Heartburn - Symptom Evaluation

About

Heartburn is a symptom that occurs due to irritation of the food pipe either due to acid reflux or direct contact with spicy and irritant foods.

Heartburn is a burning and painful feeling in the chest just behind the chest-bone. In a normal person, the part where the food pipe meets the stomach is guarded by muscular valve called the lower esophageal sphincter. The sphincter ensures movement of food from the food pipe into the stomach, and at the same time prevents contents of the stomach from moving back into the food pipe. In some cases however, the tone of the lower esophageal sphincter may be reduced, allowing the acidic contents of the stomach to move back into the food pipe. This results in symptoms of heartburn. Heartburn may also occur due to direct irritation of the food pipe. The pain of heartburn typically appears after a meal and is increased if the person lies down soon after the meal. Patients with reflux symptoms usually experience heartburn at least twice a week.

On long term, reflux can cause complications including cancer of the food pipe in some individuals. Reflux not only causes inflammation of the food pipe; the acid may reflux into the respiratory tract resulting in cough, laryngitis (inflammation of the sound box), pharyngitis (inflammation of the upper throat), sinusitis (inflammation of the sinuses) and lung complications like bronchitis, asthma, and pneumonia.

The cause of heartburn is usually obvious in each case. Once heartburn is diagnosed, it is important to treat it early to prevent complications.

Some causes of heartburn are listed below:

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Substances that irritate the food pipe:

Substances like spicy foods, citrus fruits, cigarette smoke and aspirin-like painkillers that irritate the food pipe can result in heartburn. Decreased lower esophageal sphincter tone:  In many cases, the cause of decreased tone of the lower esophageal sphincter is not known. In other cases, it may be due to:

• Intake of certain foods and beverages: Certain foods and beverages like peppermint, caffeinated drinks like coffee, tea, and soft drinks, chocolate, fatty foods, and alcohol decrease the tone of the lower esophageal sphincter resulting in reflux and heartburn.
• Scleroderma: Patients with autoimmune conditions like scleroderma may have a decreased lower esophageal sphincter tone resulting in reflux.
• Smoking: In addition to acting as an irritant, smoking also decreases lower esophageal sphincter tone leading to reflux.
• Medications: Some medications like anticholinergic drugs and smooth muscle relaxants relax the lower esophageal tone and result in reflux.
• Surgery: Damage to the lower esophageal sphincter due to surgery can decrease the tone of the lower esophageal sphincter.

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Conditions where the gastric contents are near the gastroesophageal junction: This happens in the following situations:

• While lying or bending down: Contents of the stomach tend to move backwards into the food pipe when a person lies or bends down especially soon after a meal.
• Hiatus hernia: Hiatus hernia is a condition where a part of the stomach moves up into the chest due to weakness in the diaphragm (the muscular partition between the chest and the abdomen). Symptoms may be more obvious in conditions like pregnancy where the pressure on the stomach is increased.

Conditions where pressure in the stomach is increased: The pressure on the stomach is increased in conditions where the intra abdominal pressure is high. This is seen in conditions like obesity, pregnancy, ascitis (accumulation of fluid in the abdomen) and wearing tight clothes.

FAQs

1. Which doctor should I visit if I experience heartburn?

You should visit a gastroenterologist if you experience heartburn.

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2. What are the tests done to evaluate heartburn?

The doctor may do an endoscopy to evaluate the heartburn and to check for the extent of complications. Other tests include an upper GI series, esophageal manometry to measure the pressure of the lower esophageal sphincter, and pH measurements to test for gastric acid secretion and reflux into the esophagus.

3. How is heartburn treated?

Heartburn is treated using antacids, and medications to reduce acid secretion and reduce the chances of reflux. Foods and activities that cause heartburn should be avoided. Surgery may be required in severe cases, especially in those who develop complications.