heartburn - Pathophysiology, Causes, Diagnosis, Treatment

A burning sensation usually felt intermittently within the chest over the lower part of the breastbone. It results from regurgitation of the contents of the stomach into the lower part of the oesophagus, inducing a spasm. In some cases this is due to part of the stomach rising into the opening where the oesophagus passes through the diaphragm (hiatus hernia).

(Discuss) Name of Symptom/Sign:
Heartburn
Classifications and external resources

ICD-10	R12
ICD-9	787.1

Heartburn or pyrosis is a painful or burning sensation in the esophagus, just below the breastbone caused by regurgitation of gastric acid.

Heartburn actually has nothing to do with the heart;

Pathophysiology

The sensation of heartburn is caused by exposure of the lower esophagus to the acidic contents of the stomach. If the sphincter relaxes for any reason (as normally occurs during swallowing), stomach contents, mixed with gastric acid, can return into the esophagus.

Causes

Foods that may cause heartburn:

Alcohol Coffee, tea, cola, and other caffeinated and carbonated beverages Chocolate Citrus fruits and juices Tomatoes and tomato sauces (such as pizza and pasta sauce) Spicy foods and fatty foods (including full-fat dairy products) Peppermint and spearmint Dry foods such as peanuts Fatty foods such as ice cream

It can also be psychosomatic, primarily in relation to stress.

Diagnosis

Physicians typically diagnose gastroesophageal reflux disease (GERD) based on symptoms alone.

Treatment

Prevention

If heartburn occurs when lying down, raising the head with pillows or sitting up frequently provides relief – although care must be taken to avoid placing continuous strain on the neck.

Medications

Antacids, H2-receptor antagonists and proton pump inhibitors are used (in that order) to treat heartburn.

Antacids

Daily treatment with Antacids is effective for 25-30% of people with GERD.

Water

Some have suggested that drinking a large glass of water dilutes the high pH levels in the stomach (since pure water has a neutral pH of 7) and allows the pain to temporarily subside. However, because pH is measured on a logarithmic scale (a shift of 1 on the pH scale corresponds to a change by a factor of 10), to substantially dilute the pH of stomach acid would mean drinking at least 10 times as much pure water as the volume of acid.

H2-receptor antagonists

With the advent of proton-pump inhibitors, H2-receptor antagonists are not widely used.

Proton-pump Inhibitors

Proton pump inhibitors are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors directly block acid production in the stomach cells and provide more effective relief than less powerful medications.

Restricting Diet

Restricting diet is very important, since 90-95% of sufferers of heartburn or esophageal disorder can link their symptoms to specific foods. Therefore, it is important that heartburn sufferers manage their diets as a way to treat their heartburn. Sufferers should choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers.