Heartburn or acid reflux refers to acid moving up the esophagus. Heartburn treatment includes antacids prescribed after evaluating heartburn symptoms.

Heart Burn

Heartburn

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Iqra Mazhar

Overview

Heartburn, also known as acidic indigestion, is described as an irritation of the esophagus caused by stomach acids.

Heartburn is a common complaint in adults, especially after eating spicy food. It is described as an irritation of the esophagus or food pipe (the tube which connects the throat and stomach), that often gets worse after eating, or when lying down or bending over.&nbsp;

Heartburn is generally caused by stomach acid and can cause a burning discomfort in the upper belly or just below the breastbone. While the symptoms may be similar to a heart attack and despite its name, it has nothing to do with the heart. This can easily be managed with lifestyle changes and nonprescription medications. However, if it frequently interferes with your daily routine, it could be due to an underlying condition, requiring medical care.&nbsp;

 
Heartburn is a common symptom of acid reflux, a condition in which the contents of the stomach travel back up to the esophagus or food pipe, causing burning pain in the lower chest. However, if the heartburn occurs more than twice a week, it is called gastroesophageal reflux disease (GERD). Heartburn is also a symptom of GERD. Similarly, according to the American College of Gastroenterology, more than 15 million people in the United States experience heartburn symptoms every day. Though, the true prevalence of heartburn in Pakistan remains inconclusive because of limited studies. However, studies are highlighting the prevalence of GERD-caused heartburn in Asia and South-Central Asia. Hospital-based studies on GERD in Pakistan highlight that GERD is prevalent in 22.2% and 24.0% of the population<a href="#accordion">[1]</a>. Heartburn can affect general health and cause frequent interruptions during sleep, work, and social activities, adversely affecting an individual&rsquo;s well-being.

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Your heartburn may be caused because of a more serious condition, such as <a href="https://www.merisehat.pk/disease/gerd-56" target="_blank">gastroesophageal reflux disease or GERD</a>. Acid reflux can either be mild, moderate, or severe.&nbsp;

&nbsp;

<h5>Mild Acid Reflux&nbsp;</h5>

In this type of acid reflux, the lower part of your esophagus will be mildly inflamed. If you have been diagnosed with <a href="https://www.merisehat.pk/disease/gerd-56" target="_blank">GERD</a> you likely have the first stage of the disease. The symptoms of mild acid reflux include:&nbsp;

<ul>
	<li>Heartburn&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/angina" target="_blank">Pain in the chest&nbsp;</a></li>
	<li>The feeling of a lump in the back of the throat</li>
	<li>Regurgitation of food and liquid&nbsp;</li>
</ul>

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<h5>Moderate Acid Reflux&nbsp;</h5>

The main difference between mild and moderate acid reflux is that in this type of reflux, the symptoms appear several times a week. This causes irritation and inflammation in the esophagus. The symptoms of moderate acid reflux include:&nbsp;

<ul>
	<li>Heartburn&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/angina" target="_blank">Pain in the chest&nbsp;</a></li>
	<li>The feeling of a lump in the throat&nbsp;</li>
	<li>Regurgitation&nbsp;</li>
</ul>

&nbsp;

<h5>Severe Acid Reflux&nbsp;</h5>

In this type of acid reflux, the symptoms are quite extreme and may be linked with erosive esophageal inflammation. 15% of individuals suffer from severe acid reflux. The symptoms include:&nbsp;

<ul>
	<li>Heartburn</li>
	<li>Regurgitation&nbsp;</li>
	<li>Sore throat&nbsp;</li>
	<li>Hoarseness&nbsp;</li>
	<li>Chronic cough that does not get better</li>
</ul>

&nbsp;

<h5>Heartburn During Pregnancy&nbsp;</h5>

Studies have shown that more than half of pregnant women experience severe heartburn, during their second and third trimesters. Heartburn in pregnant women is characterized by irritation or burning sensation of the esophagus caused by a reflux of stomach contents. Heartburn in pregnancy may be triggered because of a change in hormone levels which affects the muscles of the digestive tract, in addition to how the body can handle different foods.&nbsp;

Pregnancy hormones can cause the lower esophageal sphincter (the muscle between the stomach and the esophagus that keeps acids in the stomach) to relax, causing the stomach acids to flow back into the esophagus. Additionally, when the baby grows, the uterus also enlarges and this may cause the abdomen to crowd, pushing the stomach acids upwards and triggering heartburn. Gallstones can also trigger heartburn in pregnancy, although this is quite rare. The symptoms of heartburn during pregnancy may include:&nbsp;

<ul>
	<li>Burning sensation or pain in the chest especially after eating&nbsp;</li>
	<li>Feeling of heaviness or bloating</li>
	<li>Burping&nbsp;</li>
	<li>Sour, bitter taste in the mouth</li>
	<li>Sore throat or cough</li>
</ul>

&nbsp;

<h5>Heartburn In Children And Infants&nbsp;</h5>

While heartburn is a common complaint in adults, infants, and children may also experience heartburn. About 2% of children between the ages of 3 and 9 years are affected by heartburn, whereas 5% of children, aged 10 to 17 years have heartburn<a href="#accordion">[2]</a>. The symptoms of heartburn in children can present early.&nbsp; 
&nbsp;

Heartburn in children is generally a symptom of gastroesophageal reflux disease. The harsh stomach acids can line up and irritate the delicate lining of the stomach. Sometimes this acid may even move up to the mouth causing heartburn and other symptoms. According to a study highlighting reflux in children, 1% of infants are affected with heartburn<a href="#accordion">[2]</a>. A common characteristic feature of heartburn in children is fussiness during feeding. In very young children, the reason for heartburn may be an immature digestive tract which tends to resolve by the age of 1.&nbsp;

&nbsp;

However, GERD in older children is different than it is in infants and adults. Children who are overweight, exposed to secondhand smoke, and eat spicy foods are at a higher risk of heartburn.&nbsp;

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Children with neurological conditions, for example, cerebral palsy are also at an increased risk. Symptoms of heartburn in children include a burning sensation in the chest, neck, and throat. Whereas if the heartburn is caused because of GERD, the infant or child may also show symptoms including:&nbsp;

<ul>
	<li>Arching of the back during feeding&nbsp;</li>
	<li>Chest pain or discomfort&nbsp;</li>
	<li>Chronic cough&nbsp;</li>
	<li>Hoarseness</li>
	<li>Fussiness&nbsp;</li>
	<li>Pain while swallowing&nbsp;</li>
	<li>Poor eating habits, such as refusing to eat or gagging and choking while eating</li>
	<li>Sore throat&nbsp;</li>
	<li>Vomiting&nbsp;</li>
	<li>Wheezing&nbsp;</li>
	<li>Crying during feeding&nbsp;</li>
	<li>Failure to gain weight</li>
</ul>

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Signs And Symptoms

The most common signs and symptoms of heartburn are a burning sensation in the chest and throat and a feeling of warmth because of the stomach acids going back up into the esophagus. Other symptoms of heartburn may include:&nbsp;

<ul>
	<li>A burning sensation or discomfort in the middle of the chest&nbsp;</li>
	<li>The pain in the chest may get worse when lying down or bending over</li>
	<li>Indigestion-like pain&nbsp;</li>
	<li>Foul, acidic taste in the mouth</li>
	<li>Difficulty swallowing</li>
</ul>

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Causes

While heartburn is rarely a significant cause of concern, it can be an indication of other underlying health issues. People of all ages may experience heartburn.&nbsp;

&nbsp;

Some of the most common causes of heartburn are obesity and smoking. Heartburn is caused because of a problem in the lower esophageal sphincter (LES), which is located where the esophagus meets the stomach, right below the rib cage. The lower esophageal sphincter normally keeps stomach acid in the stomach with the help of gravity. The LES opens and allows food to move into the stomach and closes again. However, if the LES doesn&rsquo;t close tightly enough, the stomach acids can travel up to the esophagus causing a burning sensation. The reason behind this is often overeating, constipation, pregnancy, hiatal hernia, GERD, or obesity which may put too much pressure on the stomach. Certain foods and drinks can also trigger heartburn. Some foods that may relax the LES and increase the production of acids are:&nbsp;

<ul>
	<li>Coffee or tea</li>
	<li>Tomatoes&nbsp;</li>
	<li>Garlic&nbsp;</li>
	<li>Onions&nbsp;</li>
	<li>Citrus fruits&nbsp;</li>
	<li>Chocolate&nbsp;</li>
	<li>Peppermint&nbsp;</li>
	<li>Foods high in fats and oils&nbsp;</li>
</ul>

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Heartburn can be triggered by certain eating and lifestyle habits, also. For example, eating large portions of food or having meals close to bedtime and high levels of stress. Other causes of heartburn may include:&nbsp;

<ul>
	<li>Certain medications such as anti-inflammatory drugs and aspirin</li>
	<li>Being <a href="https://www.merisehat.pk/disease/obesity" target="_blank">overweight</a></li>
	<li>Stress and a lack of proper sleep&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li>Wearing tight clothes or belts</li>
</ul>

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Diagnosis

If the heartburn persists for a long time, it may be caused because of a more serious underlying condition such as gastroesophageal reflux disease. The diagnosis is based on several tests, including: 
&nbsp;

<ul>
	<li>X-Ray: This test includes drinking a barium suspension that will coat the lining of your upper gastrointestinal tract, the esophagus, stomach, and upper small intestine. The coating will highlight defects, meaning that there is a problem in your digestive tract.&nbsp;</li>
	<li>Endoscopy: an endoscopy includes putting a small camera on a flexible tube down your throat. It will help the doctor see the upper GI tract.&nbsp;</li>
	<li>Ambulatory Acid Probe Test: An ambulatory probe test or esophageal pH monitoring is a 24-hour study that is recommended if you have unusual symptoms. For example, asthma-like symptoms, coughing, abdominal and chest pain. The doctor will put an acid monitor in the esophagus and measure how much acid backs up into the esophagus.&nbsp;</li>
	<li>Esophageal Manometry: Esophageal manometry measures the pressure and movement of acids into the esophagus.&nbsp;</li>
	<li>Electrocardiogram: An electrocardiogram will record the heart&rsquo;s electrical activity to check whether a heart problem is causing the symptoms.&nbsp;</li>
</ul>

&nbsp;

<h5>Heartburn Or Heart Attack?</h5>

A heart attack occurs when the arteries connected to the heart are blocked. Whereas heartburn occurs when the stomach acids travel back up to the esophagus. Symptoms of heartburn and heart attack both include chest pain. For this reason, many people having a heart attack may not act thinking that it may just be heartburn. However, if you are experiencing heartburn alongside other symptoms, for example, sweating or shortness of breath, your chest pain could be a heart-related issue. Other symptoms of a heart attack include:&nbsp;

<ul>
	<li>Squeezing pressure or fullness in the chest</li>
	<li>Nausea&nbsp;</li>
	<li>Lightheadedness&nbsp;</li>
	<li>Pain or discomfort in the arms, back, neck, jaw, and stomach</li>
</ul>

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Seek emergency medical help if you are experiencing any of these symptoms.

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Treatment

Heartburn can be treated with over-the-counter medications, including:&nbsp;

Antacids: the medications are available over the counter and can help relieve mild heartburn, stomach pain, indigestion, and gas.&nbsp;

Proton Pump Inhibitors (PPIs): proton pump inhibitors work by reducing the amount of stomach acids and calming the symptoms of acid indigestion.&nbsp;

H2 Blockers: the medication helps heal the esophageal lining by reducing the levels of stomach acid.&nbsp;

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<h5>Mild Heartburn&nbsp;</h5>

In the case of mild heartburn, the treatment generally revolves around making lifestyle changes to fight acid reflux. For example, avoid irritating foods and drinks, such as coffee, tea, spicy foods, and oily foods. In addition to a healthy diet, avoid meals before a least three hours of bedtime, and have over-the-counter antacids. If your heartburn is a symptom of GERD, you can try raising your head while sleeping with an extra pillow.&nbsp;

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<h5>Moderate Heartburn&nbsp;</h5>

While the symptoms of moderate heartburn are similar to less serious cases of acid reflux, they are not always very easy to control. Over-the-counter medications are often not as effective and you may have to ask your doctor to prescribe you something stronger, such as a proton pump inhibitor or H2 receptor blocker. Both these treatments require prescriptions.&nbsp;

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<h5>Severe Heartburn&nbsp;</h5>

At this stage of acid reflux, medication is essential to control the reflux. If not treated promptly, you are at a high risk of complications. If acid reflux is left untreated, you can develop precancerous lesions or esophageal cancer. The precancerous change in the esophagus is known as Barrett&rsquo;s esophagus. Around 10% of people with untreated acid reflux may develop cancers<a href="#accordion">[3]</a>. For this type of acid reflux, your doctor will perform special tests to determine whether you have a precancerous lesion. You may also have to undergo surgery or treatment for cancer.

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While occasional heartburn is rarely dangerous, underlying medical conditions causing the heartburn, for example, GERD can lead to serious problems:&nbsp;

<ul>
	<li>Long-term cough&nbsp;</li>
	<li>Inflammation of the larynx</li>
	<li>Inflammation of the esophagus or ulcers&nbsp;</li>
	<li>Difficulty swallowing because of narrowing of the esophagus&nbsp;</li>
	<li>Barrett&rsquo;s esophagus, a precancerous condition that can likely develop into esophageal cancer</li>
</ul>

&nbsp;

Certain foods and drinks can cause heartburn:&nbsp;

<ul>
	<li>Onions&nbsp;</li>
	<li>Citrus fruits&nbsp;</li>
	<li>Spicy foods&nbsp;</li>
	<li>Tomatoes&nbsp;</li>
	<li>Ketchup&nbsp;</li>
	<li>Chocolate&nbsp;</li>
	<li>Carbonated drinks&nbsp;</li>
	<li>Coffee or other caffeinated drinks&nbsp;</li>
	<li>Oily foods or fatty meals&nbsp;</li>
</ul>

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These include:

<ul>
	<li>Maintain a healthy weight&nbsp;</li>
	<li>Avoid foods and drinks that can trigger heartburn&nbsp;</li>
	<li>Wear clothes that are loose around the waist</li>
	<li>Eat smaller meals and avoid eating very close to bedtime&nbsp;</li>
	<li>Stop smoking&nbsp;</li>
	<li>Minimize stress&nbsp;</li>
	<li>Make sure you&rsquo;re getting at least 6 to 8 hours of sleep every night&nbsp;</li>
	<li>Wait for at least 3 hours after a meal before lying down&nbsp;</li>
	<li>Elevate your head 6 to 8 inches when lying down</li>
</ul>

&nbsp;

Key Points

<ul>
	<li>Heartburn, also known as acid indigestion, is a common complaint in adults, especially after eating spicy foods.&nbsp;</li>
	<li>Heartburn often worsens when eating, lying down, or bending over. Symptoms of heartburn include a burning discomfort in the upper belly and below the chest bone.&nbsp;</li>
	<li>The condition can easily be managed with lifestyle changes and over-the-counter medications. However, if symptoms continue to worsen, seek medical help immediately as it may be a symptom of an underlying pathology.</li>
</ul>

&nbsp;

[1] Riaz, H., Kamal, S.W. and Aziz, S., 2010. Students' Corner Gastroesophageal reflux disease (GERD) in students of a government medical college at Karachi. JPMA. The Journal of the Pakistan Medical Association, 60(2), p.147.

[2] Rybak, A., Pesce, M., Thapar, N. and Borrelli, O., 2017. Gastro-esophageal reflux in children. International journal of molecular sciences, 18(8), p.1671.

[3] Herbella, F.A., Neto, S.P., Santoro, I.L. and Figueiredo, L.C., 2015. Gastroesophageal reflux disease and non-esophageal cancer. World Journal of Gastroenterology: WJG, 21(3), p.815.