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Heartburn


Heartburn is a common condition experienced by more than 60 million Americans at least once a month.


Symptoms

As the name implies, heartburn is often experienced as a burning discomfort in the chest, behind the breastbone. The sensation can move up the neck and throat and some people may even experience a bitter or sour taste of acid in the back of the throat. The symptoms are often worse after eating food and may be worse when lying down.


Heartburn that occurs two or more times a week may indicate a more severe problem known as gastroesophageal reflux disease, or GERD.


Discomforts in the chest, especially severe chest pain or pressure and combined with other symptoms such as pain in the arm or jaw or difficulty breathing require immediate medical attention, as they may be symptoms of a heart attack.


Causes

A muscular valve separates our esophagus from our stomach and all its contents. Normally, the valve opens to allow food into the stomach and closes to keep the foodstuff and stomach juices from back flowing.


Sometimes when we eat certain foods, overeat, or when there is increased pressure on our stomach (such as in obesity or pregnancy), the muscular valve does not close or tighten as it should. When the muscular valve is inappropriately open, the stomach acid can leak backward up into the esophagus. This backflow of stomach acid due to a faulty valve is known as gastroesophageal reflux. Heartburn symptoms are caused by this reflux of stomach acid up into the esophagus.


Diagnosis

Heartburn can be diagnosed by a doctor based on symptoms and risk factors. The doctor may recommend additional evaluation and testing if there is:

  • Persistent symptoms despite use of over-the-counter medication

  • Heartburn symptoms that occurs two or more times a week

  • Difficulty swallowing

  • Persistent nausea or vomiting

  • Unintentional weight loss or weight loss due to poor appetite


A gastroenterologist might use one or more of the following procedures to check for GERD:

  • X-ray with barium solution swallow: To view the structure of the esophagus and stomach

  • Upper endoscopy: Use a flexible tube with a camera to see the esophagus and may take a small sample for testing

  • Esophageal manometry: To measure the movement and pressure of the esophagus

  • Esophageal pH monitoring: To determine if and how long stomach backs into the esophagus


Management

Heartburn can be managed with lifestyle changes, dietary changes, and over-the-counter medications.


Lifestyle changes

Lifestyle changes that can help relieve heartburn include:

  • Weight loss can help people who are overweight to reduce acid reflux

  • Raising the head of the bed six to eight inches allows gravity to prevent acid from refluxing

  • Quitting smoking to encourage saliva flow to help neutralize refluxed acid

  • Wearing loose, comfortable clothing may help alleviate pressure on the stomach


Dietary changes

Avoid foods that trigger symptoms. Common food triggers include:

  • Spicy foods

  • High fat foods

  • Chocolate

  • Garlic

  • Alcohol

  • Coffee

  • Tea

  • Soda

  • Citrus fruits


Medications

Over-the-counter heartburn medications include:

  • Antacids may provide quick relief by neutralizing stomach acid

  • H2 receptor blockers can reduce stomach acid

  • Proton pump inhibitors can reduce stomach acid




References

https://medlineplus.gov/heartburn.html

https://gi.org/topics/acid-reflux/

https://www.uptodate.com/contents/gastroesophageal-reflux-disease-in-adults-beyond-the-basics

https://familydoctor.org/condition/heartburn/

https://www.mayoclinic.org/diseases-conditions/heartburn/