The Collison Newsletter April 2016

 

                                    HEARTBURN*   

 

 

Heartburn is a burning pain in your chest, just behind your breastbone. The pain is often worse when lying down or bending over. It usually occurs after eating, and may occur at night.

 

Heartburn is usually due to regurgitation of gastric acid (gastric reflux) into the oesophagus.

 

The term ‘indigestion’ includes heartburn, along with a number of other symptoms. Indigestion is sometimes defined as a combination of epigastric pain and heartburn.

GORD (gastroesophageal reflux disease) is the most common cause of heartburn. In this condition acid reflux has led to inflammation of the oesophagus. 

Occasional heartburn is common, and most people can manage this symptom on their own, with lifestyle changes and over-the-counter medications.

 

Heartburn that is more frequent, or that interferes with your daily routine, may be a symptom of a more serious condition that requires medical care. An appointment should be made with your doctor if:

  • Heartburn occurs more than twice a week
  • Symptoms persist despite use of over-the-counter medications
  • You have difficulty swallowing
  • You have persistent nausea or vomiting
  • You have weight loss because of poor appetite or difficulty eating.

Heart attack symptoms and oesophageal symptoms can be very similar (there is a common nerve supply to, the heart and oesophagus). Seek immediate help if you experience severe chest pain or pressure, especially when combined with other signs and symptoms such as pain in the arm or jaw or difficulty breathing. Chest pain may be a symptom of a heart attack.

Causes 

Heartburn occurs when stomach acid backs up into the tube that carries food from your mouth to your stomach (oesophagus).

 

Normally when you swallow, a band of muscle around the bottom of your oesophagus (lower oesophageal sphincter) relaxes to allow food and liquid to flow down into your stomach. Then the muscle tightens again.

 

If the lower oesophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your oesophagus (acid reflux) and cause heartburn. The acid backup may be worse when you're bent over or lying down.

Risk factors 

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

Large or fatty meals.

Being overweight or pregnant also can increase your risk of experiencing heartburn.

Complications 

Heartburn that occurs frequently and interferes with your routine is considered gastroesophageal reflux disease (GORD). GORD treatment may require prescription medications and, occasionally, surgery or other procedures. GORD can seriously damage your oesophagus.

 

If an appointment is needed with your doctor, the following questions should be asked to gain a full understanding of the condition and what it means to you:

What's the most likely cause of my symptoms?

Is my condition likely to be temporary or chronic?

What kinds of tests do I need?

Do these tests require any special preparation?

What treatments are available?

Should I remove or add any foods to my diet?

I have other health conditions. How can I best manage these conditions together?

Your doctor should take a thorough history, and may ask some or all of the following:

When did you first begin experiencing symptoms, and how severe are they?

Have your symptoms been continuous or occasional?

What, if anything, seems to improve or worsen your symptoms?

Are they worse after meals or when lying down?

Do your symptoms wake you up at night?

Does food or sour material ever come up in the back of your throat?

Do you experience nausea or vomiting?

Do you have difficulty swallowing?

Have you lost or gained weight?

The incidence of GORD (Gastro Oesophageal Reflux Disease) in Australia:

  • 10.4% of patients visiting a GP
  • An estimated 9.2% of the Australian population (some 2 million people) [www.aihw.gov.au]
Tests and Diagnosis 

 

 

To determine if your heartburn is a symptom of GORD, your doctor may recommend:

  • X-ray, to view the shape and condition of your oesophagus and stomach.
  • Endoscopy, to check for abnormalities in your oesophagus. A tissue sample (biopsy) may be taken for analysis.
  • Ambulatory acid probe tests, to identify when, and for how long, stomach acid backs up into your oesophagus. An acid monitor that is placed in your oesophagus connects to a small computer that you wear around your waist or on a strap over your shoulder.
  • Oesophageal motility testing, to measure movement and pressure in your oesophagus.
Treatment and Drugs 

 

 

Antacids help neutralise stomach acid, thus they can help to relieve heartburn.

 

The most common of these over-the-counter medications are antacids such as calcium carbonate and sodium bicarbonate (for example, Gaviscon), aluminium hydroxide (Amphogel), magnesium hydroxide (Milk of Magnesia) and bismuth subsalicylate (Pepto-Bismol).

 

Antacids may provide quick relief. But they cannot heal an oesophagus damaged by stomach acid.

 

If over-the-counter treatments do not work, or you rely on them often, you may need prescription medication that works by reducing the production of acid in the stomach. The most common of these are:

  • H-2-receptor antagonists (H2RAs), such as Zantac and Pepcid. H2RAs do not act as quickly as antacids, but may provide longer relief.
  • Proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec or Losec).
Lifestyle and Home Remedies 

 

 

Lifestyle changes can help ease heartburn:

  • Maintain a healthy weight. Excess weight puts pressure on your abdomen, pushing up your stomach and causing acid to back up into your oesophagus
  • Avoid tight-fitting clothing, which puts pressure on your abdomen and the lower oesophageal sphincter
  • Avoid foods that trigger your heartburn
  • Avoid lying down after a meal. Wait at least three hours
  • Avoid late-night meals
  • Do not exercise after 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 is not effective.
  • Avoid smoking. Smoking decreases the lower oesophageal sphincter's ability to function properly.
  • Try not to increase abdominal pressure through bending or lifting.

Anxiety and stress can worsen heartburn symptoms. If these are present, appropriate stress management would be required.

Conclusion 

Knowing what heartburn is, the cause and the risk factors, and the judicial use of medication (antacids and, where necessary, H2 receptor antagonists or proton pump drugs), combined with the lifestyle changes outlined, means that this disorder can be effectively and easily managed.

 

*Copyright 2016: The Huntly Centre.

Disclaimer: All material in the huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.

 

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