., diltiazem, beta-blockers, e.g.,
propranolol
• Medications used to treat arthritis and inflammation, like
aspirin, ibuprofen.
• Medications used to treat osteoporosis like bisphosphonates.
• Medications used to treat anxiety, insomnia, depression, and
pain like diazepam, amitriptyline.
• Medications used to treat Parkinson's disease like those
containing levodopa.
• Medications used to treat cancer.
Dignosis of heartburn
Endoscopy is the most commonly used test and involves a fibre
optic tube which is passed down the throat, enabling the doctor
to examine the esophagus, stomach, and duodenum. Sometimes an
X-Ray is used which monitors the passage of a drink containing a
heavy element which shows up the esophagus and stomach in
silhouette. |
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Treatment of
heartburn
It is important to treat heartburn. Over time, ongoing reflux can
damage the lining of the esophagus and cause serious problems.
Depending on how severe the heartburn is, treatment may involve one
or more of the following lifestyle changes and medications or
surgery.
Lifestyle changes
• Eating less each meal or smaller, more frequent meals can help
lower the risk of acid reflux associated with mealtimes., since
large meals expand the stomach and increase upward pressure against
the esophageal sphincter.
• Avoidance of those foods that will often cause heartburn. The
foods and beverages that are known heartburn triggers for the
majority of sufferers, include coffee, tea, carbonated beverages,
alcoholic beverages, spices, onions, tomatoes and tomato based
products, citrus fruits (e.g. oranges and grapefruits, fried foods,
fatty foods.
• Lying down within three hours of eating meals may lead to reflux
of stomach acids that is working to digest the food. So it is
advisable to avoid lying down after 3 hours of consumption of meals.
• Lying down flat presses the stomach's contents against the LES.
With the head higher than the stomach, gravity helps reduce this
pressure.
• Being overweight is one of the strongest risk factors for
heartburn, since obesity increases abdominal pressure which can then
push stomach contents up into the esophagus. Hence it is required to
reduce weight.
• Cigarette smoking inhibits the production of saliva, one of the
body's defenses against damage to the esophagus, since they contain
acid-neutralizing chemicals (bicarbonates) which help to neutralize
stomach acid. Therefore it is required to stop smoking.
• Clothing that fits tightly around the abdomen will squeeze the
stomach, forcing food up against the LES, and cause food to reflux
into the esophagus.
Medications used for treating heartburn
includes
• Antacids such as gelusil, rolaids, neutralize stomach acid and can
provide quick relief.
• H2 blockers (histamine receptor blockers, such as Pepsid AC,
Zantac, Tagamet) decrease stomach acid production and are effective
against heartburn. They provide longer relief.
• Proton-pump inhibitors, eg, omeprazole also inhibit acid
production by the stomach, but are much more effective than H2
blockers for some people. They allow damaged esophagus to heal.
• Prokinetic agents (also known as motility drugs) eg, cisapride act
on the LES, stimulating it to close more tightly, thereby keeping
stomach contents out of the esophagus.
• Herbal remedies include bananas, aloe vera gel, chamomile (Matricaria
recutita). Licorice (Glycyrrhiza uralensis) can help relieve the
symptoms of heartburn by reestablishing balance in the acid output
of the stomach.
• Several homeopathic remedies are useful in treating heartburn
symptoms. Among those most often recommended are Nux vomica, Carbo
vegetabilis, and Arsenicum album.
• Acupressure and acupuncture may also be helpful in treating
heartburn.
Surgery Surgery is
usually treatment of last resort. Laparoscopic surgery is a
minimally-invasive procedure that creates an improved valve
mechanism at the bottom of the esophagus so that food will not
reflux back into the esophagus.
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