There is almost no person in the world who is exempt from one of the most distressing phenomena in our body: heartburn! burning in chest! Our expert explains why this happens to us, what it has to do with the food we put in our mouths and how it can be treated. And also: when heartburn is just a symptom of a much more problematic medical condition.
Almost everyone will suffer from heartburn at least once in their lifetime. The encouraging news is that heartburn usually goes away on its own, but sometimes it can be a symptom of more serious symptoms.
What are the symptoms of heartburn?
The first symptom of heartburn is a burning pain in the chest area, behind the sternum. Sometimes the burning sensation can continue towards the neck and reach the mouth.
The symptoms usually appear after eating, but can also appear at night. Lying down or leaning forward can make symptoms worse.
What happens in the body during heartburn?
Inside the abdominal cavity, in the lower part of the esophagus (which is the tube that connects the mouth to the stomach) there is a gatekeeper – an annular muscle whose function is to prevent the acidic stomach juices from rising into the esophagus and causing the heartburn sensation.
When the food is swallowed, the lower sphincter (gatekeeper) muscle is relaxed and allows food and drink to pass into the stomach. After the swallowing process, the goalkeeper returns to its normal (contracted) position.
When the gatekeeper does not function properly due to the weakening of the muscle or because the gatekeeper has risen into the chest, for example due to a diaphragmatic hernia – the gastric juices can move up into the esophagus and cause a burn or injury to the lining of the esophagus. The heartburn sensation (burning sensation in the chest area) is attributed to these injuries.
Why do you feel burning in chest (oesophagus) and not in the stomach?
The stomach produces a very strong acid to digest food. The lining of the esophagus, unlike the lining of the stomach, is not used to being exposed to acid.
Exposure of the esophagus to stomach contents (gastroesophageal reflux, reflux) is a physiological phenomenon, that is, it occurs in all people. When this exposure occurs many times a day, it causes heartburn. The reason: the acidic stomach juices rise into the esophagus and cause a real burn in the esophageal cells, hence the heartburn sensation.
Does heartburn always result from reflux (return) of stomach contents into the esophagus?
Exposure of the esophagus to the contents of the stomach is the main cause of heartburn, but there are two other groups of diseases that cause similar symptoms:
1. Hypersensitivity of the distal esophagus . There are people who suffer from hypersensitivity of the inner lining of the esophagus. They suffer from heartburn even if their esophagus is exposed to a normal amount of stomach contents.
2. Functional heartburn . There are people who for an unknown reason suffer from heartburn even if there is no pathological exposure of the esophagus to the contents of the stomach.
How do you differentiate between these diseases and gastroesophageal reflux disease?
The diagnosis is made with the help of two tests: endoscopy and monitoring of the acidity of the esophagus. In endoscopy, a tube with a camera at the end is inserted into the esophagus – through the mouth. With its help, inflammation of the esophagus can be diagnosed. By monitoring the acidity of the esophagus (pHmetry) it is possible to check how long the esophagus has been exposed to the contents of the stomach.
Why does pregnancy increase the risk of heartburn?
Pregnancy raises intra-abdominal pressure and increases the risk of heartburn. On top of that, a pregnant woman has an increased production of the hormone progesterone. This hormone causes the relaxation of most muscles, including the goalkeeper muscle.
And why does being overweight increase the risk of heartburn?
Excess weight causes increased pressure on the stomach and diaphragm and the opening of the gate at the bottom of the esophagus.
What is the treatment for heartburn? How can it be transferred?
In most cases, heartburn is a transient phenomenon. Most people who suffer from heartburn can deal with the discomfort associated with heartburn through lifestyle changes and over-the-counter medications.
Lifestyle changes include:
• Maintaining a healthy weight. Being overweight causes an increase in intra-abdominal pressure – a phenomenon that causes an increased passage of stomach contents into the esophagus. Studies show that being overweight, which is common in the western world, has a great effect on the incidence and severity of the disease.
• Lifting from the head of the bed. You can put a block or brick under the legs of the bed, on the side of the head, that will raise the upper body while lying down, so that the head is slightly higher than the legs. This condition in itself may prevent leakage of gastric juices into the esophagus.
• Avoiding large meals or night meals . Avoid eating 2 to 3 hours before going to bed.
• Avoiding prolonged lying down after meals.
• The studies show conflicting conclusions regarding the effectiveness of avoiding certain types of food such as high-fat food, carbonated drinks, spicy food, citrus fruits, citrus juices, mint, fatty/fried food, alcohol, coffee.
When should you see a doctor?
• If the heartburn appears two or more times a week or interferes with daily functioning.
• If the change in lifestyle and treatment with over-the-counter drugs do not help.
• If heartburn is accompanied by pain or difficulty swallowing.
• If the symptoms first appeared between the ages of 50 and 60.
• If the symptoms are accompanied by weight loss or lack of appetite.
• If there are symptoms of bleeding from the digestive system such as vomiting blood, black stools, bloody stools or the presence of occult blood in the stool.
It should be remembered that chest pain can be the first symptom of an acute heart attack . You should contact your doctor or an emergency room immediately if you have severe chest pain or chest pain accompanied by symptoms of a heart attack such as pain in your hand or lower jaw or shortness of breath .
What medicines are there for heartburn?
In addition to changing the lifestyle, heartburn can also be treated with various medications:
• Antacid drugs. These drugs neutralize stomach acidity. They quickly relieve the symptoms, but do not treat the damage caused to the esophagus. Examples of preparations containing antacids: Tamas or Rani. They can be purchased without a doctor’s prescription and used as needed, depending on the symptoms.
• Medicines that block histamine type 2 (H2 Blockers). These drugs suppress the secretion of stomach acid. Examples of these drugs: Famotidine and Ranitidine . Of these, famotidine can be purchased in a dose of 20 milligrams without a doctor’s prescription.
• Medicines that inhibit the activity of the hydrogen pumps (PPI) in the stomach. These drugs also suppress the secretion of stomach acid. Examples of such drugs: Omeprazole , Nexium , Lanton and Controlloc . All these drugs require a doctor’s prescription except for omeprazole in a dose of 20 milligrams in a small package of 14 capsules, which can be purchased without a prescription.
• Prokinetic drugs. These increase the motility of the upper digestive system and inhibit the passage of acid into the esophagus. Examples of such drugs: Permin and Motilium . In the past, it was customary to use these drugs for a long time to relieve nausea and other symptoms in the digestive system, but today their use is limited, usually only for a few days.
If the over-the-counter drugs do not help or if there is frequent use of them, you should contact your doctor for clarification. The doctor will consider the possibility of giving treatment with prescription drugs.
What is gastroesophageal reflux disease (GERD)?
The definition of gastroesophageal reflux disease is “stomach contents rising into the esophagus and causing symptoms that impair the patient’s quality of life.”
This is a condition that affects the patient’s daily life and may even cause complications. Between 10% and 20% of the population suffer from this disease. Heartburn is one of the distinct symptoms of this disease, but it must be emphasized that most patients who experience feelings of heartburn do not suffer from gastroesophageal reflux disease.
The usual treatment for the disease is the administration of drugs, but there are cases when surgery will achieve better results. This option should be considered after discussion with a surgeon specializing in this field. The operation includes, among other things, performing a fundoplication – wrapping part of the stomach around the distal esophagus (closer to the stomach). This action strengthens the gatekeeper area between the esophagus and the stomach.
How do you know if heartburn is related to gastroesophageal reflux disease?
Heartburn that occurs twice a week or more or interferes with daily functioning is one of the symptoms of gastroesophageal reflux disease.
To find out the causes of heartburn, one or more of the following tests must sometimes be performed:
• Upper endoscopy – examination of the esophagus and stomach using a flexible tube containing a camera at the end for the purpose of taking a biopsy and looking at the lining of the esophagus and stomach.
• Prolonged monitoring (for 24 hours) of the acidity level (pH) in the esophagus using a thin tube inserted through the nose. This test is called Esophageal pHmetry.
• Testing of esophageal motility using a thin tube inserted through the nose.
Can heartburn be dangerous?
The complications of gastroesophageal reflux disease include, among other things, irritation and appearance of inflammation in the esophagus (Esophagitis), narrowing of the esophagus (Stricture) and a slight increase in the risk of developing esophageal cancer.
In some cases, the esophagus must be examined using an endoscope (a tube with a camera at the end that is inserted through the mouth while the patient is sedated) to make sure that there is no significant damage to the cells in the esophagus due to the continuous acid stimulation. Such a condition may, as mentioned, eventually turn into esophageal cancer if not treated thoroughly.
What is a diaphragmatic hernia and what does it have to do with heartburn?
The esophageal tube runs along the chest in an area known as the “strait” (mediastinum) parallel to the trachea and behind it. It penetrates through a hole in the diaphragm muscle, which separates the chest cavity from the abdominal cavity, and immediately enters the stomach.
A diaphragmatic hernia is a condition in which part of the stomach rises into the chest cavity. A congenital defect or increased pressure in the abdominal cavity due to obesity are two of the causes of the development of a diaphragmatic hernia.
If the hernia is large, it may worsen heartburn symptoms due to further weakening of the sphincter located at the bottom of the esophageal tube. In the case of a significant diaphragmatic hernia, surgery is sometimes necessary to close the hole in the diaphragm and return the stomach to the abdominal cavity.