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Heartburn,
also known as acid indigestion, is a common symptom of
gastroesophageal reflux (GERD) or acid reflux. You may
experience GERD when acid contents in your stomach back
up into your esophagus. This occurs when a muscle at the
end of the esophagus, called the lower esophageal sphincter
(LES), fails to operate properly. The LES opens when swallowing
to allow the passage of food to the stomach and then closes
to prevent food juices from returning, or refluxing, back
into the esophagus.
The cause of heartburn is unknown, but certain factors
may contribute to the condition. They include:
•
Specific foods such as garlic, spicy foods and fried foods
•
Smoking
• Caffeine
• Pregnancy
•
Being overweight
•
Alcohol
•
Certain medications, such as nitrates and some muscle
relaxants
A condition known as hiatal hernia also may contribute
to heartburn. A hiatal hernia occurs when the upper part
of the stomach is above the diaphragm, the muscle wall
that separates the stomach from the chest. The diaphragm
helps the LES keep acid from coming up into the esophagus.
When a hiatal hernia is present, it is easier for the
acid to come up.
Occasional heartburn doesn't mean you have GERD. Ten percent
of the population experiences heartburn and other symptoms
of GERD at least once a week. But heartburn that occurs
more than twice a week may be considered GERD, which can
lead to more serious health problems such as inflammation
of the esophagus, or Barrett's esophagus, and lung problems.
Signs and Symptoms
Heartburn is a burning pain in the lower breastbone that
may travel toward your neck. It also is associated with
regurgitation of food and liquid into your mouth and a
bitter or acidic taste.
Heartburn, also known as acid indigestion, is actually
a common symptom of an underlying condition called gastroesophageal
reflux (GERD) or acid reflux. In addition to heartburn,
symptoms of GERD may include:
•
Persistent sore throat
•
Hoarseness
•
Chronic cough
•
Asthma
•
Chest pain
•
Feeling like there is a lump in your throat
Diagnosis
Talking with your doctor about your symptoms may be enough
for him or her to make a diagnosis of gastroesophageal
reflux (GERD). However, additional tests may be recommended
to determine its severity, including:
• Upper
GI Endoscopy — An endoscope is a device
consisting of a flexible tube and a mini camera. In endoscopy,
this device is introduced through the mouth to view the
esophagus, stomach and upper small intestines.
•
Upper GI Series — These are a series
of X-rays that examine the esophagus, stomach and small
intestine. The X-rays are taken after you have swallowed
a barium suspension, which coats the lining of the upper
gastrointestinal tract. A radiologist then looks for irregularities
in the linings, which can help diagnose a variety of digestive
problems.
• Esophageal
Manometry — This test measures the motor
action of the lower esophageal sphincter and esophageal
body. A catheter measures esophageal pressure and records
the duration and sequence of contractions..
• Esophageal
pH Monitoring — This is a test to measure
the frequency and duration of stomach acid that enters
the esophagus.
Treatment
- If you have ever experienced occasional heartburn associated
with gastroesophageal reflux (GERD), you are probably
familiar with the popular over-the counter antacids that
neutralize stomach acid and relieve heartburn symptoms.
However, these medications will typically not work if
your heartburn is more frequent and severe. Other medications,
which work to prevent reflux and block acid production,
are available for more severe cases of heartburn.
- In addition, lifestyle and dietary modifications are
recommended and may relieve symptoms in some patients.
A surgical procedure called fundoplication to tighten
the lower esophageal sphincter muscles, or LES muscles,
may be an alternative to drug therapy.
- Recently, less invasive endoscopy techniques have been
developed to tighten the barrier between the esophagus
and the stomach. However, the safety and effectiveness
of these new alternatives to surgery are still being determined
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