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Heartburn

Heartburn

Heartburn is an uncomfortable but common feeling of burning or warmth in the chest. Although the pain of heartburn is felt in the chest, heartburn has nothing to do with your heart. Instead, heartburn is caused by stomach acid.

 

Continual bouts of heartburn can be a symptom of a more serious condition calledgastroesophageal reflux disease or GERD. Frequent or severe heartburn may limit daily activities and lead to further complications such as ulcers in the esophagus. With proper understanding of heartburn and treatment, relief can be obtained from this condition.

 

About 30% of adults experience occasional heartburn, while 10% experience heartburn every day. About 25% of pregnant women have heartburn or related symptoms.

Symptoms

The pain of heartburn is described as a burning feeling in the chest. Often, the sensation may spread up into the throat, jaw, arms, or back. That's why heartburn is often mistaken forchest pain due to a heart attack. However, do not second guess yourself. If you are having chest pain for any reason, seek medical attention immediately, if only to rule out a heart attack.

 

Heartburn (often called acid indigestion) typically occurs 30-60 minutes after meals. The pain is worse when lying down, bending forward, and straining to pass stools. The pain is relieved by standing upright, swallowing saliva or water, or by taking antacids.

 

  • If small amounts of stomach acid or food travel beyond the esophagus and up into the mouth, you may experience bitter or sour taste. This is known as regurgitation. It is common after meals, especially if you are lying down, bending over, or straining.
  • Stomach acid can also affect therespiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth). You may feel as if you have a lump in your throat.
  • If the acid exposure continues for long periods of time, the esophagus becomes damaged. You may then have difficulty swallowing. In more serious cases, you may lose weight and become dehydrated. Very rarely, the esophagus may bleed or tear completely because it is so damaged. In severe cases, you may vomit blood or have small amounts of blood in your bowelmovements. However, all these are uncommon.

Causes

The food that is swallowed travels from the mouth to the stomach through a hollow tube called the esophagus (or food pipe). Before entering the stomach, food must pass through a tight muscle at the lower part of the esophagus called the lower esophageal sphincter (LES). The lower esophageal sphincter prevents food from traveling backward into the esophagus.

 

Once in the stomach, stomach acid digests the food. This acid is very strong and can damage most parts of the body. Fortunately, the stomach is protected from its own acid by a special mucous layer. The esophagus, however, does not have any such special protection. If the lower esophageal sphincter does not close completely, the lower part of the esophagus can be damaged by stomach acid. When this happens, heartburn may be experienced.

 

The lower esophageal sphincter may not close completely thus allowing stomach acid into the esophagus for these reasons:

  • Certain foods and drinks are known to loosen the lower esophageal sphincter. These include chocolate, peppermint, caffeine-containing beverages (such as coffee, tea, and soft drinks), fatty foods and alcohol.
  • Heartburn often depends on the body's position. It is easier for stomach acid to flow back into the esophagus if you are lying down or bending over.
  • Anything that increases the pressure on the stomach and forces stomach acid backward into the esophagus can also cause heartburn. This is why lifting, straining, coughing, tight clothing, obesity and pregnancy can worsen heartburn.
  • People who suffer from certain medical conditions may have an increased chance of heartburn. These conditions include hiatal hernia, diabetes, and many autoimmune diseases (CREST syndrome, Raynaud phenomenon, and scleroderma).
  • Many prescription medications can loosen the lower esophageal sphincter, including certain blood pressure and heart medications, and the asthma drug theophylline.
  • Many substances directly irritate the lining of the esophagus and can contribute to heartburn. These include spicy foods, citrus fruits and juices, tomatoes and tomato sauces, cigarette smoke, aspirin, ibuprofen (with brand names such as Motrin and Advil) and medicines for osteoporosis.

Treatment

Your health care provider will recommend treating heartburn in a stepwise fashion. 

  • Over-the-counter antacids are the oldest effective self-treatments for heartburn. Through the centuries, people have chewed on chalk (the active ingredient is calcium carbonate) to ease heartburn. Antacid tablets are slow to act. Tablets are less powerful in neutralizing stomach acid than liquid antacids. 
  1. Antacids are useful because they provide rapid relief of heartburn, especially if it is caused by foods or certain activity. But relief is only temporary. Over-the-counter antacids do not prevent heartburn from returning or allow an injured esophagus to heal. If you need antacids for more than 2 weeks, talk with your health care provider to get a better diagnosis of your condition and appropriate treatment. 
  2. Most varieties of antacids you can buy in drug stores are combinations ofaluminum and magnesium hydroxide. Antacids containing these ingredients may produce unwanted diarrhea or constipation. 
  3. Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands are Tums and Titralac.
  • Follow label instructions and do not take more than the recommended daily dose. Most commonly, users take antacids after meals and at bedtime-or when you have symptoms. 
  • Always tell your health care provider about your antacid use.
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