Heartburn, also known as pyrosis, is a painful, burning sensation in the chest or throat. The problem occurs when stomach acid travels up into the esophagus, the portion of the digestive tract that transports food from the mouth to the stomach. Although heartburn is usually temporary and not serious, for some individuals it develops into a chronic problem. It may be a symptom of a more serious disorder, such as gastroesophageal reflux disease (GERD), which may eventually cause extensive damage to the esophagus.

Causes of Heartburn

When stomach acid travels back up into the esophagus the process is known as reflux. Normally, once a person swallows food, the lower esophageal sphincter, a circular band of muscles located at the bottom of the esophagus, keeps food from backing up. If this sphincter weakens enough, however, there is a reflux of stomach acid, resulting in heartburn. There are a number of factors that may contribute to heartburn, including:

  • Obesity
  • Pregnancy
  • Smoking or alcohol consumption
  • Taking certain medications, such as NSAIDs
  • Eating spicy or acidic foods
  • Connective tissue disorders, such scleroderma
  • Diseases such as diabetes or asthma
  • Hiatal hernia or ulcer
  • Esophageal cancer

Heartburn, if it occurs frequently, may be a symptom of GERD, particularly if the heartburn is accompanied by one or more of the following symptoms:

  • Hoarseness
  • Dry cough
  • Nausea or vomiting
  • Difficulty swallowing

If heartburn occurs when the patient lies down 1 or 2 hours after eating, GERD is suspected.

Diagnosing the Cause of Heartburn

Heartburn is such a common complaint that it is sometimes ignored when its underlying causes are serious. Heartburn can also be mistakenly diagnosed when the problem is a more urgent health problem, such as a heart attack or pulmonary disease. Diagnostic tests performed to diagnose the reason for heartburn include:

  • Esophageal pH (acid) testing
  • Esophageal motility test or manometry
  • X-ray of the upper digestive system with contrast dye
  • Upper endoscopy and possible biopsy

In order to make a definitive diagnosis, the patient may be required to undergo two or more of these procedures.

Treatment of Heartburn

Heartburn, as a symptom of GERD, is often a chronic condition. There are numerous steps, however, that may be taken to reduce the frequency or severity of episodes of heartburn. Among these are:

  • Taking over-the-counter antacids
  • Taking prescribed proton-pump inhibitors
  • Taking prescribed H2 inhibitors
  • Giving up smoking
  • Reducing alcohol consumption
  • Losing weight
  • Eating a healthy diet

In severe cases, heartburn may be a symptom of GERD or another medical problem that requires surgical intervention. In some situations, bariatric surgery may be necessary to promote extreme weight loss. In others, a procedure known as Nissen fundoplication may be needed to tighten the lower esophageal sphincter to treat GERD. In still others, repair of a hiatal hernia may be required.



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