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Heartburn: Causes, Investigation, Treatment

Heartburn is a burning pain in your chest, just behind your breastbone. The pain is often worse after eating, in the evening, or when lying down or bending over.  Heartburn

Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own with lifestyle changes and over-the-counter medications. But if heartburn is more frequent or interferes with your daily activities, then it may be a more serious condition and requires medical care.

What is the cause of heartburn?

Heartburn happens when your stomach acid flows back into your esophagus or food pipe. This causes an uncomfortable burning feeling in your chest that can move up to your neck and throat. You may also have a bitter or sour taste in the back of your throat. Heartburn can last from a few minutes to several hours, and often feels worse after you eat.

If you have heartburn often and it is severe, you may have gastroesophageal reflux disease (GERD). If this is the case, you should consult a specialist.

Several factors may lead to heartburn or make it feel worse. These include:

Eating habits

  • The habit of eating large food portions at one time
  • Eating certain foods such as onions, chocolate, peppermint, high-fat foods, citrus fruits, garlic, spicy foods, and tomatoes or tomato-based products
  • Drinking alcohol, citrus juices, caffeinated beverages, and carbonated beverages
  • Meals shortly before bedtime

Lifestyle habits

  • Smoking
  • Wearing tight clothes and belts
  • Stress

Medical reasons

When to see a doctor

Even though heartburn is common, it can sometimes lead to more serious health problems. Severe, chronic heartburn/GERD has been linked to inflammation and narrowing of the esophagus, respiratory problems, chronic cough, and Barrett’s esophagus, which may lead to esophageal cancer.

You should contact your doctor if:

  • Your heartburn symptoms become more severe or frequent.
  • It is hard or hurts to swallow.
  • If you also have associated vomiting or food coming up to your throat.
  • You have had substantial, unexpected weight loss.
  • A specialist should be consulted if you needed over-the-counter antacids for more than two weeks (or for a longer time than recommended on the label) and you still have heartburn symptoms.
  • When the heartburn symptoms persist even after taking prescription or non-prescription medicines.
  • In case you also have serious hoarseness or wheezing.
  • The problem interferes with your lifestyle or daily activities.

Diagnosis

Initially, the specialist doctor can diagnose Acid reflux disease from your symptoms and can prescribe medications and advised lifestyle modifications. Tests or Investigations are needed when we want to confirm the diagnosis and assess the severity of the problem. Usually, an endoscopy is suggested if you need medications for more than a few weeks or you have not benefited from medications.

Investigations are done to determine if your heartburn is a symptom of GERD, has it led to complications like ulcers, narrowing or Barret’s esophagus. Tests also help to give us the information weather this problem is likely to get prolonged and need long term medications or not. Your doctor may recommend:

Endoscopy

Upper G I endoscopy

The test is done to check for abnormalities in your esophagus. This is the first and the most routinely done investigation. By and endoscopy we can know if there are ulcers, if there is a hiatus hernia and if there are some more serious problems like narrowing and Barret’s ulcer. A tissue sample (biopsy) may be taken for analysis.

 

 

Ambulatory 24 hr pH with Impedance test

 

24 hr pH with Impedance study

Ambulatory 24 hr pH and Impedance tests, to identify when, and for how long, stomach acid backs up into your esophagus. An acid monitor that is placed in your esophagus connects to a small device that you wear around your waist or on a strap over your shoulder. To watch the video about why and when it should be done click this link. To watch the video about how this test is done click this video.

 

 

Esophageal manometry test

Esophageal manometry

It is done to measure movement and pressure in your esophagus. It gives  information about the weakness of the valve and the proper functioning of the food-pipe. This test actually a part of the pH and Impedance test.

 

 

X-rays (Barium swallow)

X rays are taken after you swallow a liquid called Barium or a dye, to view the shape and condition of your esophagus and stomach. Although in today’s time its role has become limited and is advised only in selected patients, especially when surgery is required.

 

Lifestyle and home remedies

GERD and Acid reflux is a lifestyle disease, and hence we are noticing a massive increase in the incidence of heartburn. Hence, Lifestyle change is the key to prevent this problem, as well as to have good and long term outcome with treatment.

In many early cases, it itself can sort out the problem. When the disease has progressed further, you may need medications or surgery, but still, need to modify your lifestyle for better outcomes.

Lifestyle changes that can help ease heartburn are:

  • Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
  • Tight-fitting clothing should be avoided, which puts pressure on your abdomen and the lower esophageal sphincter.
  • Every patient with heartburn has their own trigger foods that increase heartburn. One should avoid these trigger foods in their diet. 
  • If you lie down or bend after meals, the food and acid can easily come up in your food-pipe. This causes ulcers in food-pipe and heartburn. Avoid lying down for sometime after a meal. Wait at least three hours.
  • Avoid late meals. Eating your meals earlier, especially dinner makes your stomach empty by the time you go to bed. And thus decreases the chances of reflux.
  • Elevate the head of your bed if you regularly experience heartburn at night or while trying to sleep. If that’s not possible, insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows usually isn’t effective.
  • Stop smoking and alcohol. Both smoking and drinking alcohol decrease the lower esophageal sphincter’s ability to function properly. If you have heartburn, this is a must for you to have a sustained relief from heartburn.
  • Large meals increase the chances that food along with acid will come up your food-pipe with even little exertion. Hence, avoid large meals. Instead, eat many small meals throughout the day.

To watch our video on diet and lifestyle modifications for patients having heartburn click here.

Treatment

Many over-the-counter medications can help relieve heartburn. The options include:

  • Antacids, which help neutralize stomach acid. Antacids may provide quick relief. But they can’t heal an esophagus damaged by stomach acid.
  • H-2-receptor antagonists (H2RAs), which can reduce stomach acid. H2RAs don’t act as quickly as antacids, but may provide longer relief.
  • Proton pump inhibitors, such as lansoprazole (Prevacid 24HR) and omeprazole (Nexium 24HR, Prilosec OTC), which also can reduce stomach acid.

If over-the-counter treatments don’t work or you rely on them often, see your doctor. You may need prescription medication and further testing.

Need for long term Medications

May patients who have a more severe problem with their LES valve, may need long term medications. There are a large number of such patients who are taking antacid medications for years. Proper investigations, including an endoscopy and pH study can help predict if you would need long term medications or not. For many such patients, a laparoscopic surgery may be a more preferred option of treatment.

Need for a surgery

There are a small number of GERD patients, who have a more pronounced mechanical problem with LES valve and hiatus hernia. Due to the mechanical problem, either they are dependent on PPI antacid medications or they face problems even with medications. For such patients, a laparoscopic surgery to repair the hiatus hernia and creating a new valve is the ideal option. Done after thorough evaluation, this surgery gives excellent results. It improves the quality of life and the antacid medications are no more required. This surgery is certainly a very specialized surgery and should be done after a manometry and pH study test, and should be done by a surgeon who has the required skill and knowledge.

Also Read

 

GERD/Acid reflux/Heartburn: Diet and Lifestyle

GERD / Acid Reflux / Heartburn: Does surgery really solve the problem?

Dilemma of a patient with Heartburn: How long to suffer? When to seek a permanent solution?

Patient’s Guide to Bariatric Surgery

Gallbladder stone and Diet

Fight against Obesity: Respective roles of Bariatric (weight loss) surgery and Lifestyle Modification

Activity and Exercise After Hernia Surgery

Gallbladder stone surgery: Know what happens before, during and after surgery

 

 

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