Heartburn

What is Heartburn?

The term heartburn refers to a burning sensation under the chest, just behind the breastbone or in the epigastrium. It does not necessarily mean that the condition is affecting the heart, although symptoms are commonly mistaken as heart disease because of the location of the pain. Still, heartburn itself can be a symptom of heart disorders such as acute myocardial infarction, angina and ischemic heart disease.

In most cases, occasional heartburn is not a serious condition and almost everyone is affected once or many times in his or her life, yet it is still best to consult a doctor for any pain in the chest. Heartburn is a typical symptom of a common disease called gastroesophageal reflux disease (GERD), which results from excessive reflux of gastric contents into the esophagus. If heartburn occurs simultaneously with abdominal pain or bleeding, it may be a symptom of a more serious condition. Heartburn with abdominal pain is typical of patients with underlying heart disease, peptic ulcer disease or gallbladder disease. If heartburn is accompanied by bleeding, immediate attention is needed because large amounts of bleeding may lead to a life-threatening situation.

Heartburn is very common and is estimated that 42% of the United States population has experienced this symptom sometime in their life. Population data shows that females experience heartburn later in their life compared to males, while older age and obesity increase the risk of heartburn.

What Causes Heartburn?

There are a variety of causes underlying the development of heartburn, but the main cause is the reflux of the acid from the stomach to the esophagus or food pipe. The lining of the esophagus is not tolerant to acidic substances as it has a different lining composition than the stomach, thus the lower part of the esophagus is often exposed to acid and can be damaged.

One of the main culprits for the development of this condition is smoking, because it causes the lower esophageal musculature to relax and loosen. Eating or drinking certain foods or beverages may also cause this problem: chocolates, caffeinated or carbonated drinks, tomatoes and spicy foods. Fried and fatty foods also influence the condition as they tend to stay longer in the stomach, slowing the digestion of food and increasing the tendency to be refluxed upward into the esophagus.

Lifestyle also plays a part in the development of this condition. For instance, people who have poor posture are likely to push the stomach upward and reduce its food-holding capacity, forcing a surplus of food into the esophagus. Some habits related to this are frequent straining, lifting, bending and wearing tight jeans. Also, eating heavy meals and lying down afterwards causes the digested food to reflux from the stomach to the esophagus; this is especially true if a person does have the habit of eating 2 to 3 hours prior to bedtime. In addition, conditions that increase intra-abdominal pressure are noted to be the cause of the problem and some of the most common are pregnancy and hiatal hernia. The use of certain medications, such as aspirin, ibuprofen, antihistamines, prednisone, iron, potassium, and sleeping pills can also contribute to the appearance of heartburn.

Symptoms of Heartburn

Heartburn in itself is a symptom that is often described as a burning sensation in the chest, just behind the breastbone. This is the characteristic pain that differentiates heartburn from angina pectoris, in which the pain is relieved through rest and nitroglycerine tablets; or heart attack whose pain is a dull, crushing pain in chest that radiates to the shoulders and jaw. Additionally, the heartburn can last up to 2 hours, or even longer, that starts after meals and can be worsened by bending or lying down. The symptom is temporarily relieved by sitting or standing up.

Other commonly associated symptoms are:

• Indigestion, a feeling of fullness in the stomach
• Sour or bitter taste in the mouth due to acidic content of chime
• Nausea
• Damage on the enamel of the teeth may be caused by recurrent heartburn due to gastric acid that can easily erode the tooth enamel.

More serious associated symptoms that require immediate medical evaluation are:

• Difficulty in swallowing or a feeling that food sticks at the back of the throat. (Dysphagia)
• Blood in the stool or red-stained vomitus
• Chronic cough, asthma, and shortness of breath
• Dizziness
• Frequent and recurrent attacks of heartburn, especially if it is not relieved by antacids or by any traditional means.
• Sudden weight loss and dehydration due to metabolic acidosis or too much acid levels in the body.

Diagnosis of Heartburn

Under normal circumstances, doctors will suspect heartburn after physical complaints of the patient. But the main reason why it is still necessary to perform diagnostics and tests is to uncover the reason(s) behind the development of the disease.

Initially, physical assessment and inspection of the mouth, teeth, and buccal mucosa are done to check any unusual occurrences caused by heartburn. The next step is to conduct advanced visualization techniques such as endoscopy. This is a procedure where a tube with a special camera at the end is inserted into the stomach through the mouth to examine any defects on the gastroesophageal wall down to the gastro-intestinal area. Alternatively, barium X-rays may be performed after the patient swallows a barium paste that is opaque to x-rays; the paste will coat the lining of the esophagus so that structures will stand out clearly on the x-ray film.

Other tests include 24-hour pH monitoring that is used to check the acid content in the stomach. The test involves inserting a very thin tube from the nose through the esophagus and acid reflux is measured within a 24 hour period while the patient is ambulatory and doing his-her normal physical activity.

Laboratory tests to detect presence of H. pylori bacteria in the body are routinely performed. H. Pylori that can cause ulcerations in the part of the esophagus and intestines.

Esophageal manometry may also be helpful to recognize the strength of muscular contraction in the esophageal area.

If a heart problem is suspected by the doctor, further diagnosis and tests are done to evaluate the degree of the seriousness of the condition.

Treatment of Heartburn

To treat heartburn and prevent further occurrences, a change in lifestyle is normally advised. Initially, eating habits are modified by instructing patients to decrease carbohydrate consumption. The recommended diet for this condition is high-protein, low fat meals because these types of foods are easily metabolized and digested in the stomach. Ideally, meals are taken 2-3 hours before sleeping or lying down. Smoking and alcohol intake are discouraged as they increase the likelihood of heartburn. People experiencing the symptoms of heartburn are also advised to raise the head of the bed to promote the downward movement of the stomach contents. It is also recommended that tight fitting clothes and belts are used minimally.

Although use of over the counter medication may be helpful in relieving the symptoms experienced by the heartburn patients, it would still be better to ask for prescribed medication from your doctor to accurately treat the underlying cause. The most popular over the counter medication used in the treatment of heartburn are antacids. The acid neutralizing capacity of this medication has been proven to provide immediate and temporary relief of the symptoms. It is recommended to look for antacids that contains both magnesium and aluminum hydroxide to prevent the side effects common in antacids such as diarrhea or constipation.

For those people that have levels of gastric acid above normal, H2 blockers and proton-pump inhibitors are prescribed to reduce production of acids by the stomach.

Alternative Treatment

Natural herbs, such as aloe vera, are thought to have a calming and soothing effect and may help relieve heartburn. On the other hand, effective stress management with aromatherapy, gentle exercise or massage can also have a positive effect on heartburn symptoms.

Prognosis of Heartburn

There is an excellent prognosis for heartburn because treatment is simple and does not normally lead to severe conditions; this is especially true if prompt treatment is made. That is why diagnosing the cause of heartburn is very important so treatment is done to the underlying cause. Heartburn is simply a symptom of a potentially serious disease. If a severe condition develops, the outlook may not be as favorable.

Preventing Heartburn

Heartburn can be prevented by avoiding eating patterns and foods that contribute to the appearance of this symptom. In general, people should eat smaller and more frequent meals, avoid beverages containing alcohol or caffeine, carbonated beverages, citrus fruits and juices; tomatoes and tomato sauces, chocolate, spicy and fatty foods.

Living with Heartburn

Heartburn normally does not interfere with activities of daily living because the pain is temporary. But if the person does not tolerate the pain and the heartburn episode is accompanied by anxiety and stress, it can impact normal lifestyle.

The patient should concentrate on things that prevent the occurrence of heartburn. Diet changes can be difficult for an individual to follow, so the goals must be realistic. Cessation of smoking can be hard, but it must be done because it aggravates heartburn and generally deteriorates your health status. Alcoholic drinks should be reduced and never taken after a meal or whenever the stomach is full. Foods like chocolate, peppermints, fatty foods, carbonated drinks and hot, spicy food must be decreased in the diet.

It is also important to follow the drug regimen prescribed by a doctor. Take them on time, especially the H2 and proton-pump inhibitors. Avoid over the counter drugs in times of sudden sickness, unless specified by the doctor. Non-prescribed medication can negatively interact with your drug regimen or even worsen the heartburn in the long term.

Because heartburn can appear as the result of a variety of agents or conditions, it is important to keep a record of the heartburn episodes, meals and their composition. This may help to diagnose the particular source of heartburn by identifying what triggered the acid reflux episodes. The record should also detail the severity of heartburn episodes, other associated symptoms, and any procedures or medication that provides relief. You should make your doctor aware of this information in order to better identify and plan the lifestyle changes that are needed and treatments that will provide optimal relief.

Current Research of Heartburn

Heartburn is a widely felt and important symptom that is experienced in a variety of conditions. For that reason, research often does not focus on heartburn per se, but rather on the specific underlying conditions.

Current research focuses on development of diagnostic procedures to help identify the cause of heartburn and on cases where this symptom cannot be relieved by standard therapy. There is also special attention to pregnancy-associated heartburn, in order to choose safe and effective treatment approaches that will improve the quality of life of pregnant women.