HEARTBURN

Heartburn is the most common symptom of a condition called gastroesophageal reflux or acid reflux. A sphincter (specialized muscle), known as the lower esophageal sphincter (LES), is located at the end of the esophagus and opens during swallowing to allow food to pass into the stomach. The LES muscle then closes quickly to prevent the return (reflux) of food and stomach juices back into the esophagus.

However, the LES muscle does not always work perfectly. Gastroesophageal reflux occurs when the LES muscle either relaxes inappropriately or is weak. This allows stomach juices to back up, or reflux, into the esophagus, creating heartburn. When the acid contents from the stomach regularly back up into the esophagus, a chronic condition called gastroesophageal reflux disease, or GERD, occurs. Heartburn is sometimes called acid indigestion and usually occurs after meals. In addition to heartburn, symptoms of acid reflux may include persistent sore throat, hoarseness, chronic cough, asthma, heart-like chest pain and a feeling of a lump in the throat.

There are several factors that influence the frequency and severity of acid reflux: the ability of the LES muscle to open and close properly, the type and amount of stomach juices that reflux up into the esophagus, the ability of the stomach to empty properly, the clearing action of the esophagus, the acid-neutralizing effect of saliva and other factors.

Symptoms of Heartburn

Heartburn is a symptom of another digestive disorder, and not a disorder by itself. For example, heartburn is the most common symptom of gastroesophageal reflux disease (GERD). Acid reflux is a medical condition, with heartburn as a possible symptom of that condition.

Many people have different heartburn triggers, but most people have similar heartburn symptoms.

A burning sensation in the chest
This burning sensation usually starts behind the breastbone (the sternum), and may travel up to the throat. It usually occurs shortly after eating, and can last from a few minutes to several hours.

A burning feeling in the throat
This is a sensation of burning, usually high up in the neck though it can occur lower. The pain may worsen with swallowing. This burning sensation can result from irritation when stomach contents that have refluxed up into the throat.

Sour or bitter taste in the mouth
This sour or bitter taste can occur when stomach contents reflux up into the esophagus and may reach the back of the throat.

When the contents enter the back of the throat, a person will often have a sour or bitter taste in their mouth.

Difficulty swallowing
Trouble with swallowing (dysphagia) occurs when food does not pass normally from the mouth through the esophagus to the stomach. There may be a sensation of food sticking in the throat, chest pressure or "burning" after eating, or a feeling of choking. Difficulty swallowing could be a sign of various conditions, including erosive esophagitis and esophageal cancer, and should always be evaluated by a physician.

Chronic coughing
In some studies, GERD accounted for about 41% of cases of chronic cough in nonsmoking patients. If refluxed stomach acid is aspirated, it can cause coughing.

Wheezing or other asthma-like symptoms
Several studies suggest a significant link between GERD and asthma. The results of these studies show that up to 60% of people with asthma also have gastroesophageal reflux disease (GERD), compared with 10% of the general population. GERD can affect asthma when refluxed acid from the stomach is aspirated into the airways and lungs, and can make breathing difficult and cause the patient to wheeze and cough.

What causes GERD?

The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Most of the time, a hiatal hernia produces no symptoms.

Other factors that may contribute to GERD include

• obesity
• pregnancy
• smoking

Common foods that can worsen reflux symptoms include

• citrus fruits
• chocolate
• drinks with caffeine or alcohol
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, salsa, chili, and pizza
  

Tips to Control Heartburn (Reflux)

The following are general measures the patient can take to reduce reflux:

• Avoid lying down right after eating and within two to three hours of bedtime.
• Elevate the head of the bed four to six inches.
• Lose weight if overweight.
• Stop smoking.
• Avoid eating large meals. Instead, eat smaller, more frequent meals.
• Avoid:
  • Chocolate
  • Coffee and alcohol
  • Fried and fatty foods
  • Mint products (i.e., peppermint, spearmint)
  • Carbonated beverages, and citrus fruits or juices
  • Tomato sauce, ketchup, mustard and vinegar
  • Aspirin and most pain medicines (other than acetaminophen).