Heartburn and reflux disease. The essence of the problem.
The main thing about heartburn
- Heartburn is the most common symptom of gastroesophageal reflux disease (GERD).
- Heartburn can occur if acid or other stomach contents get into the esophagus.
- Although heartburn is rarely life-threatening, it can significantly reduce its quality. Heartburn affects the daily activities, sleep and diet of the patient.
- Heartburn can often be reduced by changing behavior and abandoning certain habits or taking over-the-counter medications, but if symptoms persist or become more and more disturbing, you need to contact a gastroenterologist to conduct additional research, including to rule out more serious diseases.
Between the esophagus and the stomach is located formed by the muscles of the lower esophageal sphincter. When a sip occurs, this sphincter opens, allowing food to pass into the stomach. After the pharynx, to prevent food lumps from returning and gastric juice to leak into the esophagus, this sphincter closes quickly.
When the lower esophageal sphincter relaxes uncoordinated or very weakly, the acidic contents of the stomach can be thrown back into the esophagus. This throw is called gastroesophageal (gastroesophageal) reflux and often causes heartburn, that is, burning in the chest, behind the place where the ribs converge. In addition to heartburn, GERD symptoms may include: constant sore throat, hoarseness, chronic cough, choking attacks, similar to chest pains from the heart, feeling of a lump in the throat. If acidic contents from the stomach regularly enter the esophagus, GERD can become chronic.
The occurrence and severity of gastroesophageal reflux and heartburn are influenced by various factors, including:
- the ability of the muscles of the lower esophageal sphincter to open and close properly
- composition and volume of gastric juice that enters the esophagus during reflux
- the quality and speed of cleansing the esophagus from harmful substances on its mucosa
- neutralizing action of saliva and another.
People experience heartburn and GERD in different ways. Heartburn is usually manifested as a burning sensation that occurs behind the sternum and rises up to the throat. Often there is a feeling that swallowed food returns to the mouth, which is accompanied by a sour or bitter taste. Heartburn usually occurs after a meal.
Heartburn symptoms may include:
- burning in the chest region
- burning in the chest and reflux, which are aggravated if the patient is lying or bending down.
Sometimes, despite the presence of reflux-damaging mucous membrane of the esophagus, there are no symptoms of the harmful effects of acid on the esophagus.
How often does heartburn occur?
Although heartburn is common, it is rarely life-threatening. However, heartburn can seriously limit daily activities and the effectiveness of labor. With proper understanding of the causes of heartburn and targeted treatment of it, most patients achieve improvement.
Is hiatal hernia causing heartburn?
The hernia of the esophageal opening of the diaphragm allows the stomach to shift into the chest cavity through the opening in the diaphragm. Although hernia of the esophageal orifice is not the cause of heartburn, it predisposes to the appearance of heartburn. A hernia of the esophageal opening of the diaphragm can shorten the esophagus, which can cause chronic heartburn. Hernia of the esophageal opening of the diaphragm, hernia can occur in people of any age and is often found in otherwise healthy people 50 years and older.
Note: any chest pain or difficulty swallowing requires immediate medical examination. All possible causes of such pain.
How to get rid of heartburn?
If heartburn does not go away
To relieve heartburn, which is not frequent, non-prescription medications can be useful, which are taken strictly according to the instructions. If long-term and frequent use of OTC drugs becomes necessary, or if they do not completely alleviate the patient’s condition, consult a gastroenterologist.
Patients with severe heartburn or heartburn, which, despite the measures described above, are not weakened, may require a more complete examination. A variety of tests and diagnostic procedures are currently used to find out the causes of heartburn and decide on further treatment.
Endoscopy – a procedure during which a thin flexible tube with a video camera and an illuminator at the end is inserted into the patient’s esophagus. Through this tube (endoscope), the doctor can see and assess the condition of the esophageal mucosa.
Biopsy – taking for the study of a small piece of the mucous membrane of the esophagus.
Manometry of the esophagus – a procedure for measuring pressure in the esophagus, necessary to determine the critically low pressure in the lower esophageal sphincter and to detect other disorders in the functioning of the muscles of the esophagus.
Impedancemetry – a procedure by which the velocity of fluid in different parts of the esophagus is measured. When used in conjunction with pH monitoring, impedancemetry provides the attending physician with a more complete picture of reflux in the esophagus, revealing both acidic and non-acidic episodes of reflux. A combined study (pH + impedancemetry) is also recommended for patients who are not susceptible to therapy with proton pump inhibitors, with persistent typical symptoms of GERD, chronic cough, unexplained excessive belching and regurgitation.
Acidity Monitoring (pH) – for difficult to diagnose patients, doctors can choose one of two methods for measuring the acidity (pH) in the esophagus. In the first variant, a thin tube is inserted into the esophagus through the nose – a pH probe, the other end connected to a small recording device that the patient wears on a belt. With their help, for 24 hours, refluxes are recorded during normal daily activities and during normal patient nutrition.
In the second method, instead of a tube (pH probe), a small wireless pH sensor attached to the esophageal mucosa is used. It transmits the collected data to the receiver, worn by the patient on the belt from 24 to 48 hours. Here the patient also conducts normal daily activities. After some time, the disposable transducer detaches from the esophageal mucosa and exits naturally from the digestive tract.
Surgery. A small number of patients with heartburn, possibly due to severe refluxes and poor therapeutic outcomes, will require surgery. To reduce the number of reflux, perform the operation of fundoplication. Patients who do not want to take medications that are necessary to get rid of heartburn are also candidates for surgery.