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VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk

Heartburn is a very unpleasant ailment. Many patients must have felt the characteristic burning behind the breastbone when bending down and after a hearty lunch. What are the causes of heartburn and why does this symptom occur? How to deal with heartburn and what are the therapeutic options in this case?

Heartburnis an unpleasant burning sensation behind the breastbone in the esophagus. This may be accompanied by a sour taste in the mouth and the burning sensation may extend up to the throat.Heartburnis caused by the abnormal reflux of acid in the stomach into the esophagus. The esophagus is not adapted to the acidic content and causes irritation, and in some cases even deeper damage.

Chest pain and heartburn - differentiation

Heartburn may be accompanied by chest pain, which in some cases resembles the angina-like pain associated with a heart attack. It is worth being aware of this, as these causes of chest pain should be differentiated.

In the case of regurgitation of gastric contents, pain is provoked by a copious meal, bending, but also lying down - these activities increase the regurgitation of irritating contents into the stomach. In the case of angina symptoms, the pain worsens under the influence of stress, physical exertion, cold air, but also - a heavy meal, and disappears after the cessation of physical exertion.

However, in the case of a heart attack, the pain lasts longer (more than 20-30 minutes) and does not go away after the end of physical activity. It may be accompanied by other symptoms such as shortness of breath, weakness, nausea, vomiting, as well as profuse sweating.

If a patient experiences chest pain, it is necessary to conduct a thorough medical history and perform an ECG test, which will initially help to differentiate the causes of chest pain.

Heartburn - causes of heartburn

Heartburn is the most important symptom of gastro-esophageal reflux disease - that is, the regurgitation of gastric acid into the esophagus, which leads to unpleasant symptoms for the patient. What is the result of the appearance of this symptom? The most important factors that predispose to occurrencegastro-oesophageal reflux disease and heartburn include:

  • hiatus sliding hernia - this condition consists in the fact that part of the stomach moves from the correct anatomical position, i.e. from the abdominal cavity to the chest cavity. The hernia causes the gastroesophageal barrier to be weakened, which promotes the flow of contents from the stomach into the esophagus,
  • slowing down gastric emptying - prolonged gastric content in the stomach and its accumulation promotes heartburn, slower gastric emptying may accompany diabetes and some neurological diseases,
  • smoking - affects the symptoms in such a way that it reduces the tension of the lower esophageal sphincter (short from the English words LES), which is a specific anti-reflux barrier, too low its tension predisposes to reflux gastric contents into the esophagus,
  • alcohol - its abuse also predisposes to reflux, because similarly to cigarettes - it reduces LES tension,
  • high-fat diet - fatty foods release the hormone cholecystokinin - a substance that lowers LES tension. The symptoms of reflux are also aggravated by acidic and spicy foods,
  • obesity, overweight - excess body weight increases the pressure in the stomach and changes the position of the LES, which predisposes to reflux,
  • pregnancy - this condition also contributes to acid reflux. This is because during pregnancy, the pressure in the abdomen increases, as well as the concentration of estrogens (sex hormones), which reduces the tension of the LES,
  • taking medications that lower LES tension - these include, among others: calcium channel blockers (commonly used in the treatment of hypertension), nitrates, oral contraceptives, or β2-agonists (used in the treatment of asthma).

Gastro-esophageal reflux disease - it's not only heartburn

What other symptoms may accompany gastro-esophageal reflux disease? It should be mentioned here above all:

  • belching,
  • pain localized in the epigastric region,
  • hoarseness - acid stomach contents can irritate the vocal cords and thus cause a change in the timbre of the voice,
  • cough, typically dry, as well as bronchospasm - the acidic content can enter the bronchi and irritate the airways. These symptoms can also result from the vagus nerve reflex - this nerve is irritated in the lower esophagus, causing the bronchial tubes to constrict and therefore breathing problems in the form of wheezing,
  • chest pain already described in the first paragraph,
  • excessivesalivation - due to irritation of the esophagus,
  • damage to tooth enamel due to acidic gastric content,
  • laryngitis - mainly associated with episodes of nocturnal reflux.

It is worth mentioning here that gastro-oesophageal reflux disease may be asymptomatic and asymptomatic. Esophagitis is then discovered accidentally during gastroscopy.

Heartburn and alarm symptoms - when to urgently perform a gastroscopy?

Certain clinical symptoms that may accompany gastro-esophageal reflux disease require urgent endoscopic diagnosis - gastroscopy to be exact. These symptoms may indicate a more serious medical condition, such as cancer. The alarm symptoms associated with acid reflux include:

  • dysphagia - problems with swallowing, difficult swallowing,
  • odynophagia - pain when swallowing,
  • weight loss,
  • bleeding from the upper gastrointestinal tract - may manifest as tarry, dark stools, drop in blood hemoglobin levels, weakness and sometimes vomiting with blood,
  • persistent vomiting - may indicate a narrowing of the esophagus,
  • resistance in the epigastrium palpable during palpation - may indicate a developing tumor in the stomach or esophagus.

Heartburn - pharmacological treatment of gastroesophageal reflux disease

Medicines that reduce the secretion of hydrochloric acid are the basis of pharmacological treatment of heartburn. The first-line drugs are proton pump inhibitors, which we refer to as PPIs for short. Please list here:

  • omeprazole,
  • rabeprazole,
  • lansoprazole,
  • esomeprazole,
  • pantoprazole,
  • dexlansoprazole.

These drugs are used in the morning on an empty stomach, at the beginning the therapy starts with one capsule / tablet - taken once a day. Sometimes drugs that block histamine receptors are also used - more precisely, H2 blockers, which include ranitidine and famotidine. These drugs reduce gastric secretion, but by a different mechanism than proton pump inhibitors (these drugs inhibit histamine-dependent secretion of gastric acid).

Preparations such as magnesium and aluminum compounds, alginic acid and sucralfate are used less frequently.

As an aid, preparations are used that stimulate gastric emptying - such a substance is itopride. Medicines are selected by a doctor, depending on the severity of symptoms and history.

Heartburn - when may I need surgery?

The indication for the procedure is primarily largehiatal hernia. The operation of choice is fundoplication using the Nissen method - it is nothing else than creating a collar from a part of the stomach (or more precisely from its bottom) that surrounds the lower part of the esophagus, which significantly strengthens the anti-reflux barrier and prevents the gastric contents from flowing back into the esophagus.

The indication for the procedure is also intolerance and a bad response to pharmacological treatment. In the case of advanced obesity (above all, stage III obesity, when the patient's BMI is above 40), bariatric surgery to eliminate obesity is considered as a trigger for oesophageal reflux.

Heartburn - preventing esophageal reflux

The mainstay of preventing heartburn in gastro-esophageal reflux disease is non-pharmacological treatment. What rules should be kept in mind to significantly reduce the number of episodes of burning pain and discomfort? First of all, remember about:

  • avoiding eating two or three hours before going to bed - lying position predisposes to reflux,
  • while sleeping, it is worth setting your headboard and pillow higher,
  • avoiding alcohol consumption and quitting smoking,
  • weight loss if you are overweight or obese,
  • resignation from eating fatty and spicy meals, moreover - avoiding carbonated drinks,
  • avoiding taking medications that lower the tone of the lower esophageal sphincter (LES) - these medications have already been mentioned in this article, if there is a possibility of replacing a specific drug with another preparation, it is worth discussing it with your doctor,
  • resignation from vigorous exercise immediately after eating a meal,
  • no need to wear clothes that press against the waist,
  • reducing the volume of food intake - it is better to eat food more often and in small amounts than less often and in large amounts, as this leads to stretching of the stomach walls and thus increasing the risk of acid regurgitation into the esophagus.

Following these rules and taking the preparations recommended by the doctor will in most cases control the symptoms of gastroesophageal reflux disease.

Gastro-oesophageal reflux disease - complications of heartburn

Unfortunately, untreated gastroesophageal reflux disease may be associated with complications that are dangerous for the patient's he alth. They mainly include:

  • esophagitis,
  • erosions of the esophageal mucosa,
  • esophageal ulcers - these are deeper changes than erosions,
  • metaplasiaintestinal (i.e. the so-called Barrett's esophagus) - this is a condition in which the squamous multilayered epithelium is replaced with the epithelium characteristic of the stomach (cylindrical monolayer epithelium). Barrett's esophagus is a precancerous condition - it increases the risk of developing adenocarcinoma of the esophagus,
  • bleeding due to tissue damage and ulceration,
  • narrowing of the esophagus due to damage, which leads to difficult swallowing, i.e. dysphagia, which is discussed in this article.

As you can see, complications of untreated heartburn can be very serious and even lead to the development of an oncological disease. For this reason, it is not worth underestimating recurring heartburn and in case of its occurrence - go to the doctor, preferably at the beginning to the general practitioner (i.e. family doctor).

The doctor, after examining the patient and conducting a thorough interview, will decide whether further diagnostics are necessary (for example, a gastroscopic examination that allows you to see the esophagus and stomach) and, if necessary, introduce appropriate pharmacological treatment.

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