Heartburn

What is heartburn?

Heartburn is a type of indigestion. It occurs when acid and digestive juices flow back (reflux) from the stomach to the oesophagus (food tube), where they irritate the oesophagus lining causing pain and damage. The medical term for heartburn is reflux oesophagitis.

What are the symptoms of heartburn?

Symptoms include a burning sensation in the centre of the chest, which travels up the sternum (breastbone) to the throat; a taste of acid at the back of the throat; and small food particles re-entering the mouth.
Symptoms occur after eating and get worse on bending or lying down. Symptoms may be worse at night and improve on belching or on drinking milk. It may hurt to consume some food and drink, particularly hot drinks and spicy foods.

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When and why do people get heartburn?

There is a circle of muscle at the bottom of the food tube, which acts as a valve, and keeps food and acid down in the stomach.
If there is a lot of pressure on your stomach from outside (for example, if you are pregnant, you wear tight clothes or a belt, if you bend over, or if you are overweight) or you lie down; this can force acid up into your food tube.
If your stomach becomes too full (for example if you eat a huge meal, or eat very spicy food or drink large amounts of beer) this can also push acid up through the valve into the food tube.
If you have a hiatus hernia, part of your stomach gets pulled up into your chest, and the valve no longer works properly. Smoking can also cause the muscle valve to relax.
The lining of the food tube is not as tough as the stomach lining, and when acid touches it, it burns and gives you pain. Once the acid is in the food tube it may get stuck there where it causes damage and may over a period of time cause narrowing of the food tube.

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What tests will be done?

Diagnosis is usually made from the symptoms alone. If, however, your doctor is unsure of the exact diagnosis or your symptoms do not ease with treatment he/she will investigate further. There are two main diagnostic tests:
• An endoscopy ('magic eye'), where a small tube with a light on the end is inserted down your throat and
• A barium swallow and meal, where you swallow a white compound that can be seen by X-rays as it passes through your digestive system. An eyepiece at the other end allows the doctor to examine your oesophagus. Your doctor may take a biopsy (a small tissue sample).

What treatment is available?

The most important treatment is for you to change your lifestyle, as shown in the box below. There are several different types of medication.
• Antacids, which neutralise any excess acid.
• Medication that floats at the top of the stomach weighing the contents down and preventing the acid from coming up into the oesophagus.
• Proton-pump inhibitors and H2-receptor antagonists, which reduce the amount of acid produced by the stomach.
• Medication that tightens the valve and improves stomach emptying.
• Rarely surgery is required, usually when a hiatus hernia is present and treatment has not reduced the symptoms.

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Are there side-effects?

The side-effects depend on the type of medication you are prescribed. Common side-effects include diarrhoea, constipation, flatulence, fluid retention, dizziness and loss of balance.

Help yourself

• Stop smoking. Cutting down is not enough. ? ? ? ?
• If you are overweight, lose weight. Symptoms often stop when normal body weight is regained.
• Avoid large meals and large amounts of alcohol.
• Avoid fatty or spicy foods, hot drinks, and fruit juice.
• Drink milky drinks.
• Avoid aspirin if possible.
• Keep an upright posture for about an hour after eating. Always eat a few hours before going to bed.
• Raise your bed head by 4-6 inches (use bricks, books or blocks) or sleep with two or three pillows.
• Avoid tight clothes and belts around your stomach.
• Take your medication exactly as recommended by your doctor.
• Avoid bending and stooping, instead squat or kneel.
• Tell your doctor if you are taking any other medicine.

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