Dr. Manoj Kumar Sahu
Heartburn, despite its name, has nothing to do with the heart. Some of the symptoms, however, are similar to those of a heart attack or heart disease.
Heartburn is an irritation of the esophagus (food pipe) caused by stomach acid. This can create a burning discomfort in the upper abdomen or below the breast bone.
A muscular valve called the lower esophageal sphincter, or LES, is located where the esophagus meets the stomach. Normally, it opens to allow food into the stomach or to permit belching, then closes again. But if the LES opens too often or does not close tight enough, stomach acid can reflux or seep into the esophagus and cause the burning sensation.
Occasional heartburn isn’t dangerous, but chronic heartburn or gastro esophageal reflux disease (GERD) can sometimes lead to serious problems.
Chronic heartburn is associated with a significant impact on health-related quality of life and reduction in personal and work-related productivity. It is also associated with a greater risk of Barrett’s esophagus, a pre-malignant condition that may progress to esophageal cancer. Fortunately, heartburn can, generally, be treated safely and effectively.
The prevalence of chronic heartburn or GERD is increasing worldwide, including in Odisha. The reason for the increasing prevalence of GERD is not entirely clear but it appears to be linked to the increasing prevalence of obesity and, perhaps, to other dietary factors.
In heartburn, pain can be felt as a burning sensation behind the sternum or breastbone, either as a spasm or a sharp pain. Many times the pain of acid reflux (heartburn) can be mistaken for the pain of a heart attack. The pain of acid reflux can remain in the lower chest or can radiate to the back of the throat and be associated with water brash, a sour taste in the back of the throat. If there is acid reflux near the larynx (voice box) in the throat, it may cause coughing or hoarseness. Reflux of stomach acids over prolonged periods of time can wear away the enamel on teeth and cause decay.
Heartburn may also be the presenting feature of other conditions ranging from functional heartburn to eosinophilic esophagitis and motility disorders such as achalasia as well as extra-esophageal conditions, including ischemic heart disease.
Certain foods and drinks can trigger heartburn in some people, including spicy foods, onions, citrus products, tomato products such as ketchup, fatty or fried foods, peppermint, chocolate, alcohol, carbonated beverages, coffee or other caffeinated beverages and large or fatty meals. Being overweight also can increase your risk of experiencing heartburn.
You should consult the doctor if heartburn symptoms persists for more than 3 months, severe or nocturnal heartburn continues after 2 weeks of treatment with a over the counter medication, new-onset of heartburn at age more than 50 years, difficulty in swallowing or painful swallowing, vomiting blood or black material or black tarry stool, anemia, symptoms of laryngitis as hoarseness, wheezing, coughing, or choking, unexplained weight loss, continuous nausea, vomiting or diarrhoea.
If the heartburn is persistent and troublesome, the doctor may recommend Endoscopy to check for abnormalities in your esophagus, Ambulatory acid probe tests to identify when, and for how long, stomach acid backs up into your esophagus and Esophageal motility testing to measure movement and pressure in your esophagus. Proper management and monitoring can control symptoms and avoid complications of heartburn.
Many over-the-counter medications can help relieve heartburn. The options include Antacids, which help neutralize stomach acid. Antacids may provide quick relief but they can’t heal an esophagus damaged by stomach acid. H-2-receptor antagonists (H2RAs), which can reduce stomach acid, don’t act as quickly as antacids but may provide longer relief. Proton pump inhibitors, such as lansoprazole , pantoprazole, omeprazole, rabeprazole etc, can also reduce stomach acid.
If over-the-counter treatments don’t work or you rely on them often, see your doctor.
Lifestyle changes can help ease heartburn. Maintain a healthy weight. Excess weight put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. Avoid tight fitting clothes which put pressure on your abdomen and the lower esophageal sphincter. Avoid foods that trigger your heartburn. Avoid lying down immediately after a meal but wait at least three hours. Avoid late meals. Elevate the head of your bed if you regularly experience heartburn at night or while trying to sleep. If that’s not possible, insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows usually isn’t effective. Avoid smoking as it decreases the lower esophageal sphincter’s ability to function properly and increases reflux of acids.
Anxiety and stress can worsen heartburn symptoms. Some complementary and alternative treatments may help you cope with anxiety and stress. If your heartburn is worsened by anxiety and stress, consider trying aromatherapy, gentle exercise such as walking or riding but avoid vigorous exercise, which can worsen heartburn.
The World Gastroenterology Organisation (WGO) wishes to raise awareness of heartburn and to provide a broad overview on this common symptom. “Heartburn: A Global Perspective,” the WGO campaign for World Digestive Health Day 2015, being observed today, seeks to translate research into clinical practice and facilitate communication between healthcare providers, healthcare providers and heartburn sufferers to ensure that patients receive appropriate dietary and lifestyle advice as well as appropriate investigations and treatment, relevant to their condition and circumstances.
The department of Gastroenterology at IMS and Sum Hospital, Bhubaneswar observes the World Digestive Health Day by creating awareness about the common gastrointestinal symptoms and advising healthy diet and life style measures to prevent those symptoms. The department is equipped with all advanced technology for the diagnosis and management of all gastrointestinal and liver diseases.
* Dr. Manoj Kumar Sahu is the HoD, Department of Gastroenterology and Liver Diseases IMS and Sum Hospital, Bhubaneswar.
(Published on the occasion of World Digestive Health Day today)