What is heartburn?
Heartburn is the symptom of a condition called gastro-oesophageal
reflux disease, in which acid juice from the stomach returns into
the oesophagus. This may lead to a harsh, burning sensation in the
upper abdomen, moving through the chest and throat to the neck.
Why does heartburn occur?
The oesophagus or the food pipe, has a small ring of muscle called
the lower oesophageal sphincter (LES). This acts as a valve,
opening during swallowing and closing immediately to prevent
moving back of the contents from the stomach to the oesophagus.
When however, this valve fails to close adequately, the stomach
acids may reflux back into the oesophagus causing a burning
sensation.
What contributes to a heartburn?
Fatty and spicy foods delay stomach emptying leading to an
increased tendency to reflux.
Certain types of medications like ibuprofen.
Excessive alcohol intake and smoking.
Obesity, which may lead to an increased pressure in the
abdominal cavity, causing the contents of the stomach to move back
to the oesophagus.
A structurally weak sphincter muscle.
Hiatus hernia, in which the stomach may push through the
diaphragm, preventing the muscle fibres of the diaphragm from
closing the lower end of the oesophagus.
What are the symptoms?
Painful burning in the upper chest or abdomen
Indigestion causing upset stomach
Regurgitation or throwing up
Difficulty in sleeping after eating
Hoarseness and sore throat
Bitter or sour taste in the throat.
How is the condition diagnosed?
Medical history and physical examination: a detailed record of
the eating and sleeping patterns and life style is taken by the
doctor.
Barium upper GI series: a special X-ray showing the oesophagus,
stomach and upper part of the small intestine may help the doctor
see the actual problem.
Endoscopy: This may be used to identify complications like
oesophagitis (inflammation of the oesophagus) and Barrett’s
oesophagus (a condition leading to cancer). In this procedure, a
small flexible tube with a tiny video camera is passed into the
oesophagus to allow the doctor see the oesophagus and stomach from
inside.
How is heartburn treated? A reflux problem is treated in 3 steps:
1. Lifestyle changes: Avoiding alcohol and eating less fatty foods
may help. It is also advisable to lose weight, reduce smoking and
alter eating and sleeping patterns. Taking small, frequent meals
rather than large, heavy meals is recommended.
2. Drug therapy: Taking antacids may reduce the frequency and
severity of attacks. In severe cases drugs like ranitidine which
reduce the amount of acid production may be prescribed. Drugs to
strengthen the oesophageal sphincter or relieve the symptoms may
also help.
3. Surgery: Patients who do not respond well to drug therapy, may
need to undergo a surgical procedure called anti-reflux surgery,
the commonest being Nissen’s fundoplication. This operation may be
done by an open procedure or by a laparoscope.
Anti-reflux surgery involves reinforcing the “valve” between the
oesophagus and the stomach by wrapping the upper portion of the
stomach around the lowest portion of the oesophagus. In a
laparoscopic procedure, surgeons use small incisions, to enter the
abdomen through canulas (narrow tube like instruments). The
laparoscope, which is connected to a tiny video camera, is
inserted through the small incision, giving a magnified view of
the patient’s internal organs on a television screen.
Even after the operation, it is advised to maintain a lifestyle
with regular, balanced meals, avoidance of alcohol and smoking and
maintenance of ideal body weight
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