Heart burn (GERD)

Heartburn Basics

Heartburn is the most common symptom of a condition called
gastroesophageal reflux disease (GERD), also known as acid reflux.

Heartburn occurs when acid or other stomach contents back up in the esophagus.

While heartburn is rarely life-threatening, it can greatly reduce your
quality of life by affecting your daily activities, your sleep and what
you eat.

Heartburn can typically be controlled through behavior modification and
over-the-counter medication, but if symptoms persist or worsen, a
gastroenterologist should be consulted for additional tests and to rule
out more serious conditions.

GERD?

The muscle (lower esophageal sphincter) located between the esophagus
and stomach normally opens after swallowing. This allows food to pass
into the stomach. This lower esophageal sphincter muscle then closes
quickly to prevent the return (reflux) of food and stomach juices back
into the esophagus.

When the lower esophageal sphincter muscle either relaxes
inappropriately or is very weak, the acid contents of the stomach can
back up, or reflux, into the esophagus. This is called
gastro-esophageal reflux and typically produces heartburn, a burning
sensation below the sternum where your ribs come together. In addition
to heartburn, symptoms may include a persistent sore throat,
hoarseness, chronic cough, asthma, heart-like chest pain and a feeling
of a lump in the throat. When the acid contents from the stomach
regularly back up into the esophagus, chronic GERD can occur.

Several factors influence the occurrence and severity of gastroesophageal reflux and heartburn, including:

The ability of the lower gastroesophageal sphincter muscle to open and close properly.
The type and amount of stomach juices that are backed up into the esophagus.
The clearing action of the esophagus.
The neutralizing effect of saliva and other factors.
People experience GERD and heartburn in a variety of ways. Heartburn
usually begins as a burning pain that starts behind the breastbone and
radiates upward to the neck. Often there is a sensation of food coming
back into the mouth, accompanied by an acid or bitter taste. Heartburn
is sometimes called acid indigestion and usually occurs after meals.

Symptoms

Burning pain behind the breastbone area.
Burning pain or reflux symptoms that is worse when one is lying down or bending over.
Some people have reflux that damages the lining of the esophagus, but
they have no symptoms to alert them that acid injury is occurring.

How Common Is Heartburn?

Although
heartburn is common in our society, it is rarely life-threatening.
However, heartburn can severely limit daily activities and
productivity. With proper understanding of the causes of heartburn and
a consistent approach to a treatment program, most people will find
relief

Is Heartburn Caused by Hiatal Hernia?

A hiatal hernia is the pushing up of the stomach into the chest cavity through a hole in the diaphragm.

While heartburn is not caused by hiatal hernia, hernias predispose
individuals to heartburn. Chronic heartburn can cause a shortening of
the esophagus resulting in hiatal hernia. Hiatal hernias can occur in
people of any age and are often found in otherwise healthy people age
50 or older.

Note: Any chest pain or difficulty swallowing requires prompt medical evaluation. Other causes should be considered.

Controlling Heartburn

These recommendations may not apply to all individuals. Patients should
keep a diary to help them better manage their symptoms. The listed
items are common contributors but do not need to be changed unless
proven to worsen symptoms in an individual. Discuss any concerns with
your physician.

Avoid food, beverages and medicines that affect the lower esophageal
sphincter muscle action or irritate the lining of the esophagus, such
as:
Fried or fatty foods.
Chocolate.
Peppermint.
Alcohol.

Coffee (decaf too).
Carbonated beverages.
Ketchup and mustard.
Vinegar.
Tomato sauce.
Citrus fruits or juices.
Aspirin, anti-inflamatory and pain medications other than acetaminophen.
Decrease the size of portions at mealtimes. Don’t overeat!
Eat meals two to three hours before lying down.
Elevate the head of the bed four to six inches using blocks or telephone books.
If you are overweight, lose weight.
Avoid situations that can increase the pressure on the abdomen, as they
will cause more reflux. Try simple things like avoiding tight clothing
or control top hosiery and body shapers. Less obvious causes include
sit-ups, leg-lifts or abdominal crunches.
Stop smoking, as cigarettes decrease the ability of the lower esophageal sphincter muscle to work properly.
For occasional heartburn, over-the-counter medicines taken as directed
can be helpful in reducing symptoms. If prolonged or frequent use of
nonprescription medicines (more than directed on the product) becomes
necessary, or if they do not completely control symptoms, a
gastroenterologist should be consulted.
If Symptoms Persist

People with severe esophageal reflux or heartburn symptoms unresponsive
to the measures described above may need a more complete diagnostic
evaluation. A variety of tests and procedures are currently used to
further evaluate thethe patient with heartburn

Endoscopy

A procedure during which a thin flexible tube with a
camera and a light at the end is placed into the esophagus so your
physician can see the tissue lining

Biopsy

The removal of a small sample of the tissue lining the esophagus to better determine the causes of underlying disease.

Esophageal manometric studies

Takes pressure measurements of the esophagus, which
may be needed to identify critically low pressure in the lower
esophageal sphincter muscle and determine other disorders of esophageal
muscle function.

Impedance monitoring

This test measures the rate of fluid movements at
various points along your esophagus. When used in combination with pH
monitoring, impedance monitoring offers your gastroenterologist a
fuller picture of
[both acid and non-acid reflux episodes. The combined results are also
useful in the evaluation of patients with PPI-resistant typical reflux
symptoms, chronic unexplained cough, excessive belching and
regurgitation.

pH (acid) monitoring

In difficult-to-diagnose patients, physicians may
choose one of two methods to measure pH (acid) levels in the esophagus.
In ambulatory nasoesophageal pH monitoring, a tube connected to a
recording device is placed through your nose into the esophagus for 24
hours. The test measures reflux during normal everyday activities and
regular eating patterns.

A second test replaces the tube with a small wireless transducer
temporarily placed at the end of the esophagus. It sends data it
collects to a receiver worn on your belt for 24 to 48 hours — again,
all while you go about normal, daily activities. At the end of the
test, the disposable capsule holding the transducer will pass naturally
through your digestive tract.

Surgery

A small number of people with heartburn may need
surgery because of severe reflux and poor response to medical treatment
plans. Fundoplication is a surgical procedure that reduces reflux.
Patients not wanting to take medication to control their symptoms are
also candidates for surgery.

Medications Available to Relieve Heartburn Symptoms

There
are a number of over-the-counter and prescription medications available
to relieve heartburn symptoms. These medications stop acid production
or help the muscles that empty your stomach. Many of these drugs may be
effective in combination with each other due to the different ways they
work. Talk to your gastroenterologist to determine which medicine(s)
may work best for you.

Antacids
Often the
first drugs recommended to relieve heartburn and other mild GERD
symptoms, these over-the-counter medications neutralize the acid in the
stomach. Patients using antacids may experience side effects including
diarrhea and constipation. Some antacids can also be a supplemental
source of calcium.

Foaming Agents
These over-the-counter drugs work by coating the stomach contents with foam to prevent reflux.

H2 Blockers
Available in
both over-the-counter and prescription strength, these drugs decrease
acid production and provide short-term symptom relief. The H2 blockers
are effective for about half of the patients with GERD symptoms.
[B]Proton Pump Inhibitors (PPIs)[/
These primarily prescription drugs (some are available in over-the
counter strength) are more effective than the H2 blockers and can
relieve symptoms and heal the esophageal lining in almost everyone who
has GERD.

Prokinetics
These
prescription drugs help strengthen the LES and speed stomach emptying.
The side effects associated with the drugs, including fatigue,
sleepiness, depression, anxiety and problems with physical movement,
may limit their usefulness.

Treatments for GERD do not improve the function of the lower esophageal
sphincter. If acid suppression treatment is stopped, your GERD symptoms
will most likely return. Even if they don’t, you may experience the
asymptomatic complications listed above, making it critical that you
talk to your gastroenterologist before stopping treatments of any kind

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