What is heartburn? |

Causes and Symptoms

Heartburn occurs when acid travels backward from the stomach to the esophagus. Acid is normally present at very high concentrations in the stomach, where it aids digestion. Contrary to popular belief, most people who suffer from heartburn do not produce too much acid. Rather, they have a malfunction of the lower esophageal sphincter (LES), a ring of muscle between the stomach and the esophagus. Normally, unless food is being swallowed, the LES stays closed. This keeps acid confined to the stomach. If the LES remains open, or if it is weakened, then stomach acid can travel freely to the esophagus and irritate its inner lining, resulting in heartburn.

Heartburn is described as a hot, burning feeling in the chest. It usually occurs thirty minutes to one hour after eating and lasts for several minutes. It is often worsened by lying down or bending over and is improved by standing up. Other associated symptoms may include a sour taste in the mouth, sore throat, or hoarseness. Some patients develop a dry cough as a result of acid irritating the throat. Heartburn must be distinguished from more ominous causes of chest pain, including a heart attack or other heart-related chest pain. Usually, chest pain attributable to such causes becomes worse with exertion, while heartburn should not. Some cases of heartburn may also be caused by the condition known as Barrett esophagus.

Treatment and Therapy

The initial therapy for heartburn includes elimination of dietary and lifestyle factors that weaken the LES: tobacco, excessive alcohol, fatty foods, chocolate, and caffeine. Medications such as calcium-channel blockers and nitrates can also worsen heartburn, but they should not be discontinued without consulting a physician. It has been suggested that avoiding late-night meals and elevating the head of the bed with blocks underneath the headboard can improve heartburn, especially if symptoms occur mostly at nighttime. Occasional heartburn can be treated with over-the-counter antacids or medications such as ranitidine, which reduces acid production. If symptoms do not improve, then prescription medications are also available.

Surgery to reinforce the LES, called a Nissen fundoplication, is another option. Although results are excellent, patients often must take acid-suppressive medications after the procedure. Heartburn that is persistent or accompanied by trouble swallowing, weight loss, or bleeding requires more thorough investigation, as with endoscopy, to exclude the possibility of cancer or another serious medical condition.

Bibliography

Alan, Rick, Daus Mahnke, and Brian Randall. "Conditions InDepth: Gastroesophageal Reflux Disease (GERD)/Heartburn." Health Library, March 18, 2013.

Cheskin, Lawrence J., and Brian E. Lacy. Healing Heartburn. Baltimore: Johns Hopkins U P, 2002. Print.

"Heartburn." Mayo Clinic. Mayo Foundation for Medical Education and Research. 7 Aug. 2014. Web. 16 Feb. 2015.

"Heartburn." MedlinePlus. Natl. Lib. of Medicine, Natl. Institutes of Health, 3 Dec. 2014. Web. 16 Feb. 2015.

Longo, Dan, et al., eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill, 2012. Print.

Minocha, Anil, and Christine Adamec. How to Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux. New York: Wiley, 2001. Print.

Shimberg, Elaine Fantle. Coping with Chronic Heartburn: What You Need to Know About Acid Reflux and GERD. New York: St. Martin’s Griffin, 2002. Print.