Heart Burn
What is Heart Burn?
Heartburn is a common phrase used to refer to a burning chest pain that occurs after eating a meal. It is caused by acid reflux from the stomach into the oesophagus (a tube that connects you mouth to your stomach)causing irritation and pain. It is a symptoms of a wider condition known as GORD (gastro-oesophageal reflux disease). Other symptoms of GORD which are commonly associated with heartburn include acid reflux (may leave a bad taste in your mouth), pain and difficulty swallowing.
GORD is very common and affects a large proportion of people generally over the age of 40 years old. Medications can be given to treat these symptoms and they work well for most people.
What causes Heart Burn?
Most cases are caused by a weakening of the entrance to the stomach (lower-oesophageal sphincter – LOS). For most of the time, it should be firm and constricted which prevents regurgitation of stomach contents and acid into the oesophagus and up into the mouth. There are many risk factors which increase the chance of developing GORD and heartburn and these include obesity, a high-fat diet, smoking, excessive alcohol, chocolate, pregnancy, stress and having a hiatus hernia. Certain medications (e.g. nitrates and calcium channel blockers) can relax the LOS and other medications can contribute to the inflammation of the oesophagus (e.g. NSAIDs such as ibuprofen, SSRIs for depression, etc).
What are the symptoms of Heart Burn?
Heartburn is a symptom of GORD. The other symptoms that may or not be present alongside heartburn include acid reflux, dysphagia (trouble swallowing) and odynophagia (pain on swallowing). Heartburn is characterised by a burning pain in your stomach (upper abdomen) that occurs and is worse after eating. Some patients suffer from heartburn when they bend over or lie down. Patients who suffer from GORD may complain of a long-term cough, which can be caused by irritation to the back of throat from the regurgitation of stomach acid.
How is Heart Burn treated?
Lifestyle changes can be useful in GORD and managing risk factors can improve symptoms. Certain medications can reduce the amount of acid you produce and others can reduce the pH (acidity) of the stomach contents, reducing irritation of the oesophagus. These medications can be bought from a pharmacity and are called proton-pump inhibitors. Other medications include antacids (e.g. gaviscon) which can offer relief and H2RAs (which block gastric histamine, a stimulator for stomach acid production). You doctor may prescribe further medications if your symptoms are long standing and persistent and may order investigations to see if there is any noticeable problems. For more serious cases, there are several surgical options which attempt to reduce the reflux of acid by narrowing the end of the oesophagus and improving the seal of the LOS.
