What is heartburn?
Heartburn is a common condition with as many as one in five adults in the UK having regular attacks. This condition is also called reflux, indigestion, dyspepsia or GORD (gastro-oesophageal reflux disease).
Symptoms
Heartburn is often felt as an uncomfortable, burning sensation in the chest or high in the abdomen. It can also be associated with belching, bloating, sour taste at the back of the mouth, bad breath and a persistent cough.
Causes
Heartburn is most often caused by stomach acid leaking up into the food pipe (i.e. oesophagus). The symptoms can also be mimicked by non-acidic stomach content refluxing into a sensitive food pipe, hence occasionally the initial treatment concentrating on anti-acids may not be effective in controlling symptoms.
The leaking of stomach content into the food pipe is caused by insufficiency of the lower oesophageal muscles. This insufficiency is commonly caused by weakness of the muscle, a hiatus hernia, and excessive gastric acid – or a combination of these factors. An overly-sensitive food pipe may cause symptoms despite low levels of leaking.
Treatments
New onset heartburn after the age of 55 with weight loss, persistent symptoms despite anti-acids, vomiting, difficulty or painful swallowing requires urgent medical consultation and investigation.
The assessment of heartburn symptoms will include a history and physical examination by your doctor. There may be a need to carry out blood tests as well as endoscopic, X-ray, food pipe acid and muscle pressure measurements.
The treatment of heartburn is aimed at resolving the exacerbating factors and controlling the symptoms, while reducing the risk of long-term complications. You will be guided by your doctor on the following possible management approaches:
- Increasing exercise
- Losing weight
- Having small and regular meals
- Using medicines to reduce the levels of acid in the stomach
Short-term medical treatments can also be used at highly symptomatic periods to increase the rate of stomach emptying or to coat the inner lining of the food pipe.
Complications
While heartburn does not lead to long-term problems for most people and can be controlled with the above measures, uncontrolled acid reflux can lead to damage to the food pipe. This is seen as erosions or ulcers of the food pipe, spasms of the food pipe muscles, narrowing of the food pipe, and a condition known as Barratt’s oesophagus.
Barratt’s oesophagus is caused by persistent irritation of the food pipe, with resultant changes of the inner lining cells. This condition requires long-term stomach acid suppression treatment and regular surveillance by your doctor. The surveillance is needed as it poses a small risk of developing oesophageal cancer. With treatment and surveillance there is a higher chance of diagnosing and treating any potential pre-cancerous cells.
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as to the accuracy or completeness of any of the information in this article, or found by following any link from this article. Please consult a doctor or other healthcare professional for medical advice.
Dr Mani Naghibi, Gastroenterologist
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