Heartburn

Heartburn usually manifests as a burning feeling in the chest or esophagus, underneath the breast bone, and is caused by the body regurgitating gastric acid (acid reflex)

It can be quite painful and uncomfortable. Pain begins in the chest and rises to the neck, throat and possibly jaw. Heartburn can cause chronic coughing, and may present with symptoms similar to asthma.

Despite its name, heartburn really has nothing to do with the heart. The heart in heartburn refers only to the location of the discomfort, rather than the cause or target of it. Some more serious heart problems can also present with symptoms similar to heartburn, so if your discomfort cannot be alleviated or becomes worse, seek emergency medical assistance.

Heartburn is caused by a failure of the lower esophageal sphincter, or LES, which usually separates the stomach from the esophagus and prevents the esophagus from being exposed to the stomach’s acidic contents. When you swallow, the lower esophageal sphincter relaxes, which may allow stomach contents, including gastric acid, to enter the esophagus, a process called reflux.

When this happens on a regular basis, it is termed GERD, or gastroesophageal reflux disease. The refluxed material will normally be passed back into the stomach by the normal muscular contraction of the esophagus, a process called peristalsis. Gastric acid can also be neutralized by saliva.

Some foods are more likely to cause heartburn than others, and should be avoided if possible if you are predisposed to suffer from it. They include fizzy drinks, spicy foods, mint, very dry foods, very fatty foods, citrus fruit and fruit juice, and chocolate. Some recreational drugs are also known to cause or exacerbate heartburn. They include tobacco in any of its various forms, cocaine (particularly meth), alcohol (particularly red wine) and caffeine.

Heartburn can also be triggered by psychological problems, especially stress and related issues, tiredness and fatigue. Treatment for heartburn generally takes the form of antacids, H2 receptor antagonists, or proton pump inhibitors.

Antacids will be effective for between one-quarter and one-third of all patients with gastroesophageal reflux disease.

Examples of antacids currently on the market, along with their respective trade names, are - sodium bicarbonate (Alka-Seltzer), calcium carbonate (Rennie, Tums, Rolaids), magnesium hydroxide (Milk of Magnesia), Bismuth subsalicylate (Pepto-Bismol), Magaldrate and Simethicone (Pepsil), and Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta).

Antacids should preferably not be used for a prolonged period of time, as they interfere with the stomach’s ability to digest certain nutrients, like B vitamins or iron, and the reduced acidity of the stomach will inhibit its ability to kill bacteria, making regular antacid users particularly vulnerable to infection.

Sodium bicarbonate (Alka-Seltzer) is probably the best and safest way to treat heartburn as a first option. It works to neutralize the acid and thereby ease the pain in the esophagus.

For those patients who are unresponsive to antacids, proton pump inhibitors may be useful. These drugs block the production of acid in stomach cells and are therefore likely to be more reliable than antacids which merely react to the acid already produced.

Dietary management is probably the single most important feature of any heartburn treatment program. The vast majority of heartburn sufferers will be able to tell you which foods or types of food are likely to cause them pain. Avoiding these foods is by far the best and safest way to handle the condition.

Other lifestyle modifications that may help to prevent or alleviate the condition include raising the head of your bed to prevent stomach acid from slipping back into the esophagus simply by way of gravity and avoiding tight clothing that may squeeze your stomach and raise the acid closer to the esophageal entrance.

In the case of acute heartburn with complications (such as bleeding or metaplasia - the abnormal transformation of the cells that line the esophagus), surgery may be considered as a last-ditch option. Surgery in this case generally involves augmenting the natural barrier between the stomach and esophagus.

Severe heartburn that lasts for extended periods of time and is very painful should be investigated by a medical professional as soon as possible. Some more serious types of GERD can lead to further complications developing, including cancer.

Additionally, if your symptoms persist or deteriorate suddenly or following treatment with antacids, you should seek emergency medical help in case your condition is not heartburn after all but rather something more serious. A myocardial infarction, or heart attack, can sometimes present with symptoms that mimic heartburn.