Heartburn: Causes, Symptoms and Treatment

Heartburn is one of the most common symptoms. So, according to the results of studies conducted in 2006, heartburn was identified in almost half of the respondents.

Moreover, often, doctors underestimate the significance of this symptom, do not treat it, or prescribe the wrong therapy. Patients, on the other hand, prescribe treatment for themselves or completely ignore heartburn.

But self-treatment can be either ineffective or harm the body. But heartburn cannot be ignored either, because later it can cause serious illnesses and complications.

Heartburn is a symptom of many medical conditions. But before we start looking at them, let's talk about what exactly is heartburn?

What is called heartburn

Many patients describe heartburn as a burning sensation behind the breastbone. This is true, but such a description does not distinguish heartburn, for example, in GERD, from heart disease.

Therefore, heartburn is understood as a burning sensation behind the sternum, which rises from the sternum to the neck.

Why does heartburn occur?

There are many reasons for the appearance of heartburn. This can be both a mistake in food and a symptom of a disease.

A burning sensation that rises from the sternum to the neck may appear after eating the following foods:

• coffee;
• alcohol;
• roast;
• citrus;
• strong tea;
• spicy dishes;
• marinades;
• tomato paste and tomatoes;
• mint;
• cocoa.

Heartburn can also appear when wearing tight belts, bending the body forward after eating, lifting weights over 8 kg, overweight. Also, heartburn is characteristic of pregnancy and constipation, due to increased intra-abdominal pressure.

A burning sensation behind the breastbone and in the esophagus is one of the symptoms of many diseases. Let's take a closer look at them.

GERD

Gastroesophageal reflux disease is the main cause of heartburn. This pathology develops due to the weakness of the lower esophageal sphincter.

The result is the throwing of gastric or even intestinal contents into the esophagus. Constant casting leads to damage to the lining of the esophagus, which becomes inflamed.

If you do not treat GERD, then over time complications will appear (bleeding, an ulcer in the esophagus, narrowing of its lumen, cancer).

With reflux disease, in addition to heartburn, the patient is worried about belching, dysphagia, odonophagia, soreness along the esophagus, increased salivation.

Belching often occurs after eating or drinking soda. Regurgitation may also occur.

Dysphagia - impaired swallowing, single phagia - pain when swallowing. These symptoms are due to impaired motor activity of the esophagus.

Soreness when swallowing with GERD appears with inflammation of the esophageal mucosa.

There are other signs of GERD that do not have to be present in every patient:

• dental syndrome - caries on the teeth, ulcers in the mouth;
• symptoms from the ENT organs: lump in the throat, hoarseness;
• bronchopulmonary symptom – cough, bronchial asthma, shortness of breath.

Sometimes GERD causes vomiting, nightmares, and insomnia.

Gastritis

Gastritis is an inflammation of the lining of the stomach or duodenum. It is also characterized by heartburn, but only if the inflammatory process is localized in the antrum.

In addition, if the pathological process is located in this area, the patient will complain of nausea, belching, regurgitation, soreness in the epigastrium (in the navel area and 2-3 cm above it), an unpleasant taste in mouth.

Ulcer

Heartburn in this disease occurs only if the ulcerative defect is located in the area of ​​the pylorus.

Then, in addition to heartburn, the patient will complain of nausea and vomiting, sour belching. It is characteristic that vomiting with this pathology brings relief.

NSAID gastropathy

A disease that occurs against the background of prolonged use of NSAIDs (for example, Diclofenac, Ketorol, Pentalgin, etc.).

Since this group of drugs inhibits the production of protective mucus in the stomach, erosion or ulcers are formed. The antrum of the stomach is more often affected.

With NSAID gastropathy, the patient experiences heartburn, nausea, belching, and vomiting.

Esophageal carcinoma

With this pathology, the patient feels a burning sensation and soreness behind the breastbone while eating. Swallowing disorders, regurgitation of food intake, loss of appetite and weight are also characteristic.

Hernia of the esophageal opening of the diaphragm

This disease is characterized by displacement of organs (stomach or esophagus, or intestines) into the chest cavity through the esophageal opening in the diaphragm.

In some patients, this location of the hernia can cause GERD or worsen its course.

In addition to heartburn, with a hernia of the esophageal opening of the diaphragm, patients experience pain in the epigastrium or in the left hypochondrium, sometimes in the region of the heart.

Soreness occurs immediately after eating, increases with flexion of the trunk and in a horizontal position.

Also, the patient will complain of vomiting, sour eructation, reflux of gastric contents into the esophagus, hiccups. Changes in the appearance of the chest are characteristic. With large hernias, there may be coughing and palpitations.

Angina pectoris

Sometimes the patient can confuse heartburn with pain in the heart. Angina pectoris is characterized by the occurrence of burning, pressing, squeezing pain behind the sternum.

In this case, soreness can appear in the neck, under the left shoulder blade, in the epigastrium, in the face, and in the jaw. These sensations arise after physical exertion, stress, cold.

The pain goes away either on its own, within 5 minutes, or after taking nitroglycerin. It is characteristic that taking proton pump inhibitors (Omeprazole) or antacids (Almagel, Maalox) does not relieve pain.

Myocardial infarction (abdominal variant)

This type of heart attack occurs if the lower wall of the heart is affected. In addition to burning in the upper abdomen, nausea, vomiting, bloating, and diarrhea appear. PPIs and antacids in this case also do not bring relief.

What if you have heartburn?

First of all, consult a doctor. He will compile a number of diseases in which there is heartburn, and send them to the necessary examinations.

Let's figure out what examinations a doctor can prescribe for heartburn.

Survey

To identify the cause of the burning sensation behind the sternum, it is necessary to undergo the following examinations:

• esophagogastroduodenoscopy (EGDS). Allows you to detect inflammatory changes in the tissues of the esophagus. Both erosion and ulceration of the mucous membrane are possible. In severe cases, there is a narrowing of the opening of the esophagus;
• esophagogastroduodenoscopy with biopsy. Tissue is taken from the area where there is inflammation. Then, in the laboratory, it is examined under a microscope to exclude the tumor process and identify the cause of the inflammatory changes;
• measuring the level of acidity in the esophagus. Such a procedure is carried out if no changes in the esophagus were detected during EGDS. The duration of the study is at least a day;
• manometry­– allows you to determine the level of pressure in the lower esophageal sphincter. If it is lowered, then gastric contents are thrown into the esophagus, which causes heartburn;
• pH impedance measurement - allows you to register the reflux of gastric contents into the esophagus;
• X-ray examination will help in the diagnosis of hiatal hernia, stomach ulcers;
• an electrocardiogram is indicated for the differential diagnosis of heartburn with chest pain in angina pectoris and myocardial infarction;
• a general blood test - in some cases (with a hernia of the esophageal opening of the diaphragm, NSAID gastropathy), anemia (a decrease in the number of red blood cells and hemoglobin) may be detected.

Treatment

How to help yourself with heartburn? First of all, you need to follow the regime and diet. In addition, you can use first aid drugs yourself.

Along with taking medications, you can use traditional medicine, but only after consulting a specialist. We will talk about all this further.

Non-drug treatment

Sometimes, to eliminate the burning sensation behind the sternum and in the esophagus, it is enough just to change the diet and follow some rules.

Diet

To avoid heartburn, you need to eliminate the following foods from your diet:

• spicy food;
• pickles;
• fatty meat and fish;
• salty;
• roast;
• sour fruits and juices;
• coffee;
• tea;
• potato;
• cabbage;
• beans;
• chocolate;
• tomatoes;
• carbonated drinks;
• alcohol.

Food should be taken at least 3-4 times a day. You need to give up snacks and overeating. The last meal should be no later than 2 hours before bedtime.

Mode

You can not lie down and bend over immediately after eating. You need to wait at least half an hour. It is necessary to reduce weight, quit smoking, do not lift heavy objects weighing more than 8 kg.

Don't wear tight belts. Sleep with the head of the bed raised. Stop taking NSAIDs if you drink them for a long time.

Drug treatment

What drugs will help with heartburn? PPIs, Antacids, Alginates, Adsorbents and Prokinetics are suitable as first aid remedies.

Proton pump inhibitors

This group of drugs includes Pantoprazole, Lansoprazole, Esomeprazole, Omeprazole, Dexlansoprozole. PPIs are currently the most effective treatment for heartburn.

They reduce gastric acidity and prevent further damage to the esophagus or stomach. Due to these properties, the burning sensation is eliminated.

The duration of taking these drugs is different and depends on the severity of the process that led to heartburn, be it an ulcer, gastritis or GERD. The average duration of taking the drug is 1 month.

It is necessary to say separately about such a drug as Dexlansoprazole. It contains 2 types of granules, which are released at different times in different parts of the intestine. This drug is suitable for patients who suffer from heartburn both at night and during the day.

Antacids

This group includes Almagel, Fosfalugel, Maalox. Due to the creation of a protective barrier on the surface of the esophagus or stomach, the contact of hydrochloric acid with the damaged tissue site stops, and heartburn disappears.

These medications can be taken after a food error or with other medications. Heartburn after taking antacids stops almost immediately.

If this does not happen, you need to think about the development of any complications. If, after long-term use of Antacids, heartburn began, on the contrary, to intensify, it means that a "rebound symptom" has developed, characteristic of this group of drugs.

Also, after taking some antacids, constipation may appear.

Alginates

The drug from this group is Gaviscon. It creates an obstacle to the reflux of stomach contents into the esophagus, and also helps damaged cells to regenerate faster, protecting them from gastric juice.

Gaviscon is also indicated for heartburn in pregnant women. You need to take the medicine 30 minutes after meals and before bedtime. Duration of action - not less than 4.5 hours.

Prokinetics

One of the representatives of this group is Itoprid hydrochloride. It reduces the frequency of reflux of gastric contents into the esophagus and stimulates the movement of food into the lower gastrointestinal tract. The drug is taken three times a day.

Adsorbents

This group includes Smecta, Polysorb, Enterosgel. Adsorbents reduce the acidity of gastric juice and adsorb bile acids on themselves. Due to this, heartburn is reduced. They are also suitable as first aid remedies for heartburn.

Folk remedies

It is not recommended to use alternative medicine as the main one. Folk remedies can be used only with medication and only after consulting a doctor.

Below are a few traditional medicine recipes for treating heartburn:

• flax seeds - pour 3 tbsp. flax seeds with a glass of hot water. Leave it overnight. The next day, take a tablespoon before each meal;
• with mild heartburn, you can make an aqueous solution of honey - 20 g per glass - and drink 100 ml twice a day before meals. Course - 30 days;
• take aloe leaves, mince them, add half a glass of honey and mix. Take before meals, 30 minutes in advance;
• add a tablespoon of honey to a glass of warm milk. Drink one hour before meals;
• viburnum jam. Rinse the viburnum, remove the seeds, bake in the oven, pass through a fine sieve. Add water and sugar to taste and bring to a boil. Jam take 2 tbsp. 200 ml of water;
• Add 30 g of dried celery root to 250 ml of water, bring to a boil. Take half a glass before meals;
• Grate potatoes or carrots, squeeze out the juice. Take 250 ml for 10 days;
• Release gas from mineral water. Heat it up to 40 degrees. Drink a glass one hour before meals. Course - 3 weeks;
• Pour 2 tablespoons of chamomile with a liter of boiling water. Let it brew, cool. Take 3 tbsp. before eating;
• squeeze the juice from the aloe leaves, add to 1 tbsp. juice glass of water. Take in small sips before meals.

Complications of heartburn

What can heartburn lead to? If it occurs as a result of the constant reflux of gastric contents into the esophagus, then this threatens the development of narrowing of the esophagus.

In addition, the formation of ulcers, bleeding, and esophageal cancer is possible.

Separately, it is necessary to say about the Barrett's esophagus - a condition in which cells of the intestinal epithelium appear in it, which are not typical for the esophagus. This can further give the growth of tumor cells.

If heartburn occurs against the background of a peptic ulcer, then bleeding, perforation (breakthrough of the stomach wall or esophagus), penetration (spread of the process to other organs), stomach cancer, narrowing of the lumen gatekeeper.

Prophylaxis

How to avoid heartburn? First of all, eat right. Do not overeat, do not eat too many spicy, salty, fried, hot foods. Do not abuse alcohol, stop smoking.

Don't lie down for half an hour after eating. Do not wear tight belts or lift more than 8 kg. It is imperative to reduce body weight if it is overweight.

When heartburn occurs while lying down, you need to sleep with the head end of the bed raised.

You do not need to take NSAIDs for longer than the prescribed period. And if this cannot be avoided, then together with NSAIDs you need to drink Omeprazole.

Conclusion

Heartburn can occur in many diseases: gastritis, ulcers and stomach cancer, GERD, esophageal cancer, NSAID gastropathy, hiatal hernia, angina pectoris, heart attack.

But with all these pathologies, heartburn is not the only symptom by which the disease can be diagnosed. However, only a doctor can carry out a differential diagnosis of these diseases, after examination and detailed questioning of the patient.

Therefore, when heartburn occurs, you should not ignore it. Visit your doctor to determine further treatment and diagnostic tactics.

After all, any delay threatens with serious consequences and the development of complications (bleeding, ulcers, stenosis, penetration, perforation, cancer).

EGDS, measurement of acidity in the esophagus, manometry, pH impedance measurement, X-ray examination, ECG will help diagnose the cause of heartburn.

Treatment is carried out with diet, medication and adherence. Food should be excluded from foods that increase the secretion of hydrochloric acid in the stomach.

Of the drugs for relieving heartburn, PPIs, Alginates, Antacids, Adsorbents, Prokinetics are suitable.

To prevent the disease, you need to eat at least 3-4 times a day, do not overeat, do not wear tight belts, do not lift weights more than 8 kg, do not smoke, drink alcohol in moderation.

You also need to remember that you cannot take a horizontal position within half an hour after eating and not lean forward.