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Heartburn: Causes and Treatment

by Sam Chy
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Acid Reflux

Probably everyone has experienced this unpleasant state at least once in his life. Sometimes heartburn is a relatively harmless consequence of eating inappropriate food, but often it turns out to be a symptom of serious medical conditions that require urgent treatment.

How to recognize how great the danger is? When is it time to take action and what should they be? How to treat heartburn with medications? The answers to these important questions are in our article.

What is heartburn

A burning sensation in the esophagus as a result of irritation of its mucous membrane – this is how heartburn manifests itself. But where do these sensations come from?

The environment of a healthy stomach is acidic, due to the action of hydrochloric acid – the main component of gastric juice. In the esophagus, the acidity is close to neutral. Normally, the circular muscle – the sphincter – prevents the reverse movement of food. When it weakens for one reason or another, the acidic contents of the stomach are thrown into the esophagus. This process is called reflux. The walls of the stomach are lined with a protective film of mucus. As a result, they are not subject to aggressive acid action. But there are no glands in the esophagus that produce protective mucus. Therefore, acidic stomach contents erode the mucous membrane of the organ. In fact, nothing more than a chemical burn of the esophagus is observed. This is manifested by a burning sensation, sometimes pain in the chest area.

Most often, heartburn occurs about 15-30 minutes after eating. Sometimes it disturbs patients at night.

According to statistics, from 20 to 50% of the population of developed countries periodically experience heartburn, while 10-20% experience this condition more often than once a week.

Frequent heartburn not only greatly reduces the quality of life, but also indicates serious health problems, and also leads to rather serious consequences in itself.

Heartburn Causes

The immediate cause, as already mentioned, is the weakening of the esophageal sphincter, leading to reflux. The increased content of hydrochloric acid in gastric juice is also important. And these processes, in turn, are observed in many diseases and physiological conditions.

  • Diseases of the gastrointestinal tract:
    gastroesophageal reflux disease (abbreviated as GERD), associated with the insufficiency of the esophageal sphincter. Heartburn usually occurs immediately or 20-30 minutes after eating, often accompanied by belching;
    gastritis with high acidity. The patient feels heartburn 15-30 minutes after eating. Almost always this is accompanied by complaints of pain in the epigastric region;
    peptic ulcer. A burning sensation behind the breastbone occurs 15-30 minutes after eating in case of stomach damage and after 1.5-2 hours with localization of the process in the duodenum;
    cholecystitis and gallstone disease.
  • Eating disorders. Irregular meals, overeating, eating in a hurry – all this helps to weaken the esophageal sphincter and provoke heartburn.
  • Errors in the diet. Fatty, fried, spicy foods, fresh baked goods, tea, coffee, chocolate – the abuse of such food can cause heartburn even in healthy people. Such as- GERD patients should have proper knowledge about avocado acid reflux before taking avocado and other fruits.
  • Taking certain medications. in particular NSAIDs, antihypertensive drugs can also cause heartburn.
  • Unhealthy lifestyle: bad habits (smoking, alcohol abuse), chronic stress.
  • Pregnancy is one of the possible causes of heartburn in women. Reflux occurs due to increased intra-abdominal pressure. The same mechanism for the development of heartburn is observed with excess weight.
  • Some external factors: tight clothing, heavy lifting and other similar circumstances sometimes provoke heartburn in healthy people.

The consequences of heartburn

Permanent heartburn is most likely caused by a serious medical condition. Therefore, the often arising burning sensation behind the sternum requires urgent intervention: delay with medical help can cost a person health, and sometimes life.

The danger is not only the causes of reflux, but the condition itself. With prolonged exposure to acid on the unprotected mucous membrane of the esophagus, an inflammatory disease develops – esophagitis. In some cases, erosion and peptic ulcers are formed, fraught with bleeding. A complication can be cicatricial strictures (narrowing) of the esophagus, which make it impossible for the normal process of eating.

In some patients, chronic inflammation leads to degeneration of the epithelium of the esophageal mucosa. This condition is called Barrett’s esophagus (Barrett’s syndrome) and is considered precancerous.

Thus, we see that the consequences of heartburn, if ignored for a long time, can be truly tragic, up to adenocarcinoma.

In this context, timely and high-quality diagnostics is of great importance.

It is important!
In some cases, a burning sensation behind the breastbone is a medical emergency. Under the “mask” of heartburn, an attack of angina pectoris and myocardial infarction can be hidden. Therefore, for any unusual and alarming symptoms accompanying this condition, you should immediately consult a doctor.

Diagnostics

Diagnosis of heartburn is complex. Careful collection of anamnesis, analysis of patient complaints allow the doctor to choose one or several priority areas of research.

Laboratory tests

A wide range of laboratory methods are used to diagnose the causes of heartburn.

  • A general blood test is performed to determine the level of hemoglobin, erythrocytes, leukocytes, ESR, etc. The deviation of these indicators from the norm indicates violations in the patient’s body. For example, high leukocytosis and ESR are signs of an inflammatory process, and anemia is associated with many gastrointestinal diseases. A general blood test is not a specific study and allows only indirect conclusions to be drawn for further examination.
  • A biochemical blood test determines the content of hepatic and pancreatic enzymes, bilirubin, trace elements, etc. The results help to assess the function of the liver, pancreas, gall bladder. The study is carried out on an empty stomach.
    A blood test for Helicobacter pylori antibodies is performed in all gastroenterological patients. A positive result confirms the presence of gastritis or peptic ulcer disease associated with this microorganism.
  • Stool analysis (coprogram) is an informative, although not specific, research method that allows you to assess the state and function of the gastrointestinal tract. The presence of pathological inclusions, a violation of the composition of the microflora indicate a disorder of the functions of certain organs.

FGDS

Fibrogastroduodenoscopy allows you to visually assess the condition of the mucous membrane of the esophagus, stomach and duodenum, to determine the presence of inflammatory changes, ulcers, tumors, etc.

The study is performed using an endoscope, which is inserted into the stomach through the esophagus. The image is displayed on the screen. EGDS can be combined with biopsy.

To reduce discomfort, the procedure is performed under local or general anesthesia.

Fibrogastroduodenoscopy is an informative and accurate method for diagnosing gastrointestinal diseases. With its help, it is possible to make diagnoses such as gastritis, esophagitis, peptic ulcer, etc. with high reliability.

Esophagomanometry

Manometry measures pressure in the esophagus using a catheter inserted through the mouth or nose.

With this diagnostic method, such indicators as the peristalsis of the esophagus, the functions of the upper and lower esophageal sphincters are examined.

Esophagomanometry is used to confirm the diagnosis of a disease associated with a violation of the contractile activity of the esophagus, in particular, GERD.

The method is contraindicated in patients with aortic aneurysm, acute destructive esophagitis, in patients in serious condition.

PH-metry

Direct measurement of the pH level in different parts of the stomach, esophagus and duodenum is used to accurately diagnose disorders in diseases associated with changes in acidity. The method helps to choose an effective treatment tactics for GERD, gastritis, duodenitis, peptic ulcer, etc.

Depending on the duration of the procedure, a distinction is made between short-term, daily and express pH-metry.

The study is performed using a probe inserted through the mouth or nose. A few hours before the procedure, you need to stop eating and certain medications.

Contraindications to pH-metry are the same as to manometry of the esophagus and EGD: severe diseases of the cardiovascular system and lungs, bleeding disorders, old age.

Treatment features

To understand how to get rid of heartburn, you need to know what caused it. Rare seizures caused by a violation of the regime or diet in healthy people do not require special medical intervention and quickly disappear when lifestyle changes.

It’s another matter if the patient is worried about frequent heartburn: the reasons for this, most likely, are in the gastrointestinal tract disease.

Treatment of heartburn in such cases is possible only with an integrated approach . Therapeutic measures should be aimed not only at relieving unpleasant symptoms , but also at correcting the underlying disease . Thus, the cause and treatment of heartburn are closely related.

The therapeutic effect usually involves drug therapy . The selection of medicines is carried out by a doctor, taking into account the diagnosis. Most often, drugs are prescribed simultaneously from several groups (at least antacids + gastroprotectors).

Complete relief from heartburn is possible with successful treatment of the underlying disease.

General therapeutic recommendations

In addition to taking medication, diet and lifestyle adjustments are of great importance in treating heartburn .

It is necessary to quit smoking and drinking alcohol, establish the correct diet. Food should be taken 4-5 times a day in small portions, chewing thoroughly. It is not recommended to lie down immediately after eating. The last meal should be no later than 3 hours before bedtime.

Fatty and fried foods, hot spices and sauces, carbonated drinks, coffee and strong tea, chocolate, citrus fruits, tomatoes, sour fruits and other foods that provoke heartburn should be excluded from the diet. Good cereals, lean boiled meat, steamed vegetables and low-fat dairy products.

We hope now you have in depth idea about acid reflux. If you have any other query, please let us know in the comments section.

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