Heartburn Health Article

Definition

Heartburn is a burning sensation in the chest that can extend to the neck, throat, and face. It usually occurs after eating and is worsened by bending, lifting, or lying down.

Description

Heartburn, sometimes called acid indigestion or gastroesophageal reflux, is very common. More than one third of the population suffers from occasional heartburn, as do about one half of pregnant women. Some 50 million adult Americans complain of frequent heartburn. The occurrence of heartburn generally increases with age; however, it is common—and often overlooked—in infants and children.

Heartburn occurs when digestive juices from the stomach move back up into the esophagus, the tube connecting the throat to the stomach. The upper third of the esophagus consists of skeletal muscle that propels the food downward. The lower two-thirds of the esophagus is smooth muscle. The lower esophageal sphincter (LES) is a thick band of muscle that encircles the esophagus just above the uppermost part of the stomach. This sphincter is usually tightly closed—opening only when food passes from the esophagus into the stomach—and prevents the contents of the stomach from moving back into the delicate esophageal tissue. The stomach has a thick mucous coating that protects it from the strong hydrochloric acid it secretes to digest food. However the much-thinner esophageal mucous coating does not protect against stomach acid. Thus, if the LES opens inappropriately or fails to close completely, stomach acids can back up and burn the esophagus, causing heartburn.

Occasional heartburn is usually harmless. However, frequent or chronic heartburn (recurring more than twice per week) is called gastroesophageal reflux disease (GERD) and requires early management. Repeated episodes of GERD can lead to esophageal inflammation (esophagitis). If the esophagus is repeatedly subjected to

stomach acid and digestive enzymes, ulcerations, scarring, and thickening of the esophageal walls can result. This causes a narrowing of the interior of the esophagus that can affect swallowing and the peristaltic movements that send food downward. Repeated esophageal irritation also can result in Barrett's syndrome—changes in the types of cells lining the esophagus. Barrett's esophagus can develop into esophageal cancer.

Nighttime heartburn, affecting about 80% of heartburn sufferers, is more damaging to the esophagus than daytime heartburn. It often interferes with sleep and may trigger symptoms in asthma sufferers.

Gastroesophageal reflux may occur in children under age one, particularly pre-term babies or those with cerebral palsy. It also may be a cause of some migraine headaches. In addition, chronic heartburn can be a symptom of a gastric ulcer or coronary artery disease.

Causes

Heartburn is caused by:

• a relaxed LES that does not close properly
• over-production of stomach acid
• increased stomach pressure
• a damaged esophagus with increased acid sensitivity

Many factors can contribute to LES malfunction:

• irregular eating, skipping meals
• smoking
• caffeine
• stress
• some medications, including diazepam (Valium), meperidine (Demerol), theophylline, morphine, prostaglandins, calcium channel blockers, nitrate heart medications, progesterone, and anticholinergic and adrenergic drugs (drugs that limit nerve reactions)
• paralysis and scleroderma (an autoimmune disease that hardens body organs)
• large meals that distend the stomach and prevent the LES from closing
• alcohol, which lowers the pressure on the LES, allowing it to relax and open. Alcohol also may irritate the esophageal lining
• weakening LES and loss of LES muscle tone with increasing age

Hiatal hernias are common among pregnant women, smokers, the obese, and those over age 50. The hiatus is an opening in the diaphragm (the large muscle that separates the chest cavity and the abdomen) through which the esophagus connects to the stomach. If the hiatus loses its tautness and shape, the stomach may protrude through, forming a pocket just below the LES where stomach acid can be trapped. These hiatal hernias can cause the LES to relax and open. Hiatal hernias may result in frequent and severe heartburn and GERD.

Various factors can increase stomach pressure, causing gastroesophageal reflux:

• obesity
• lying down within one or two hours of eating
• tight clothing
• Pregnancy, which causes the enlarged uterus to displace the stomach, delaying the removal of stomach contents

Eating too fast, chewing insufficiently, and smoking all increase stomach acid production. Smoking also dries up saliva that protects the esophagus from acid.

Many foods are known to contribute to heartburn:

• greasy, fried, or fatty foods
• spicy foods
• black pepper
• such acidic foods as tomatoes, pickles, and vinegar
• chocolate
• coffee with or without caffeine
• Peppermint or other mints

Symptoms

Heartburn itself is a symptom of gastroesophageal reflux and GERD. Heartburn sufferers may salivate excessively or regurgitate stomach contents into their mouths, leaving a sour or bitter taste.

Other symptoms of GERD include:

• difficult or painful swallowing
• sore throat
• hoarseness, laryngitis, wheezing, coughing
• pneumonia
• gingivitis, bad breath
• earache