Heartburn

What is Heartburn?

Heartburn is an uncomfortable burning sensation in the chest or throat. Heartburn occurs when the stomach acid irritates the esophagus— the tube that connects your throat and stomach. This leads to a burning discomfort in your chest or throat. If heartburn occurs twice a week or is more frequent, worsens at night or after meals or interferes with your daily routine may be a symptom of a more serious condition that requires medical care. This condition is gastro-esophageal reflux disease (GERD)

What happens in acid reflux and GERD

When you eat, food is carried from your mouth to your stomach through the esophagus, a tube-like structure that is approximately 10 inches long and 1-inch-wide in adults. The esophagus is made of tissue and muscle layers that expand and contract to propel food to your stomach through a series of wave-like movements called peristalsis.

At the lower end of the esophagus, where it connects to the stomach, there is a circular ring of muscle called the lower esophageal sphincter (LES). After you swallow, the LES relaxes to allow food to enter your stomach, where it mixes with acids that help with digestion. The LES then contracts to prevent the food and acid from backing up into your esophagus.

However, sometimes the LES relaxes inappropriately; this allows liquids in the stomach to wash back into the esophagus. This happens occasionally to everyone. Most of these episodes occur shortly after meals, are brief, and do not cause symptoms. Normally, reflux should rarely occur during sleep.

In some people, acid reflux causes bothersome symptoms or injury to the esophagus over time; when this happens, it is considered GERD. In general, damage to the esophagus is more likely to occur when acid refluxes frequently, the stomach contents are very acidic, or the esophagus is unable to clear away the acid quickly.

What puts me at risk of getting GERD?
  1. Hiatus hernia – This is a condition in which part of the upper stomach pushes up through the diaphragm (the large, flat muscle at the base of the lungs).
  2. Obesity
  3. Pregnancy
  4. Lifestyle factors and medications – Some foods (including fatty foods, chocolate, and peppermint), caffeine, alcohol, and cigarette .
How do I know that I have GERD?

The most common symptoms of GERD are:

 

  1. Heartburn – This typically feels like a burning sensation in the center of the chest, which sometimes spreads to the throat. It most often happens after a
  2. Regurgitation – This is when stomach contents (acid mixed with bits of undigested food) flow back into your mouth or

Other symptoms of GERD may include:

 

  • Stomach pain (pain in the upper abdomen)
  • Chest pain
  • Difficulty swallowing (called dysphagia) or pain on swallowing (called odynophagia)
  • Persistent laryngitis/hoarseness (due to the acid irritating the vocal cords)
  • Persistent sore throat or cough
  • Sense of a lump in the throat
  • Nausea and/or vomiting
How is GERD Diagnosed?

The Diagnosis of Gerd is based on symptoms — If you have the “classic” symptoms of GERD (heartburn and/or regurgitation) your health care provider may be able to diagnose you with GERD based on this alone. In this situation, they will likely suggest a trial of medication; if your symptoms improve, it is likely that GERD was the cause.

Upper endoscopy — An upper endoscopy is a test that allows a doctor to directly examine the upper gastrointestinal (GI) tract.

Why should I be treated for GERD?

 

If untreated the following complications can occur:

  • Erosive esophagitis — This is when the esophagus is damaged (eroded) as a result of burning from stomach acid.
  • Esophageal stricture — Damage from acid can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or pills to get stuck in the esophagus.
  • Barrett’s esophagus — Barrett’s esophagus occurs when the normal cells that line the lower esophagus (called squamous cells) are replaced by a different cell type (called intestinal cells). This process usually results from repeated damage to the esophageal lining; longstanding GERD is the most common cause.
  • Lung and throat problems — If stomach acid backs up into the throat, this can cause inflammation of the vocal cords, a sore throat, or a hoarse voice. The acid can also be inhaled into the lungs and cause pneumonia or asthma Over time, acid in the lungs can lead to permanent lung damage.
  • Dental problems — Repeated episodes of acid reflux can erode the enamel of the teeth over time.
How is GERD treated?

Medications that are used are directed at neutralization or reduction of gastric acid. Agents used include antacids and PPIs.
Proton pump inhibitors — Proton pump inhibitors (PPIs) are the most effective medications for reducing stomach acid. They include esomeprazole (brand name: Esomac). The recommended dosage is Esomac 40mg per day for 4-8 weeks and it should be taken 30-1hour before meals for effectiveness.
Antihistamines such as Ranitidine were used previously however in 2020, the US Food and Drug Administration (FDA) removed it after testing showed that some products were found to be contaminated with a substance that can increase a person’s risk of cancer if consumed at high enough levels over time. It has been withdrawn from the market by the Pharmacy and Poisons Board in Kenya.

Do Lifestyle changes help?

The following lifestyle changes are often recommended:

  • Losing weight (if you are overweight)
  • Raising the head of your bed six to eight inches
  • Avoiding foods that trigger symptoms
  • Quitting smoking

– Some foods (including fatty foods, chocolate, and peppermint), caffeine, alcohol, and cigarette .

References

  • Atherton JC. The pathogenesis of Helicobacter pylori-induced gastro-duodenal diseases. Annual Review of Pathology 2006; 1:63–96.
  • Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clinical Microbiology Reviews 2006; 19(3):449–490.
  • Dunn BE, Cohen H, Blaser MJ. Helicobacter pylori. Clinical Microbiology Reviews, 1997, 10: 720–741.
  • Bardhan PK. Epidemiological features of Helicobacter pylori infection in developing countries. Clinical Infectious Diseases, 1997, 25: 973–978
  • Labigne A, de Reuse H. Determinants of Helicobacter pylori pathogenicity. Infectious Agents and Diseases, 1996, 5: 191–202.
  • McColl KEL. Helicobacter pylori: clinical aspects. Journal of Infection, 1997, 34: 7–13.
  • Riegg SJ, Dunn BE, Blaser MJ. Microbiology and pathogenesis of Helicobacter pylori. In: Blaser MJ et al., eds. Infections of the gastrointestinal tract. New York, Raven Press, 1995: 535–550.
  • Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017; 112:212.
  • Fallone CA, Chiba N, van Zanten SV, et al. The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults. Gastroenterology 2016; 151:51.
  • Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66:6.
  • Begue RE et al. Dietary factors associated with the transmission of Helicobacter pylori in Lima, Peru. American Journal of Tropical Medicine and Hygiene, 1998, 59: 637–640.
  • Namavar F et al. Presence of Helicobacter pylori in the oral cavity, oesophagus, stomach, and faeces of patients with gastritis. European Journal of Clinical Microbiology and Infectious Diseases, 1995, 14: 234–237.
  • 37.Sahay P, Axon ATR. Reservoirs of Helicobacter pylori and modes of transmission. Helicobacter, 1996, 1: 175–182.
  • 38. Me´ graud F. Transmission of Helicobacter pylori: faecal-oral versus oral-oral route. Alimentary Pharmacology and Therapeu tics, 1995, 9 (Suppl. 2): 85–91.