Heartburn

 

Heartburn or discomfort under the breastbone is a common symptom of gastroesophageal reflux disease (GERD). It is like a burning pain in the middle of the chest just under the central chest region. It is caused due to acid from the stomach moving back into the esophagus (food pipe).

 

 

The burning pain is mainly caused due to direct stimulation of oversensitive food pipe lining by food and partly due to contraction of food pipe end. The burning is aggravated by bending, stooping, or lying down positions. Following are the risk factors that can cause heartburn:

1. Foods: Oranges, pineapple, chocolate, tomatoes, grapefruits, alcohol, carbonated beverages, caffeine, fatty, and spicy food

2. Drugs: Aspirin, ibuprofen, naproxen

3. Obesity: This increases the pressure within the abdomen thus predisposing you to reflux disease.

4. Smoking

5. Pregnancy: Pregnancy increases the pressure within the abdomen affecting the food pipe causing reflux of food into the food pipe.

6. Hiatus hernia: This is another condition that affects the functioning of the lower esophageal sphincter and is a risk factor for reflux.

 

 

Heartburn is a symptom of GERD which is felt like a burning pain behind the sternum (breastbone) and can spread to the neck, across the chest. This pain generally occurs when the patient lies flat or after bending or stooping, often immediately after a heavy meal. Consistent heartburn due to reflux may affect your voice causing hoarseness and may even cause bouts of coughing due to irritation.

 

 

Investigations include:

1. X-ray: A chest x-ray helps in viewing the shape of esophagus and stomach, but it is advisable to do a barium swallow or a barium meal.

2. Endoscopy: The lining of esophagus and stomach can be viewed and thus any inflammation or ulcer if present can be identified. Even biopsy to rule out any particular infection or cancerous condition can be done during an endoscopy.

3. Manometry and pH monitoring: Monitoring the pressure at the end of the food pipe and obtaining acid measurements from within it may be helpful in making the diagnosis.

 

 

There are many over-the-counter medicines that are available that could relieve your heartburn.

1. Antacids: These drugs help in neutralizing the acid in the stomach thus reducing the symptoms of heartburn, e.g., magnesium carbonate antacids.

2. Proton pump inhibitor: These drugs block the production of acid in the stomach, e. g., pantoprazole, omeprazole, and rabeprazole.

3. H2-receptor antagonist: These drugs reduce the acid production from the stomach, e.g., ranitidine, cimetidine, and famotidine.

 

 

If left untreated, the irritation caused due to acid reflux can lead to inflammation of the esophageal lining (esophagitis). Later, this inflammation becomes severe, narrowing your esophagus, and may lead to bleeding or difficulty in swallowing (dysphagia).

Skipping meals, eating spicy and fatty foods, eating outside food regularly can cause heartburn. If you suffer from heartburn even after changing this routine, see your physician. You should visit a medical professional if there is no relief after using over-the-counter medicines, or the symptoms worsen or the frequency of complaints increases.