Heartburn is a discomfort or pain caused by the stomach contents regurgitating from the stomach up into the gullet (esophagus). The esophagus is not made to withstand acid and is thus irritated and inflamed when acid from the stomach refluxes into it. This is known as reflux esophagitis.
The pain caused by the irritation of the esophagus is a burning pain which you feel in the center of the chest. There is often an associated awareness of acid and stomach contents in the back of the throat or mouth. Lying down or bending forwards tends to increase the symptoms.
The whole of the intestinal tract is in the form of a tube with muscles in the wall which move the food along (peristalsis). At the bottom of the esophagus the muscles encircling the tube work rather like a valve to stop food going backwards. This is not a perfect valve, but in some people works less well than others:
- Obesity leads to a higher pressure in the abdomen.
- Pregnancy causes a higher pressure in the abdomen and there is also evidence that the changing hormone levels cause relaxation of the muscle valve.
- Large amounts to eat or drink cause back pressure.
- In hiatus hernia, which is quite a common condition, the top part of the stomach pokes through the muscle which separates the chest from the abdomen (the diaphragm), and results in disruption of the valve mechanism.
- Smoking causes the valve to relax and also increases acid production.
Your doctor may well make the diagnosis from the symptoms you describe, but may wish to investigate further.
Endoscopy is the most commonly used test and involves a fiber-optic tube which is passed down your throat, enabling your doctor to examine the esophagus, stomach, and duodenum. If any abnormal areas are seen a sample may be taken and sent to a laboratory for analysis. Usually you are given an injection which makes you sleepy during the procedure and also tends to make you forget what went on.
Sometimes an X-Ray is used, in the form of a barium meal, which monitors the passage of a drink containing a heavy element which shows up the esophagus and stomach in silhouette.
Treatment and prevention
- If you smoke, stop.
- If you are overweight, lose weight.
- Avoid eating just before bed and if taking any tablets wash them down with a glass of water to avoid them sticking in your esophagus and slowly dissolving there.
- Consider raising the head of your bed (one tends to slip down off extra pillows and so blocks or bricks under the head end of the bed may be better).
- Small meals regularly are better than large meals infrequently.
- Avoid tight clothing around the waist.
- Avoid aspirin and other anti-inflammatory medications (NSAIDs) such as ibuprofen, except after consultation with your doctor.
- Antacids neutralize the acid in the stomach, and often one containing a seaweed product (alginate, for example Gaviscon) is used, as this floats on the stomach contents tending to keep them down.
- Various medications cause reduced acid secretion. Some of these are available over the counter and others only on prescription. Examples include H2 antagonists (for example cimetidine, ranitidine) and proton pump inhibitors (for example omeprazole, lansoprazole).
- There are medications which encourage the movement of food in the right direction (better peristalsis) and better valve action at the upper end of the stomach (for example domperidone).
- Very occasionally surgery is offered but is not undertaken lightly.