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Heartburn

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Heartburn is often described as a fire in the chest, or feeling like the heart is burning. Heartburn is typically common, and while many people suffer from occasional heartburn, it generally isn’t a great medical concern, just uncomfortable. However, heartburn should not occur more than twice per week. While some people live with daily heartburn, this can lead to esophagus damage.

HEARTBURN SYMPTOMS

Heartburn can be incredibly painful and is completely recognizable when it happens. Common symptoms include a feeling as though the chest is on fire, increased chest pain when lying down, coughing, wheezing, sore throat, asthma attacks, hoarseness, difficulty swallowing, the regurgitation of food, or burping or bringing up a sour tasting liquid. Some patients who experience heartburn for the first time mistakenly believe they are suffering from a heart attack.

HEARTBURN CAUSES

The esophagus is the long tube that allows food the enter the stomach, and the lower half is responsible for relaxing enough to allow the food the flow down while a valve is then supposed to close off the esophagus when not needed. If this valve becomes weak or relaxes too much, there is a sudden flow of digestive juices permitted back up into the esophagus. This action is known as acid reflux and can cause severe irritation of the lining of the esophagus.
Heartburn
Image: Heartburn


Foods can trigger worsening heartburn and add to the irritated esophagus. Foods that are spicy, high in fats, contain caffeine, chocolate, acids, mint, onions, tomato sauce, or carbonated beverages tend to aggravate heartburn. Eating meals that are large or over eating can also aggravate heartburn, as can lying down soon after eating. Alcohol has been known to encourage heartburn. Some medications such as calcium channel blockers, sedatives, some narcotic pain relievers, and tranquilizers can cause heartburn. Patients who experience smoking cessation often report a significant decrease in their occurrence of heartburn.

Pregnancy, obesity, peptic ulcers, hiatal hernias, asthma, diabetes, connective tissue disorders, and Zollinger-Ellison syndrome are risk factors for heartburn. Not all of these risk factors are controllable, although the ones that are should be managed to the best ability of the patient to help manage heartburn as well as other health issues.

HEARTBURN DIAGNOSIS

Heartburn is simple to diagnose. Patient complaints are typically enough for a physician to diagnose heartburn. Ascertaining how often and how severe the heartburn tends to be can help the physician determine if over the counter medications or a prescription medication is best suited for that patient’s particular heartburn. If there are risk factors and dietary habits which can be altered, this is always the first option.

HEARTBURN TEST

Tests can help determine if there is any damage to the esophagus or if there are any obstructive or deformity issues that is creating the heartburn. Barium x-rays, endoscopy, ambulatory acid probe test, and esophageal impedance test may be required in determining how to best assist the patient. These tests allow a physician to see in detail the structure of the digestive tract, take measurements of the acid returning into the patient’s esophagus, as well as to do a visual examination of the esophagus.

HEARTBURN TREATMENT

Serious untreated heartburn can eventually lead to complications other than an irritated esophagus. Complications can include narrowing of the esophagus or ulcers of the esophagus, as well as a cellular change of the esophagus that significantly increases the chances of esophageal cancer.


Most patients begin with over the counter medications with their first case of heartburn. Some over the counter medications treat the heartburn after it has begun, such as antacids, while others are aimed at decreasing the stomach acid before a meal, such as proton pump inhibitors. Some patients require stronger medications such as prescription strength medicines to help control the acid in the stomach from returning through the esophagus. In some severe cases, surgical procedures may be necessary.

Those who develop pneumonia or bronchitis due to acid reflux, esophagitis especially that bleeds, narrowing of the esophagus, signs of precancerous conditions, and those with large hiatal hernias are likely to require surgery to repair the esophagus if possible and alleviate the heartburn and acid reflux.

Heartburn can be extremely uncomfortable. If a patient is experiencing heartburn several days per week and has attempted to lose weight, change their diet, and present precautions in their eating and post-eating habits, they should be encouraged to see their physician for an evaluation.
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