What is heartburn?
Heartburn is the symptom of a condition called gastro-oesophageal reflux disease, in which acid juice from the stomach returns into the oesophagus. This may lead to a harsh, burning sensation in the upper abdomen, moving through the chest and throat to the neck.
Why does heartburn occur?
The oesophagus or the food pipe, has a small ring of muscle called the lower oesophageal sphincter (LES). This acts as a valve, opening during swallowing and closing immediately to prevent moving back of the contents from the stomach to the oesophagus. When however, this valve fails to close adequately, the stomach acids may reflux back into the oesophagus causing a burning sensation.
What contributes to a heartburn?
- Fatty and spicy foods delay stomach emptying leading to an increased tendency to reflux.
- Certain types of medications like ibuprofen.
- Excessive alcohol intake and smoking.
- Obesity, which may lead to an increased pressure in the abdominal cavity, causing the contents of the stomach to move back to the oesophagus.
- A structurally weak sphincter muscle.
- Hiatus hernia, in which the stomach may push through the diaphragm, preventing the muscle fibres of the diaphragm from closing the lower end of the oesophagus.
What are the symptoms?
- Painful burning in the upper chest or abdomen
- Indigestion causing upset stomach
- Regurgitation or throwing up
- Difficulty in sleeping after eating
- Hoarseness and sore throat
- Bitter or sour taste in the throat.
How is the condition diagnosed?
- Medical history and physical examination: a detailed record of the eating and sleeping patterns and life style is taken by the doctor.
- Barium upper GI series: a special X-ray showing the oesophagus, stomach and upper part of the small intestine may help the doctor see the actual problem.
- Endoscopy: This may be used to identify complications like oesophagitis (inflammation of the oesophagus) and Barrett’s oesophagus (a condition leading to cancer). In this procedure, a small flexible tube with a tiny video camera is passed into the oesophagus to allow the doctor see the oesophagus and stomach from inside.
How is heartburn treated?
A reflux problem is treated in 3 steps:
- Lifestyle changes: Avoiding alcohol and eating less fatty foods may help. It is also advisable to lose weight, reduce smoking and alter eating and sleeping patterns. Taking small, frequent meals rather than large, heavy meals is recommended.
- Drug therapy: Taking antacids may reduce the frequency and severity of attacks. In severe cases drugs like ranitidine which reduce the amount of acid production may be prescribed. Drugs to strengthen the oesophageal sphincter or relieve the symptoms may also help.
- Surgery: Patients who do not respond well to drug therapy, may need to undergo a surgical procedure called anti-reflux surgery, the commonest being Nissen’s fundoplication. This operation may be done by an open procedure or by a laparoscope.
Anti-reflux surgery involves reinforcing the “valve” between the oesophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the oesophagus. In a laparoscopic procedure, surgeons use small incisions, to enter the abdomen through canulas (narrow tube like instruments). The laparoscope, which is connected to a tiny video camera, is inserted through the small incision, giving a magnified view of the patient’s internal organs on a television screen.
Even after the operation, it is advised to maintain a lifestyle with regular, balanced meals, avoidance of alcohol and smoking and maintenance of ideal body weight.