Heartburn: Symptoms, Causes, Risks, Complications, Diagnosis and Treatment

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woman with Heartburn

1Overview

Rather than being a distinct disease in itself, heartburn is the key presenting symptoms of another condition- gastroesophageal reflux disease (GERD). However, it has major implications for individuals and healthcare systems. Despite this fact, the sensitivity of heartburn as a diagnostic feature for GERD does not exceed 75%. A substantial proportion of patients with GERD does not have heartburn. Conversely, a substantial portion of individuals who have heartburn does not have GERD. Therefore, it is important to recognize that heartburn may be the presenting feature of other diseases, such as ischemic heart disease and esophagitis.

Heartburn is common. Almost everyone has it at some point in time. It is an intense feeling of discomfort, pain, or burning that is felt rising up from the chest to the neck. Some people refer to it as indigestion. However, heartburn is due to the contents of the stomach rising up into the esophagus, bypassing the lower esophageal sphincter (LES). In the esophagus, the acid causes pain and inflammation. Occasionally, heartburn may be associated with regurgitation, which is when liquid or food comes into the mouth from the stomach. If heartburn occurs regularly, it is time to get treatment for it.

2Symptoms 

The most prominent symptom of heartburn is a burning pain in the chest, right behind the breastbone. Sometimes, this burning sensation reaches up to the throat. The pain is often made worse by lying down or when the person is bending over. In addition, some foods can make heartburn worse, such as caffeine, chocolate, citrus fruits, and alcohol.

3Causes

Heartburn is thought to occur when the epithelium lining the esophagus is exposed to acid from the stomach. In particular, the burning sensation is felt when the esophagus comes into contact with gastric acid, which is a type of acid that is made in the stomach. Heartburn was so named because of the acid ‘burns’ the esophagus.

Stomach contents are highly acidic. This is needed in order to properly digest food. Bacteria lining the stomach making it more acidic. In contrast to this, the esophagus is basic, meaning that its pH level is high. Therefore, when the acidic contents of the stomach come into contact with the esophagus, the burning sensation can be felt.

The reasons why stomach contents flow back up the esophagus are plenty. One theory is that the LES has weakened, either because of structural damages or other diseases. Once this sphincter has weakened, it can no longer function to keep the contents of the stomach inside the stomach. Thus, the tendency is for the contents to flow back up the esophagus.

Heartburn may also be caused by other things, such as by being overweight or pregnant. During pregnancy, the fetus presses down on the mother’s stomach, which causes pressure. This makes it more likely for the stomach contents to be pushed back up, especially when combined with a weak LES. Overweight individuals also experience heartburn because of the increased pressure that fat, or adipose tissue, has on their stomachs. Wearing tight clothes can also cause heartburn through the same mechanism. In addition, a person may feel symptoms if the stomach contents are near the LES, such as when lying down or bending over.

4Risk Factors

There are plenty of risk factors for heartburn. Chief among them is dietary. Excessive alcohol intake is associated with an increased risk for heartburn. Consuming coffee, sodas, chocolates, citrus fruits, fatty foods, garlic, onions, mint, salt and salt substitutes, spicy foods, and tomatoes or tomato juice are also dietary risk factors.

There are also diseases which are risk factors for heartburn. Motility disorders, or problems with the movement of food through the gastrointestinal tract, are one type of risk factor for heartburn. Peptic ulcer disease is also a risk factor, as is scleroderma and Zollinger-Ellison syndrome.

Lifestyle factors also contribute to heartburn. Some strenuous exercises can cause the stomach contents to travel back up the esophagus. Smoking is strongly associated with heartburn. People who are diagnosed with GERD are advised to stop smoking completely and they often find that their symptoms improve. Stress contributes to the likelihood of heartburn, possibly through the body’s release of the hormone cortisol. Lying down may also precipitate heartburn, as is wearing tight clothing.

Numerous drugs cause heartburn. These include aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), barbiturates, benzodiazepines, calcium channel blockers, dopamine, tetracycline, and tricyclic antidepressants.

Age is another risk factor. Studies have shown that people older than 50 years are more likely to experience heartburn compared to younger people. Male gender is another risk factor for heartburn.

Eating a large meal rapidly may contribute to the likelihood of heartburn. In addition, engaging in strenuous physical activity after eating a large meal may also cause heartburn. Another risk factor is smoking. 

5Complications

The complications for heartburn arise mostly when the symptom is not treated. There are many complications, and almost all of them are related to the contact between the esophagus and the stomach contents.

Ulcers and bleeding are serious consequences of heartburn. These painful and can lead to these diseases, such as esophageal cancer.

Anemia may also occur if the heartburn is severe enough that it causes extensive bleeding in the esophagus. Anemia is a condition wherein there are not enough red blood cells in the body. Therefore, the blood is unable to adequately transport oxygen to other parts of the body.

Laryngitis, or inflammation of the larynx, and hoarseness may also occur. Laryngitis typically occurs as a result of the acid coming into contact with the larynx, causing irritation and inflammation.

Heartburn is also associated with a chronic cough. Having chronic cough is problematic for patients, especially when a cough prevents them from working. It can negatively affect their quality of life.

The esophageal lining can also be inflamed, which can lead to throat cancer and Barrett’s esophagus. This condition occurs when the cells of the throat lining have begun to mutate and change in appearance. Having Barrett’s esophagus predisposes the person to a higher risk of cancer.

Esophageal strictures are another complication arising from heartburn. Strictures develop when the esophagus comes into contact with acid and is wounded. As a result of trying to heal itself, the esophagus can form scar tissue. Scar tissue is not elastic and cannot be bent or stretched. If there is enough scar tissue in the esophagus, the person cannot swallow well. This can lead to anorexia and malnutrition, as well as unexplained weight loss.

Lung problems are another complication of heartburn. These include wheezing, pneumonia, and bronchitis.

6Diagnosis

A gastroenterologist should be consulted by people who have persistent, or chronic, heartburn. If the heartburn persists even after lifestyle interventions are undertaken, then the doctor may have to check for symptoms of underlying diseases.

The first step in diagnosis is to check for the person’s medical, social, and family history. It will provide important clues for the doctor, such as lifestyle habits that can cause heartburn.

Endoscopy may also be performed. Upper endoscopy is often used to treat and manage heartburn associated with GERD. Endoscopy is performed by inserting a probe with a small camera into the throat to check for acid, lesions, and other clues.

pH monitoring is another way to diagnose heartburn. It is the gold standard for diagnosing problems with acid reflux.

Esophageal reflux testing is helpful if the patient complains of heartburn but has normal results from endoscopy. Ambulatory esophageal pH testing can also help identify patients who have GERD.

The goal of diagnosing heartburn is to treat the underlying condition that is causing it.

7Treatment 

The treatment options for heartburn are extensive. Before trying drugs to treat heartburn, most doctors recommend trying lifestyle changes first. If the patient is overweight, he/she should be advised to lose weight. The patient should be advised to wear loose clothing and to refrain from smoking and drinking.

Other lifestyle modifications include chewing food completely and slowly. This will prevent the acid from going back up the esophagus due to indigestion. Eating smaller, more frequent meals is also a treatment option for heartburn. Late night eating should be avoided.

Foods that commonly cause symptoms should be avoided, such as coffee, chocolates, spicy foods, and citrus fruits. Likewise, if a person is going to take NSAIDs, he/she should do so when the stomach is full rather than empty to reduce the risk of heartburn.

If these lifestyle modifications fail, there are drugs that can be used to treat heartburn.

H2-receptor antagonists are the first-line treatment for people with heartburn. They reduce the amount of acid that the stomach produces by antagonizing the H2 receptors. They do not relieve heartburn as quickly as antacids, but their effect is long-lasting.

Proton pump inhibitors are powerful suppressors of acid production in the stomach. They can be taken over a long period of time. These drugs inactivate the pump that brings out acid in the stomach, effectively reducing the amount of acid there.