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Heartburn

Heartburn: Causes, Symptoms, Diagnosis, Treatment, and Prevention

A common ailment, heartburn occurs in many people at some point in their lives. It is a burning sensation in the chest, usually behind the breastbone, following eating or drinking certain foods or beverages. During the night or when lying down or bending over, it can also occur. As a symptom of gastroesophageal reflux disease (GERD), heartburn may lead to complications such as inflammation, ulcers, and esophageal cancer.

Causes of Heartburn

A person with heartburn experiences acid reflux into the esophagus, which carries food from the mouth to the stomach. At the lower end of the esophagus, a ring of muscle called the lower esophageal sphincter (LES) prevents acid from flowing back up. There are a number of reasons why the LES can relax or weaken, allowing acid to escape.

  • Eating large or fatty meals

  • Eating spicy, acidic, or citrus foods

  • Drinking alcohol, carbonated beverages, coffee, or other caffeinated drinks

  • Smoking

  • Being overweight or pregnant

  • Taking certain medications, such as aspirin, ibuprofen, or some antibiotics

  • Having a hiatal hernia, which is a condition where part of the stomach bulges through an opening in the diaphragm

Symptoms of Heartburn

The main symptom of heartburn is a burning pain in the chest that may spread to the throat or jaw. Some people may also experience:

  • A sour or bitter taste in the mouth

  • Difficulty swallowing

  • Nausea or vomiting

  • Hoarseness or sore throat

  • Coughing or wheezing

Heartburn symptoms usually occur within an hour of eating or drinking and last for a few minutes to several hours. They may be worse when lying down or bending over.

Diagnosis of Heartburn

In most cases, people can diagnose heartburn by observing their symptoms and noticing what triggers it. However, if heartburn is frequent, persistent, severe, or interferes with daily activities, it may be a sign of GERD and should be examined by a doctor. A doctor may perform some tests to confirm the diagnosis and rule out other conditions that may cause similar symptoms, including:

  • X-ray: This test uses radiation to create images of the esophagus and stomach and check for any abnormalities.

  • Endoscopy: This test involves inserting a thin, flexible tube with a camera and light at the end (endoscope) through the mouth and into the esophagus and stomach. The doctor can examine the lining of these organs and take samples of tissue (biopsy) if needed.

  • Ambulatory acid probe tests: These tests measure the amount and duration of acid exposure in the esophagus. A small device that detects acid is attached to a thin wire and inserted through the nose into the esophagus. The device is connected to a recorder that is worn around the waist or over the shoulder for 24 hours.

  • Esophageal motility testing: This test measures the movement and pressure of the esophagus. A thin tube with sensors is inserted through the nose into the esophagus and connected to a machine that records the contractions of the esophageal muscles.

Treatment of Heartburn

The treatment of heartburn depends on its frequency, severity, and underlying cause. Some common treatment options include:

  • Lifestyle changes: These include avoiding foods and drinks that trigger heartburn, eating smaller and more frequent meals, not lying down or exercising after eating, losing weight if needed, quitting smoking, elevating the head of the bed by 6 to 9 inches, and wearing loose-fitting clothes.

  • Antiacids (such as Tums or Rolaids) neutralize stomach acid, H2 blockers (such as Tagamet or Pepcid) reduce acid production, and proton pump inhibitors (such as Nexium or Prilosec) block acid secretion. While these medications can relieve mild to moderate heartburn quickly, they should not be taken for more than two weeks without consulting a physician first.

  • There are a number of prescription medications available to help strengthen the LES or improve esophageal motility, including stronger doses of H2 blockers and proton pump inhibitors. If your heartburn is too severe or chronic to respond to over-the-counter medications, your doctor may prescribe these medications.

  • When medications cannot control heartburn symptoms or complications result from GERD, surgery is an option. In order to reinforce the LES and prevent acid reflux, a part of the stomach is wrapped around the lower end of the esophagus in a procedure known as fundoplication.

Prevention of Heartburn

The best way to prevent heartburn is to avoid or limit the factors that cause it. Some general tips include:

  • Eating a balanced and healthy diet that is low in fat, spice, and acid

  • Drinking plenty of water and limiting alcohol, caffeine, and carbonated drinks

  • Chewing food well and eating slowly

  • Not eating within three hours of bedtime

  • Managing stress and practicing relaxation techniques

  • Following the doctor’s advice and taking medications as prescribed

Lifestyle changes and medication can help treat heartburn, which is usually harmless. The symptoms of heartburn may indicate a more serious condition such as GERD if they persist or worsen. Therefore, it is important to consult your doctor if they persist or worsen. With proper diagnosis and treatment, heartburn can be controlled and complications can be avoided.

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