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General Surgery

Heartburn

Heart burn also called as acid indigestion is a not a life threatening disorder, but is a symptom causing discomfort or burning sensation in the chest. It is caused when the acid in the stomach flows backward into the food pipe or the esophagus. Often many individuals experience heart burn and condition may not be bothersome unless if it is the symptom of gastroesophageal reflux disease (GERD).

When the food is swallowed, it passes down the esophagus and enters stomach. The distal end of oesophagus is guarded by muscle tissue, lower esophageal sphincter, which allows the movement of food content down into stomach and prevents the re-entry of stomach content into esophagus. Improper functioning of LES because of any abnormalities or conditions may cause entry of acid-mixed food from stomach into esophagus causing heart burn.

Heart burn may become worse when you are lying down because it is easier for the stomach acid to enter the esophagus. Patients with diabetes and hiatal hernia may have more chances of having heartburn.

Other symptoms accompanying heart burn include difficulty in swallowing, chronic cough, pain, sore throat, dizziness and formation of ulcers in the esophagus. In more severe cases heartburn may result in loss of weight, dehydration and you may vomit blood or observe small amount of blood in the stool.
When the acid travels beyond the esophagus, it may result in bitter and sour taste, which is called as regurgitation which is commonly observed when you lie down or bend.

Exact cause for heart burn may be diagnosed using various tests such as upper gastrointestinal (GI) endoscopy, upper GI series, esophageal manometry and 24-hour pH monitoring.

  • In upper GI endoscopy, a special instrument called endoscope is passed into the esophagus and stomach. The tiny camera attached to end of the endoscope enables to check for damage and infection.
  • In an upper GI series you may be asked to swallow a liquid which coats the stomach and oesophagus and series of X-ray images are captured to check for abnormalities.
  • Esophageal manometry is a procedure done to measure the weakness of LES muscle. It is recommended when the endoscopy reveals no abnormalities and patients still experience the heart burn. Endoscopy procedures may not show abnormal sphincter activity.
  • Twenty four-hour pH monitoring – In this procedure, a tube will be inserted through the nose into the esophagus and positioned above the LES. The tip of the tube contains a sensor which can measure the pH of the acid content refluxed into esophagus. A recorder, strap-like device that can be worn on wrist, will be connected to record the pH of the acid content. The tube will be left in place for 24 hours. Patients can also go back home and perform their regular activities and can record the pH of the acid content when they experience the symptoms. On the next day the recorder will be connected to a computer and the data will be analysed.

Heartburn can be treated by several medications which include

  • Antacids help in neutralising the acid. It is prescribed if the heartburn is caused by foods and certain physical activity.
  • Histamine-2 receptor blockers are also prescribed which help in decreasing the amount of acid produced by the stomach.
  • Antiemetic and gastroprokinetic agents which helps to empty the food and acid from the stomach so that the acid may not be available to flow back to the esophagus.
  • Proton pump inhibitors which help in preventing the production of acid in the stomach.

Surgery is the last treatment option considered if the medications are not providing heartburn relief. The surgery is called as fundoplication. This procedure involves tightening the LES muscle which prevents the acid from traveling backward to esophagus.

By modifying certain lifestyle habits you may prevent heartburn such as:

  • Avoid smoking and intake of alcohol
  • Lose weight if you are obese
  • Ensure that you do not lie down immediately after eating
  • Avoid wearing tight-fitting clothes as it may apply pressure on the stomach causing acid to flow backward
  • Avoid taking foods that will cause heartburn such as chocolate, fried fatty foods, and caffeine
  • Eat limited food and do not overeat