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Heartburn

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The esophagus is a tube that connects the mouth to the stomach. It is made of muscles that work to push food toward the stomach in rhythmic waves. Once in the stomach, food is prevented from refluxing (moving back into the esophagus), by a special area of circular muscle located at the junction of the esophagus and stomach, called the lower esophageal sphincter (LES). A pressure difference across the diaphragm, the flat muscle that separates the chest from the abdomen, also tends to keep stomach contents in the stomach.

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Heartburn is actually a symptom of GERD (gastroesophageal reflux disease), and is caused by acid refluxing back into the esophagus. Risk factors include those that increase the production of acid in the stomach, as well as structural problems that allow acid reflux into the esophagus.

  • Some common foods that we eat and drink, stimulate increased stomach acid secretion setting the stage for heartburn. Over-the-counter medications also may precipitate heartburn. Examples of these irritants include:
    • alcohol,
    • caffeine,
    • aspirin (Bayer, etc.),
    • ibuprofen (Motrin, Advil, Nuprin, etc.)
    • Naproxen (Naprosyn, Aleve)
    • carbonated beverages,
    • acidic juices (grapefruit, orange, pineapple)
    • acidic foods (tomatoes, grapefruit, and oranges), and
    • chocolate.
  • Smoking and the consumption of high-fat content foods tend to affect function of the lower esophageal sphincter (LES), causing it to relax from the stomach and allow acid to reflux into the esophagus.
  • A hiatal hernia where a portion of the stomach lies within the chest instead of the in abdomen, can affect the way the LES works and is a risk factor for reflux. Hiatal hernias by themselves cause no symptoms. It is only when the LES fails that heartburn occurs.
  • Pregnancy can cause increased pressure within theabdominal cavity and affect LES function and predispose it to reflux.
  • Obesity may also cause increased pressure in the abdomen, and thus reflux in the same way.
  • Primary diseases of the esophagus can also present with heartburn as a symptom. These include, among others, scleroderma and sarcoidosis.

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Heartburn Symptoms

Gastroesophageal reflux disease (GERD), is a condition in which heartburn is a symptom. Stomach acid refluxes up into esophagus and causes pain. This pain can be felt as a burning sensation behind the sternum or breastbone, either as a spasm or a sharp pain. Many times the pain of acid reflux can be mistaken for the pain of a heart attack.

The pain of acid reflux (heartburn) can remain in the lower chest or it can radiate to the back of the throat and be associated with waterbrash, a sour taste in the back of the throat. If there is acid reflux near the larynx (voicebox) in the throat, it may cause coughing episodes or hoarseness. Reflux over prolonged periods of time can be severe enough that acid wears away the enamel on teeth and causes decay.

Symptoms are often worsened after heavy meals, leaning forward, or lying flat. Those affected may often awaken from sleep with heartburn.

Complications

Heartburn is not without complications. If ignored, recurrent irritation and inflammation of the esophagus can lead to ulcers, which are small areas of tissue breakdown. These can cause serious bleeding.

As well, scarring and stricture are other significant complications of GERD. Changes in the type of cells lining the esophagus may result from acid reflux, causing a condition known as Barrett''s esophagus,

  • with reflux so severe that it causes hoarseness, pneumonia, or wheezing.
  • Different surgical approaches to esophageal reflux are available. In fundoplication, the stomach is wrapped around the lower esophagus, in effect creating a new physiologic valve to take the place of the lower esophageal sphincter. New devices have been recently approved that can be wrapped around the lower esophagus that act link the LES. The specific procedure will be recommended based upon the patient's situation.

    Heartburn Summary

    • Heartburn is a symptom of a common medical condition (GERD) that affects up to 20% of the population.
    • Initial therapies to limit the amount of stomach acid production include lifestyle changes including avoiding certain foods, alcohol, anti-inflammatory medications, and quitting smoking.
    • Medications can be helpful in controlling symptoms of heartburn.
    • Weight loss may help decrease heartburn symptoms by decreasing intra-abdominal pressure.
    • Heartburn is not a benign condition. If neglected over long periods of time it may lead to other more serious conditions such as Barrett's esophagus or esophageal cancer.

    From

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    References
    Reviewed by:
    Tova Alladice, M.D.
    American Board of Physical Medicine & Rehabilitation
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