Heartburn is common condition observed in all age group of people. It is a chronic condition of burning in the chest behind the sternum (breastbone) and the burning sensation radiates to the neck and throat.
It is also known as pyrosis and cardialgia. When the stomach acids reflux to the esophagus and ruptures the esophageal inner membrane, the burning sensation in esophagus is experienced.
Heartburn has an impact on daily activities, sleep and quality of life. Heartburn is a predominant symptom of gastroesophageal reflux disorder (GERD/GORD) and also for diseases like Irritable bowel syndrome (IBS), dyspepsia, hiatal hernia, esophageal cancer. In the history of medical science heartburn has got limited attention.
A very few epidemiological studies have researched about heartburn.
Symptoms of heartburn
Heartburn is caused by the reflux action of the stomach caused due to the relaxation of a band of muscles called Lower esophageal Sphincter. The lower esophageal sphincter (LES) helps food to enter the stomach and prevents the upward movement of food and stomach acid into the esophagus by a gated channel.
When the gated movement of muscles is disturbed, the stomach acids flow out to the esophagus due to some reasons and this outward flow causes in inflammation in the esophagus resulting in heartburn. The two major symptoms of heartburn are burning sensation in the lower chest and acid regurgitation.
Burning sensation in the lower chest
Esophagus extends from the throat to the stomach. It is held by the upper esophageal sphincter (UES) muscles in the lower edge of the throat and by the Lower esophageal sphincter (LES) in the upper edge of the stomach. Esophagus is made up of several layers of cells especially mucosa cells.
The lower esophageal sphincter muscles are seen as a ring and are composed of smooth muscle cells. The LES muscle helps in the movement of food in the stomach and also helps to prevent reflux of stomach acid. The thickness of these muscle increases and decreases with the increase and decrease in the pressure influenced on the LES.
The reflux of stomach acid to the esophagus reacts with the sensitive inner lining epithelial cells of the esophagus.
The pressure exerted on the LES muscles makes the muscles to relax, which in turn causes the contents in the stomach revert back to esophagus. The burning sensation starts from the upper abdomen behind sternum and radiates to the neck and throat.
Regurgitation is a sensation of acid flow into your throat. The esophageal cells release chemicals called cytokines due to regurgitation.
These cytokines attract inflammatory cells to the esophagus which causes damage to the cells of esophagus. This ultimately results in the burning sensation and chest pain. Animal studies show that esophagus gets perfused when administrated with high concentration of acid.
Esophagus easily gets damaged when exposed to acid. Regurgitation can sometime cause partially digested food to flow back to the esophagus. The lower esophagus sphincter opens when food reaches the lower end of esophagus and it get closed, ensuring that no food content will flow back. When the stomach stretches a lot, the sphincter muscles relax and loosen temporarily, which causes the reflux action.
Esophagus does not have a protective mucous membrane lining which protects other organs from the adverse effects of microbes, biomolecules, organic compounds that enter in the human body.
The lack of this mucous membrane causes inflammation in the esophagus by the reflux actions. This inflammation is painful and results in heartburn. The reflux action can produce a sour taste in mouth.
Dyspepsia is a condition or symptom of chronic upper abdomen pain. The pain is observed recurrently in patients. It also acts as the first symptom of peptic ulcer. Bloating, belching and nausea are experienced along with dyspepsia.
Medications like NSAIDS (Nonsteroidal anti-inflammatory drugs), Cox-2 inhibitors, erythromycin, tetracyclines, and iron and potassium supplements can cause symptoms of dyspepsia. Dyspepsia is divided into subgroups based on their symptoms as ulcer-like, dysmotility-like, reflux-like and unspecified dyspepsia.
But this subgroup classification is poor in identifying the causes of dyspepsia. The symptoms of reflux-like dyspepsia are heartburn and acid regurgitation. Functional dyspepsia (non-ulcer dyspepsia) is a chronic dyspepsia condition, which is identified when no organic disease is identified in upper endoscopy and other test. Proton pump inhibitor therapy and use of prokinetic drugs provide relief to the symptoms of dyspepsia.
Severe heartburn and regurgitation can cause symptom like chronic cough, tooth decay and erosion, chest pain, nausea, asthma, laryngitis and idiopathic pulmonary fibrosis. Nausea is observed right after a meal is taken. In some patients, nausea is the only clue to identify the occurrence of heartburn. The following activities can trigger heartburns most likely:
- Eating a heavy meal
- Bending over
- Lying down (particularly on the back)
When the stomach acid that leaks out into the windpipe, it causes chronic cough and tooth decay. The irritation caused by reflux in the windpipe and into the throat is called as laryngopharyngeal reflux (LPR).
Laryngopharyngeal reflux generates a feeling of burning or an obstacle in the throat. Some patients have symptoms like hoarseness, throat clearing and difficulty in swallowing. It is also called as acid laryngitis.
They also have chronic sore throat and persistent hiccups. The coughing and wheezing from severe heartburns could become a trigger for asthma. Medical scientist assumes that severe heartburns can exert the nerves responsible for chest constrictions and acid reflux to the wind pipe. This is not proven yet by any experimental approaches.
These are symptoms of heartburns majorly observed in all age group of people. The ultimate cause of all these symptoms is the regurgitation of stomach acid to the esophagus and to the windpipe.
These symptoms persist for more than two hours, especially after meals. It also worsens during sleep, particularly lying down on the back. Antacid usages give temporarily relief to these symptoms. Patients are prescribed by continuous medication of antacid for the relaxation from these discomforts.
But these symptoms can be effectively managed by maintaining a healthy diet chart with high fiber, low carbohydrate and low fat content.