Heartburn , also known as acid reflux , is a painful and burning sensation in the esophagus, just behind the breastbone, usually associated with regurgitation of gastric acid (gastric reflux). The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn is a major symptom of gastroesophageal reflux disease, otherwise known as GERD; acid reflux is also identified as one of the causes of chronic cough, and may even mimic asthma. Despite its name, heartburn actually has nothing to do with the heart, although some heart problems may give rise to a similar burning sensation; it is called heartburn because of a burning sensation near where the heart is located.
The pain associated with acid reflux is due to the presence of acid in the esophagus. Acid is produced in the stomach as an aid to digestion and is not intended to be present in the esophagus. Unlike the stomach's lining, which can tolerate very high concentrations of acid, the presence of acid in the esophagus eats away at the lining of the esophagus and causes pain. Acid reflux does not occur because there is too much acid created by the stomach, but because the muscular barrier or valve between the esophagus and the stomach opens prematurely allowing acid, bile and other stomach contents into the esophagus. The name of this muscular barrier is the Lower Esophageal Sphincter (LES). Other sphincters in the body include the anal and bladder sphincters, in addition to the mouth and the eye. Each of them closes in circumference around a radius. When the LES doesn't stay closed or when it opens at the wrong time, reflux can occur.
In many cases, acid reflux medications known as PPI's (proton pump inhibitors) such as Nexium and Prilosec work well enough at reducing acid levels that the pain goes away. Unfortunately, PPI's don't help reinforce the LES, and in some cases surgery may be required. According to research conducted by the American Gastroenterological Association, 38% of PPI users experience break-through pain while taking PPI's.
The LES is also sometimes referred to as the cardiac sphincter, referring to a part of the stomach referred to as the cardia and not, as might be thought, to the heart, lending some additional confusion to the term "heartburn".
Diagnosis
Biochemical
Mechanical
Prevention
Relief is often found by raising the head of the bed, raising the upper body with pillows, or sleeping sitting up. Avoid pillows that raise the head only, as this does little for heartburn and places continuous strain on the neck. Eating a big meal causes excess stomach acid production, and attacks can be minimized by eating small frequent meals instead of large meals, especially for dinner. To minimize attacks, a sufferer may benefit from avoiding certain foods that stimulate excess acid secretion and/or relax the opening between the stomach and esophagus. Acidic fruit or juice, fatty foods, pretzels, coffee, tea, onions, peppermint, chocolate, or highly spiced foods are to be avoided, especially shortly before bedtime. While there are clearly other health-related benefits associated with dietary interventions, a zealous recommendation for dietary restrictions is not evidence-based, and there is stronger support for reducing the symptoms of acid reflux found in behavioral changes such as eating less and elevating one's head while sleeping. Tight clothing around the abdomen can also increase the risk of heartburn because it puts pressure on the stomach, which can cause the food and acids in the stomach to reflux to the lower esophageal sphincter.
Treatment
See also: Gastroesophageal reflux diseaseMedications
Antacids, H2-receptor antagonists, alginates, proton pump inhibitors, and other alternative treatments are used to treat heartburn.
Examples of antacids include:
- Alka-Seltzer
- Quick-Eze
- Tums, Alka-2, Titralac, Surpass Gum
- Milk of Magnesia
- Amphojel, Alternagel
- Maalox, Mylanta, Rolaids, Gelusil, Gaviscon
- Pepto-Bismol
Antacids
Antacids act as buffering agents in the lower esophagus, gastric lumen, and duodenal bulb. Antacids contain an anion and cation; the anion binds with hydrogen molecules, forming water and additional compounds, whereas the cation reacts with the chloride molecule. The result is a subtle increase in gastric pH. This will help ease the symptoms because the stomach reflexes will be neutralized. Antacids can adversely prevent the conversion of pepsin to pepsinogen if pH is greater than 5, and/or increase the pressure on the lower esophageal sphincter (LES.)
Sodium bicarbonate
Sodium bicarbonate is a base; when introduced to the stomach, this compound acts as an antacid. A simple and relatively harmless way to treat a one-off heartburn is to drink a solution of a small amount of sodium bicarbonate (baking soda) mixed with water, which quickly neutralizes the acid that causes the pain. Excess sodium intake, however, is thought to raise blood pressure and cause other health problems.
H2-receptor antagonists
Often called H2 blockers, H2-receptor antagonists work by decreasing the amount of acid the body releases into the stomach. H2s are systemic, meaning they require absorption into the bloodstream in order to work. Therefore, H2s can often take 30 minutes or longer before they start working, and therefore are often taken to prevent heartburn rather than for fast relief of symptoms.
Alginates
Alginates work differently than antacids and H2 blockers, by forming a protective barrier in the stomach that prevents stomach acid from refluxing back up into the esophagus. Alginic acid is naturally derived (from brown seaweed) and is non-systemic. Alginates provide faster relief than H2-receptor antagonists and PPIs, and longer-lasting relief than antacids. This is also known to have a better overall outcome for relief.
Proton-pump inhibitors
Proton pump inhibitors, called PPIs, are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors are systemic and directly block acid production in the stomach cells. In order to prevent heartburn the medication disfigures and disables the proteins (proton pumps) that control the pH of the stomach, allowing the body to digest them. Proton-pump inhibitors are not fast-acting, but provide long-lasting relief. PPIs are intended to be short-term medications only.
Diet and food remedies
Approximately 90-95% of sufferers of heartburn or esophageal disorder can link their symptoms to specific foods. One way to manage symptoms is to choose foods and drinks which have low risk of causing acid reflux, and avoiding those with high risk. For example, it has been shown that fatty foods and caffeinated beverages can cause the symptoms of heartburn.
Drinking milk is not a recommended treatment to heartburn. A glass of milk can provide quick relief; however, milk contains calcium and protein, which both stimulate more acid production in the stomach. Consequently, shortly after drinking a glass of milk, a harsher heartburn can return.
Positional therapy
Sleeping on the left side has been shown to reduce nighttime reflux episodes in patients.
A meta-analysis suggested that elevating the head of bed is an effective therapy, although this conclusion was only supported by nonrandomized studies. The head of the bed can be elevated by plastic or wooden bed risers that support bed posts or legs, a therapeutic bed wedge pillow, or a wedge or an inflatable mattress lifter that fits in between mattress and box spring. The height of the elevation is critical and must be at least 6 to 8 inches (15 to 20 cm) to be at least minimally effective to prevent the backflow of gastric fluids. Some innerspring mattresses do not work well when inclined and may cause back pain; some prefer foam mattresses. Some practitioners use higher degrees of incline than provided by the commonly suggested 6 to 8 inches (15 to 20 cm) and claim greater success.
Surgery
In some cases, laparoscopic surgery of the esophagus may be a possible alternative treatment.
See also
- Acid indigestion
- Gastroesophageal reflux disease
References
- ^ Heartburn
- ^ "Lifestyle Changes to Manage Your Heartburn" WebMD
- ^ http://www.medscape.com/viewarticle/536343
- ^ http://www.mediprimer.com/Gastroenterology/heartburn/95.html
- ^ http://www.healthscout.com/ency/68/418/main.html
- ^ Khoury, RM; Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO (1999). "Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease". Am. J. Gastroenterol. 94 (8): 2069–73. doi:10.1111/j.1572-0241.1999.01279.x. PMID 10445529. ...
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