Heartburn

HeartburnHeartburn is not actually the burning of heart, but it is a pain in the top part of abdomen in the chest.

Heartburn (pyrosis) is a form of indigestion, which causes a burning pain behind the breastbone in the centre of the chest. It is often associated with burping and a bitter taste at the back of the throat. The cause is a leakage of concentrated hydrochloric acid from the stomach up into the gullet (oesophagus), which runs from the back of the throat, down through the chest to the stomach. The stomach is lined with a thick layer of acid resistant mucus, but the oesophagus lacks this protection, and any stomach acid entering it causes burning pain.

Common simple causes include over eating, rapid eating, excess alcohol consumption and advanced pregnancy (pressure of the enlarged womb causes acid to be forced up into the oesophagus from the stomach).

Smoking can be an aggravating factor in all causes of heartburn. More serious causes include inflammation of the oesophagus from acid repeatedly coming up from the stomach (reflux oesophagitis) and a hiatus hernia (part of the stomach slips up into the chest cavity).

Barrett oesophagitis or syndrome, causes narrowing at the lower end of the oesophagus (gullet) from long term reflux of acid from the stomach up into the oesophagus. It occurs in 10-15% of people with acid reflux. The syndrome predisposes to cancer of the oesophagus, and as a result, regular follow up gastroscopies are necessary to detect any change. It is named after the English surgeon Norman Barrett, who noted this abnormality in the early 1950s.

Reflux oesophagitis causes inflammation and ulceration of the lower part of the oesophagus, and if left untreated for years, repeated irritation causes scarring and narrowing. The patient suffers from difficult and painful swallowing as well as the symptoms of reflux oesophagitis. The diagnosis is confirmed by a barium swallow x-ray or preferably by gastroscopy and biopsy of the affected tissue

Sometimes a peptic ulcer (ulceration of the stomach from excess acid production), or rarely a cancer of the stomach or oesophagus, may cause heartburn.

A number of serious conditions may cause pain in the chest that can be mistaken for heartburn. A heart attack is the most common of these, but a blood clot in the lungs, angina, (reduced blood supply to the heart) and inflammation of the membrane around the heart (pericarditis) may also be responsible. As a result, any heartburn that does not respond rapidly to simple medications (eg. antacids) must be checked by a doctor.

Medication (eg. proton pump inhibitors, H2 antagonists) can be used to control the acid reflux, and antacids can be swallowed to give immediate relief. If a stricture forms, it can be dilated by passing gradually larger dilators down the throat while the patient is anaesthetised.

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