Heartburn, GERD (gastroesophageal reflux disease): What's it, causes, symptoms, diagnostics, treatment, prevention

Heartburn; Pyrosis; GERD (gastroesophageal reflux disease); Esophagitis

What is heartburn

Heartburn is a painful burning sensation in the upper chest, in the esophagus. It is usually caused by the release of acidic stomach contents into the esophagus., known as reflux or gastroesophageal reflux. Heartburn is a common symptom of many gastrointestinal disorders and most often occurs after eating or while lying down..

Causes of heartburn

Heartburn is usually caused by acidic stomach contents back up into the esophagus., known as reflux or gastroesophageal reflux. There are several factors, which can contribute to this, including:

• Lifestyle factors. Plentiful meal, eating too fast, alcohol consumption, smoking or lying down after eating can lead to heartburn.
• Medicines. Some medications, such as hormones, antacids, Calcium channel blockers, sedatives, antibiotics and some antidepressants, can affect the esophagus and cause heartburn.
• health conditions. Some diseases, such as hiatal hernia, diabetes, pregnancy and obesity, may increase the risk of heartburn.

Heartburn is more likely, if you have a hiatal hernia . Hiatus hernia is a condition, in which the upper part of the stomach protrudes into the chest cavity. It weakens the NPC, so it's easier for acid to return from the stomach to the esophagus.

Pregnancy and many medications can cause heartburn or make it worse.

Medicines, which can cause heartburn, include:

• Anticholinergic agents (used for seasickness)
• Beta blockers for high blood pressure or heart disease
• Calcium channel blockers for hypertension
• Dopamine-like drugs for Parkinson's disease
• Progestin for abnormal menstrual bleeding or birth control
• Sedatives for anxiety or sleep problems (insomnia)
• Theophylline (with asthma or other lung diseases)
• Tricyclic antidepressants

Talk to your doctor, if you think, that one of your medicines can cause heartburn. Never change or stop your medication, without consulting your doctor first.

Symptoms of heartburn

The main symptom of heartburn is a burning sensation in the chest.. Other symptoms may include:

• Sour taste in mouth.
• Pain or discomfort in the stomach or abdomen.
• Bloating and belching.
• Nausea or vomiting.
• Sore throat or hoarseness.
• Feeling, that food gets stuck in the throat.

When to see a doctor

In most cases, heartburn is mild and can be treated at home., but more severe symptoms may require medical attention. Seek medical advice, if you experience any of the following:

• Severe chest pain. If the pain is sharp and debilitating or lasts more than a few minutes, it could be a sign of a heart attack, and you should call the ambulance.
• Painful swallowing or vomiting. This could be a sign of Barrett's esophagus or gastritis., so you should see a doctor.
• Frequent or recurrent heartburn. If heartburn occurs more than twice a week, it could be a sign of gastroesophageal reflux disease (GERD), and you should see a doctor.

Weight loss. Unintentional and unexpected weight loss may be a sign of something more serious and should be seen by a doctor..

Questions, that your doctor may ask

When you seek medical attention for heartburn, your doctor will answer a series of questions as part of the diagnostic process. Here are some of the questions, which they can ask:

• Where is the pain?
• Are there other symptoms?
• Pain gets worse after eating?
• Have you been prescribed any medications, that can cause pain?
• What lifestyle habits can cause pain?
• You are overweight or obese?
• Have you ever had heartburn or reflux?
• What did you try to treat the pain?

Diagnosis Heartburn

If your doctor suspects, that you have heartburn, he can prescribe a series of tests to diagnose the condition. These tests may include:

• Endoscopy - this test involves inserting a thin tube with a camera at the end into the throat, to look closely at the esophagus and stomach. The doctor will look for signs of irritation or acid damage..
• US – this test involves using sound waves to create an image of the stomach and esophagus to look for any abnormalities.
• pH monitoring - in this test, a tube is inserted into the esophagus, and the monitor measures the amount of acid in the esophagus. This information can help the doctor determine, does reflux cause heartburn.
• Roentgen X-rays can be used to look for signs of GERD or other diseases.

Heartburn Treatment

Treatment for heartburn will depend on the cause., intensity and frequency of pain. Treatment options include:

• Medicines. OTC antacids can be used to neutralize stomach acid and relieve heartburn. Your doctor may also prescribe stronger medications, such as proton pump inhibitors or H2 blockers.
• Lifestyle Changes. Certain lifestyle changes can help reduce or prevent heartburn.. These include avoiding certain foods, giving up alcohol and cigarettes, eating small meals and avoiding activities, which can make the pain worse, like lying down after eating.
• Operation. If other treatments fail to provide relief, the doctor may suggest surgery to correct structural problems in the esophagus.

home treatment for heartburn

Home remedies can relieve heartburn and can be used along with other treatments. You must treat heartburn, because reflux can damage the lining of the esophagus. This can cause serious problems over time.. Changing habits may help prevent heartburn and other GERD symptoms.

The following tips will help you avoid heartburn and other symptoms of GERD.. Talk to your doctor, if you still have heartburn after following these steps.

At first, avoid foods and drinks, which can cause reflux, eg:

• Alcohol
• Caffeine
• Carbonated drinks
• Chocolate
• Citrus fruits and juices
• Peppermint and Spearmint
• Spicy or fatty foods, fatty dairy products
• Tomatoes and tomato sauces

Then try changing your eating habits:

• Don't bend over or exercise right after eating.
• Try not to eat 3-4 hours before bedtime. Lying down with a full stomach puts more pressure on the lower esophageal sphincter (NPC). This allows reflux to occur..
• Eat smaller portions.

Make other lifestyle changes as needed:

• Avoid tight belts or clothing, tight-fitting waist. These items can compress the stomach and cause food reflux..
• lose weight, if you are overweight. Obesity increases pressure in the stomach. This pressure can push the contents of the stomach into the esophagus.. In some cases, GERD symptoms disappear after, How does an overweight person lose weight? 4 to 7 kg.
• Sleep with your head elevated for about 15 centimeters. Sleeping with your head above your stomach helps prevent overcooked food from entering your esophagus.. Put books down, bricks or blocks under the legs at the head of the bed. You can also use a wedge pillow under the mattress. Sleeping on extra pillows does NOT help with heartburn, because at night you can slip off your pillow.
• Stop smoking or using tobacco. Chemicals in cigarette smoke or tobacco products weaken the LES.
• Reduce stress. Try yoga, tai chi or meditation, to relax.

If you still do not feel completely relieved, try medicine, otpuskaemыe without prescription:

• Antacids, such as Maalox, Milanta or Tums, help neutralize stomach acid.
• H2 blockers, such as Pepcid AC, Tagamet HB и Axid AR, reduce the production of stomach acid.
• Proton pump inhibitors, such as Prilosec OTC, Prevacid 24 HR и Nexium 24 HR, almost completely stop the production of stomach acid.

Heartburn Prevention

Lifestyle changes can help reduce and prevent heartburn. Consider adopting the following habits, to reduce the risk of heartburn:

• Eat slowly and avoid large portions. Eating too fast can lead to indigestion, which can cause heartburn. If you eat small meals and take your time, symptoms may decrease.
• Limit your food intake, causing heartburn. Avoid foods, causing heartburn, such as fatty and spicy foods, which can reduce the risk.
• Avoid cigarettes and alcohol. Smoking and drinking alcohol can cause heartburn. Limiting or eliminating these habits can help reduce your risk.
• Stay Active. Exercise helps reduce stomach pressure, which can lead to heartburn. Strive for 30 minutes of light or moderate activity most days of the week.
• Maintain a healthy weight. Being overweight or obese can increase your risk of heartburn.. A balanced diet and maintaining a healthy weight can help reduce this risk..

Used sources and literature

DeVault KR. Symptoms of esophageal disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 13.

Mayer EA. Functional gastrointestinal disorders: irritable bowel syndrome, dyspepsia, chest pain of presumed esophageal origin, and heartburn. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 128.