Heartburn is a form of indigestion. It is usually felt as a pain behind the breastbone. Heartburn has nothing to do with the heart, although pain is felt in this region. People who get very painful heartburn sometimes think they are having a heart attack. Severe heartburn should be checked out by a doctor to ensure it is not symptom of a more serious condition.
Heartburn is linked to eating habits and posture. It happens when acid from the stomach gets forced upwards into the tube that food is passed down (gullet, or oesophagus). The walls of the gullet are not protected by the layer of mucus that the stomach has. Instead, the acid irritates the lining of the gullet, causing the burning pain. The regurgitated acid may also leave an acidic taste in the back of your throat.
Heartburn is usually relieved by over-the-counter medicines for indigestion.
The stomach produces juices containing a powerful substance called hydrochloric acid. This is used to break down food as part of the digestive process. Heartburn happens when this acid flows upwards into the gullet (oesophagus). There is a small, muscular valve dividing the stomach from the gullet. Normally, this only allows food into the stomach and not back up again. Heartburn occurs when it relaxes and allows some of the stomach contents to flow upwards.
Heartburn usually happens after a meal. It is affected by the quantity and type of food that you eat, as well as the time at which you eat. Dietary triggers include the following:
Fatty food is more difficult to digest and stays in the stomach for longer. Stomach acid has more chance to move back into the gullet.
Foods such as peppermint, spearmint and chocolate foods - these cause the valve between the gullet to loosen or relax allowing acid to enter more easily.
Caffeinated drinks, citrus juice and alcohol - these raise the level of acidity in the stomach. Citrus juices, spicy foods and tomato products can directly irritate the gullet.
Eating big portions- the stomach produces a large amount of acid in one go to break down the food. More stomach acid increases the chance of some of it being regurgitated.
Eating before bedtime - acid levels are high after meals, and certain positions, such as lying down, make it easier for acid to move into the gullet.
Heartburn is also linked to the following:
Pregnancy - as the body makes room for the baby, organs such as the stomach are pushed upwards, increasing the pressure on the valve in the gullet.
Certain over-the-counter medicines - medicines for heart problems, asthma and high blood pressure can sometimes stimulate excess acid production in the stomach.
Hiatus hernia - this is when part of the stomach pushes upwards into the chest through the normal opening in the diaphragm.
Being overweight puts more pressure on the abdomen and the valve in the gullet.
Smoking - this can stimulate acid production and cause the valve in the gullet to relax. It also slows down saliva production, which protects the gullet.
Tight clothes - clothes that are tight around the waist can increase abdominal pressure.
Heartburn is felt as a painful tightening or burning feeling in the chest that may make swallowing uncomfortable. You may have the sensation of acid or stomach contents in the back of the throat or mouth. Lying or bending down can make the symptoms worse.
The severity of the symptoms varies from person to person. For some people, the pain may be great enough to make them think they are having a heart attack. For others, there may be only a slight feeling of discomfort behind the breastbone.
Heartburn is very common and affects most people at some point. Attacks of heartburn are usually infrequent and quite mild.
If your heartburn is persistent and painful, it is important to see your doctor to rule out any underlying conditions. Prolonged pain in your chest that does not seem to be related to eating or drinking, may indicate a more serious condition such as a heart attack or angina. A heart attack may be suspected if intense pain is felt in the centre of the chest, and spreads to the arms (particularly the left) and lower jaw, or if the pain feels ‘vice-like’.
Stomach acid that is repeatedly regurgitated can damage the lining of the gullet. This eventually causes it to become narrower (a stricture), and can make swallowing difficult.
Persistent heartburn may be investigated using a barium meal. This procedure requires you to swallow a barium solution as a series of X-rays of the abdomen and chest are taken. The barium solution shows up the stomach and gullet more clearly, and the process of digestion can be seen.
You may also have an endoscopy to investigate the problem. This is when a flexible viewing tube is inserted into the gullet to examine the lining. A tissue sample (biopsy) may be removed and looked at more closely under a microscope.
Occasional or mild heartburn can usually be treated effectively with over-the-counter medicines for indigestion. These drugs are known as antacids and they may be taken in liquid or tablet form. They work by neutralising stomach acid quickly.
If your symptoms are severe or prolonged, and unresponsive to these medicines, your doctor may prescribe ulcer-healing drugs. These drugs reduce the production of stomach acid to allow the inflamed gullet to heal. Alternatively, antispasmodic drugs and motility stimulants may be prescribed. These drugs help to relieve muscle spasms in the intestines so that the stomach empties more quickly.
For severe heartburn, surgery may be necessary. The stomach is returned to its normal position and the muscular valve in the gullet is tightened. This procedure can be carried out by endoscopic surgery. A thin, flexible tube known as an endoscope carrying tiny surgical tools is passed through the mouth and into the stomach, where the operation is carried out. Alternatively, the operation can be performed using a type of endoscope that is rigid. In this case, surgical tools are passed into the stomach through small cuts (incisions) made in the abdomen
Self-help is often the best way to prevent or relive the discomfort of heartburn. Taking the following measures may help:
Stop smoking. Smoking after a meal, when the stomach is full, increases the chance of heartburn occurring.
Manage your weight. People who are overweight are more likely to suffer from heartburn.
Eat ‘little and often’, and do not over-fill the stomach. Try to eat two or three hours before you go to bed.
Certain foods may be worth avoiding if you suffer from heartburn including fatty and spicy food, acidic fruit drinks, spirits such as whiskey and brandy, and very hot drinks.
Avoid tight clothing, particularly around the waist.
Sit up straight when eating and do not exercise immediately before or after a meal.
Pregnant women can alleviate heartburn by keeping their weight increase within the recommended limits and eating sensibly.
source NHSDirect 151204