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Heartburn

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Definition

Heartburn is a burning feeling in the middle or the lower part of chest accompanied by a sour or bitter taste in the throat and mouth. There may also be a feeling of food returning to the mouth. Heartburn is also called acid reflux disease or gastroesophageal reflux disease (GERD). It usually occurs after eating a big meal or while lying down.

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Patho-physiology and Causes

When you swallow, food passes from your mouth down a tube called the esophagus. The food passes through a gate-like aperture that allows the food to pass into the stomach. This gate-like aperture closes immediately as soon as the food passes through. If this aperture doses not close or closes incompletely, the acid in the stomach flows back through the opening and up the esophagus. This is called acid reflux. The acid can irritate the esophagus, cause heart burn, a sour taste in the mouth and a burning sensation in the throat. Some of the common causes of heartburn include:

  • Fatty foods
  • Chocolate
  • Caffeinated drinks
  • Onions
  • Spicy foods like pizza, chili, curry
  • Mint
  • Some cheeses
  • Some medications like tranquilizers such as diazepam (Valium), alprazolam (Xanax), theophylline (Elixophyllin), aspirin, ibuprofen
  • Alcohol
  • Large meals
  • Lying down soon after eating

Heartburn some times worsens after overeating, when bending over, when lying down, obesity, pregnancy, tight clothing, cigarette smoking, citrus fruits, tomatoes and tomato products, and most certainly stress.

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Implications

Having heartburn once-in-a-while after eating fatty and spicy foods is not common. However, heartburn that is persistent over a prolonged period of time is certainly a serious concern. If heartburn goes on for a prolonged period of time, it can lead to esophagitis or an inflammation of the lining of the esophagus. If the esophagitis becomes severe, there will be scarring of esophagus, the esophagus might become narrow (due to stricture) and there might be esophageal bleeding or difficulty swallowing. Persistent and severe heartburn can also be a sign of peptic ulcer.

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What You Can Do

  • Medications
    • H2 receptor blockers such as Pepcid, Tagamet, Zantac.
    • Omeprazole (Prilosec) and lansoprazole (brand name: Prevacid), reduces the production of acid by the stomach
    • Metoclopramide (Reglan) reduces acid reflux.
    • Antacids containing both magnesium hydroxide and aluminum hydroxide Maalox, Mylanta, Riopan, TUMS and peptobismol.
  • Surgery
    • Surgery may be indicated if the heart burn is due to any of the reasons like:
        • Large hiatal hernia
        • Severe esophagitis, especially with bleeding
        • Recurrent narrowing of the esophagus
        • Barrett's esophagus, especially with progressive precancerous or cancerous changes
        • Severe pulmonary problems, such as bronchitis, pneumonia, asthma or a chronic cough due to acid reflux
  • Prevention
    • Raise the head of your bed by about 4-6 inches.
    • Try to eat at least 2 to 3 hours before going to sleep.
    • Take naps preferably in a sleeping chair.
    • Lose weight
    • Eat small but frequent meals
    • Do not overeat.
    • Eat high-protein, low-fat meals.
    • Avoid tight clothing like tight belts, tight bra, tight panties or corsettes
    • Avoid foods that give you heartburn.
    • If you are a smoker, quit smoking.

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Heartburn