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| ICD-10 | R12. |
|---|---|
| ICD-9 | 787.1 |
- This article is about the medical condition. For the film see Heartburn (film).
Heartburn or pyrosis is a painful or burning sensation in the esophagus, just below the breastbone usually associated with regurgitation of gastric acid.[1] The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn is also identified as one of the causes of chronic cough, and may even mimic asthma. Despite its name, heartburn actually has nothing to do with the heart. It is so called because of a burning sensation of the breastbone where the heart is located although some heart problems do have a similar sensation to heartburn. Compounding the confusion is the fact that hydrochloric acid from the stomach comes back up the esophagus because of a problem with the cardiac sphincter, a valve which misleadingly contains the word "cardiac" (an adjective referring to the heart) in its name.
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Diagnosis
Biochemical
- Ambulatory pH Monitoring
- A probe can be placed via the nose into the esophagus to record the level of acidity in the lower esophagus. Because some degree of variation in acidity is normal, and small reflux events are relatively common, such monitors must be left in place for at least a 24-hour period to confirm the diagnosis of GERD. The test is particularly useful when the patient's symptoms can be correlated to episodes of increased esophageal acidity.
- Upper Gastrointestinal (GI) Series
- A series of x-rays of the upper digestive system are taken after drinking a barium solution. These can demonstrate reflux of barium into the esophagus, which suggests the possibility of gastroesophageal reflux disease. More accurately, fluoroscopy can be used to document reflux in real-time.
Mechanical
- Manometry
- In this test, a pressure sensor (manometer) is passed through the mouth into the esophagus and measures the pressure of the lower esophageal sphincter directly.
- Endoscopy
- The esophageal mucosa can be visualized directly by passing a thin, lighted tube with a tiny camera attached (an endoscope) through the mouth to examine the esophagus and stomach. In this way, evidence of esophageal inflammation can be detected, and biopsies taken if necessary. Since an endoscopy allows a doctor to visually inspect the upper digestive track the procedure may help identify any additional damage to the tract that may not have been detected otherwise.
- Biopsy
- A small sample of tissue from the esophagus is removed. It is then studied to check for inflammation, cancer, or other problems.
Prevention
If heartburn occurs when lying down, raising the head of the bed, raising the upper body with pillows, or sleeping sitting up frequently provides relief. Avoid pillows that raise the head only, as this does little for heartburn and places continuous strain on the neck. To minimize attacks, a sufferer may find benefit in avoidance of certain foods that relax the opening between the stomach and esophagus shortly before bedtime, such as chocolate, peppermint, and chamomile tea. Tight clothing, specifically around the abdomen can increase the risk for heartburn because it puts pressure on the stomach, which can cause the food and acids in the stomach to reflux to the LES.
Treatment
Medications
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Antacids, H2-receptor antagonists, alginates and proton pump inhibitors are used to treat heartburn.
Antacids
Antacids work by neutralizing excess stomach acid. Therefore, although stomach acid will still splash into the esophagus, it will be neutralized, leading to decreased or absent heartburn symptoms. Antacids provide fast relief of symptoms, but relief typically lasts for only 30-60 minutes.
Sodium bicarbonate
A simple and relatively harmless way to treat a one-off heartburn is to drink a solution of a small amount of sodium bicarbonate mixed with water, which quickly neutralizes the acid that causes the pain. Excess sodium intake, however, is thought to raise blood pressure and cause other health problems.
H2-receptor antagonists
Often called H2 blockers, H2-receptor antagonists work by decreasing the amount of acid the body releases into the stomach. H2s are systemic, meaning they require absorption into the bloodstream in order to work. Therefore, H2s can often take 30 minutes or longer before they start working, and therefore are often taken to prevent heartburn rather than for fast relief of symptoms.
Alginates
Alginates work differently than antacids and H2 blockers, by forming a protective barrier in the stomach that prevents stomach acid from refluxing back up into the esophagus. Alginic acid is naturally derived (from brown seaweed) and is non-systemic. Alginates provide faster relief than H2-receptor antagonists and PPIs, and longer-lasting relief than antacids.
Proton-pump inhibitors
Proton pump inhibitors, called PPIs, are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors are systemic and directly block acid production in the stomach cells. In order to prevent heartburn the medication disfigures and disables the proteins (proton pumps) that control the pH of the stomach, allowing the body to digest them. Proton-pump inhibitors are not fast-acting, but provide long-lasting relief. PPIs are intended to be short-term medications only.
Restricting diet
Restricting diet is very important, since 90-95% of sufferers of heartburn or esophageal disorder can link their symptoms to specific foods.citation needed Therefore, it is important that heartburn sufferers manage their diets as a way to treat their heartburn. Sufferers should choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers. Specifically, it has been shown that fatty foods and caffeinated beverages can cause the symptoms of heartburn.
See also
References
Controlled Carbohydrate Diet 1. [1] 2. [2]
External links
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- This page was last modified on 2 July 2008, at 06:19.
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