Heartburn: causes, symptoms, treatment
The content of the article:
- Mechanism of occurrence
- Heartburn Causes
- Predisposing factors
- Diagnostics
-
Heartburn treatment
- Gastritis and peptic ulcer
- GERD
- Heartburn prevention
- Why you shouldn't be treated with baking soda
- Video
A burning sensation, fullness in the projection of the stomach, behind the sternum, extending upward, often accompanied by a feeling of bitterness or acidity in the mouth, is called heartburn. It occurs as a result of the throwing of acidic gastric contents into the esophagus. It can be one of the manifestations of the gastrointestinal tract disease: gastroesophageal reflux disease (GERD), gastritis, duodenitis, cholecystitis, gastric ulcer, duodenal ulcer, etc. It is noted in violation of the regimen and / or diet, some nervous disorders.
Heartburn occurs due to the reflux of stomach contents into the esophagus
Mechanism of occurrence
There are many causes of heartburn, but the basis of its development is pathological gastroesophageal reflux (GER), or the throwing of stomach contents into the esophagus. Normally, food passing through the esophagus ends up in the stomach. The reverse process is prevented by the lower esophageal sphincter - a valve device consisting of muscles and folds of the mucous membrane. Insufficient efficiency of its work is the cause of various diseases of the esophagus and the main etiological factor in the occurrence of heartburn.
Many conditions contribute to the development of an unpleasant burning sensation in the upper abdomen and behind the breastbone.
| Pathological condition, condition | Process mechanism |
| Decreased antireflux barrier function |
A decrease in pressure in the lower esophageal sphincter, an increase in the number of episodes of its transient relaxation, a violation of the sphincter structure, for example, with a hernia of the esophageal opening of the diaphragm. |
| Slowing down the clearance of the esophagus (the time it takes for the pH of the esophagus to change from acidic to neutral) | Decrease in the neutralizing effect of saliva and esophageal mucus bicarbonates, inhibition of esophageal peristalsis and decrease in muscle tone of its thoracic region. |
| The damaging effect of a refluxant - gastric contents thrown into the esophagus | The implementation of an aggressive effect on the mucous membrane of hydrochloric acid, gastric enzyme (pepsin), bile acids, pancreatic enzymes, lysolecithin (a fat-like substance that is a normal component of the contents of the duodenum). |
| Decreased or lost ability of the esophageal mucosa to withstand the aggressive action of the refluxant |
Violation of the protective system of the esophagus, which consists of three barriers: preepithelial - the salivary and submucous esophageal glands; epithelial, ensuring the restoration of mucosal cells; postepithelial, created by a full blood supply. Damage to the mucous membrane begins when aggressive agents overcome the water layer surrounding it and the mucus barrier, and the increased proliferation of epithelial cells can no longer resist the formation of damage. |
| Impaired gastric emptying | Decreased motor function of the stomach, poor mixing of food and gastric juice, contributing to the creation of an "acid pocket", or "pool" of acid, in the cardiac part of the stomach, located directly at the esophageal opening. |
| Increased intra-abdominal pressure (strenuous exercise, constipation, overeating, pregnancy) | Slowing down the evacuation of food from the stomach, the formation of a hernia of the esophageal opening of the diaphragm, gastroesophageal reflux. |
Heartburn Causes
Heartburn is most closely associated with gastroesophageal reflux disease. It is the main complaint in most patients with GERD. Often, a burning sensation in the lower part of the chest that spreads upward accompanies the following diseases:
- esophagitis;
- gastritis with increased secretory function;
- peptic ulcer, duodenal ulcer;
- chronic cholecystitis;
- gallstone disease;
- peptic ulcer of the esophagus;
- strictures (persistent narrowing of the lumen) of the esophagus;
- hernia of the esophageal opening of the diaphragm;
- Barrett's esophagus (precancerous disease);
- adenocarcinoma of the esophagus;
- systemic diseases (scleroderma, lupus erythematosus);
- pernicious anemia.
Discomfort and burning sensation in the epigastrium can be the consequences of a violation of peristalsis (undulating directed contraction of the walls) of the esophagus, stomach, duodenum.
Heartburn can be not only a symptom of various diseases, but also a separate syndrome associated with functional esophageal disorders. These include reflux hypersensitivity and functional heartburn. These conditions are based on a violation of the interaction of the gastrointestinal tract and the central nervous system. They are characterized by the absence of visible changes in the mucous membrane of the esophagus and the connection between the unpleasant baking sensations in the patient and gastroesophageal refluxes, both acidic and non-acidic.
Predisposing factors
Heartburn symptoms can be triggered by:
- obesity;
- binge eating;
- unhealthy food stereotypes (eating on the go, before bed, insufficient chewing);
- abuse of certain foods and dishes (chocolate, strong tea, coffee, fatty foods, hot and alcoholic drinks, citrus fruits);
- wearing tight clothing that squeezes the stomach;
- heavy physical activity;
- work associated with bending the body forward;
- bad habits (alcohol, smoking);
- taking medications that reduce the tone of the lower esophageal sphincter (calcium channel blockers, beta-blockers, etc.);
- the use of drugs that reduce the effectiveness of protective antireflux mechanisms (non-steroidal anti-inflammatory drugs, acetylsalicylic acid, etc.);
- prolonged stress;
- pregnancy.
Heartburn is common during gestation. In the first half of pregnancy, it is due to a change in hormonal levels: an increasing level of progesterone has a relaxing effect on the tone of the lower esophageal sphincter. In the second half of pregnancy, the main development mechanism is an increase in intra-abdominal pressure due to an enlarging uterus.
Diagnostics
It is not very difficult to suspect heartburn due to the patient's characteristic complaints, it is much more difficult to establish the exact cause of its occurrence. To do this, use:
- contrast radiography;
- daily monitoring of the pH of the esophagus;
- endoscopic examination of the esophagus, stomach, duodenum;
- esophagomanometry (measurement of the contractile activity of the esophagus);
- scintigraphy of the esophagus (radioisotope research method);
- impedance measurement (a method of recording liquid and gas refluxes based on measuring the resistance, or impedance, provided by an alternating electric current to the esophageal contents);
- ultrasound examination of the liver, gallbladder, pancreas;
- laboratory examination (clinical, biochemical blood test).
A large arsenal of modern diagnostic methods does not negate the need for a thorough study of the history of the development of the disease. For a doctor to make a diagnosis, it is very important that the patient analyzes and sets out in detail the information about when characteristic complaints appear, what provokes them, which helps to get rid of them.
Usually, when the furnace starts in the epigastrium, behind the sternum, they turn to a therapist or gastroenterologist. But given that heartburn is a symptom of many diseases, you may need to consult other specialists.
Heartburn treatment
Most heartburn patients do not see a doctor right away. Treating seizures at home with baking soda solution is a common practice. This popular way to eliminate heartburn really works, but you should not use it all the time. It is imperative to find out the cause of the discomfort and treat not only the symptoms, but also the underlying disease.
Rennie is a popular remedy for heartburn
Gastritis and peptic ulcer
For gastritis, peptic ulcer, treatment is indicated, always under the supervision of a specialist, with drugs that reduce gastric secretion: blockers of H2-histamine receptors (Ranitidine, Cimetidine, Famotidine, Nizatidine, Roxatidine), proton pump inhibitors (Omeprazole, Lansoprozole, Rabantrazol). A diet with mechanical, thermal, chemical sparing is necessary, and with pronounced heartburn, a frequent fractional meal with restriction of carbohydrates. According to the indications, Helicobacteriosis is treated.
GERD
Heartburn therapy in gastroesophageal reflux disease is aimed at normalizing acidity, gastric and esophageal motility. To do this, use proton pump inhibitors, H2-histamine blockers, prokinetics that stimulate the motility of the gastrointestinal tract (Cerucal, Raglan, Bimaral, Ganaton, etc.), antacids that neutralize hydrochloric acid (Almagel, Gastal, Fosfalugel, Gastraciden, and etc.).
Heartburn prevention
To prevent heartburn in the absence of organic lesions of the gastrointestinal tract, it is required:
- normalize weight;
- quit smoking;
- limit alcohol;
- avoid overeating;
- do not eat at night;
- do not go to bed immediately after eating;
- do not abuse foods, drinks that stimulate acid production in the stomach;
- use medicines that provoke heartburn, according to indications and after meals;
- exclude heavy physical activity.
It is not always possible to comply with all these conditions. And if a burning sensation appears, then you should not take soda to stop the attack. Before consulting a doctor, you can use antacids and alginates (Gaviscon, Laminal).
Why you shouldn't be treated with baking soda
Baking soda (sodium bicarbonate) is an antacid that is absorbed into the bloodstream. They quickly reduce acidity, but they are short-lived and have a number of side effects. When taken, carbon dioxide is formed in the stomach, provoking gastroesophageal reflux and stretching the stomach. The latter circumstance resumes gastric secretion. In addition, after the completion of the action of sodium bicarbonate, an acid rebound is often observed - an increase in acid production in the stomach.
You can use home remedies for heartburn from time to time, but not on a regular basis. If burning attacks bother you often or for a long time, you need to consult a specialist for examination and prescription of etiological treatment.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
