Heartburn (Esophageal Reflux)

This ailment is so common that 25 to 50 million Americans regularly endure its discomforts. It has nothing to do with the heart, but involves a burning pain in the chest that radiates upward into the neck and throat and sometimes the face. Heartburn usually occurs after a meal, especially if the person lies down, and is often accompanied by belching and regurgitation into the mouth of bitter gastric juices, which prompt a flow of extra saliva. Some people also have difficulty swallowing, experience mild abdominal pain, and in a few cases, vomit.

The most frequent cause is a weakening of the opening, or sphincter, located at the lower end of the esophagus. This sphincter, which connects the esophagus and stomach, opens when food moves down the esophageal tube, permitting it to enter the stomach. It then closes to prevent stomach acid (needed for digestion) from splashing up, or refluxing, into the esophagus.

If muscle tone in the sphincter is lost and it remains open when it should be closed, the result is acid reflux and the painful sensations of heartburn. This action occurs after a meal because that is when the stomach secretes acidic gastric juices. Also, pressure inside the stomach builds when it is full, making it more likely that stomach contents will be pushed back through the sphincter.

Diagnostic Methods and Procedures

A doctor normally makes a diagnosis on the basis of the patients description of symptoms. If the heartburn has continued for some time, the lower esophagus may have become inflamed. This can be detected by examination with an esophagoscope, a long, slender tube with magnifying and lighting devices. A doctor may also order an upper GI series—X-rays taken after the patient has swallowed barium, a chalky substance that coats the esophagus and stomach to make them show up on film. Because heartburn can mimic the pain of angina, an electrocardiogram and other heart studies may also be ordered to rule out heart disease.

Medical Treatments

If heartburn is severe and chronic, prescription medication may help to alleviate it. Among the commonly used agents are a class of drugs known as H2 blockers, antihistamines that decrease production of stomach acid. They include cimetidine (Tagamet), ranitidine (Zantac), and famotidine (Pepcid), to create a barrier between the esophagus and the stomach, a drug called sucralfate (Carafate) may be prescribed. To improve sphincter tone and hasten the emptying of the stomach into the small intestine, meioclopramide (Reglan) may be administered. In a few cases, severe heartburn may require surgery to correct such complications as narrowing of the esophagus due to chronic inflammation.

Alternative Therapies

Homeopathy. Homeopathic practitioners often recommend nux vomica to treat heartburn.

Naturopathy. Numerous natural remedies are said to help heartburn. One calls for drinking a cup of raw potato juice diluted with a cup of water after each meal. To make the juice, simply put a washed potato through a juicer. Another remedy is made by mixing 1 tablespoon each of honey and apple cider vinegar in 1 cup of warm water and drinking it at the first hint of discomfort. Papaya tablets might also alleviate an attack of heartburn.

Self-Treatment

There is much you can do to prevent heart-burn, starting with modifying your eating habits. Consume small frequent meals, eat slowly, and chew each bite thoroughly. Avoid alcohol, caffeine, and fatty or highly spiced foods, and keep a food diary to identify foods that trigger an attack. Drink liquids between meals, rather than while you are eating; water with meals dilutes and increases the volume of the stomach's contents, making it easier for acid reflux to occur.

Avoid stooping, bending over, or lying down for at least an hour after meals. If heartburn is bothersome at night, do not eat for a few hours before bedtime, and try sleeping with your upper body in an elevated position, using a wedged pillow or placing books or bricks under the head of your bed to raise it a few inches.

For temporary relief of symptoms, use an over-the-counter antacid. Ask your doctor or pharmacist to recommend a product, because some ingredients should be avoided if you have certain disorders. For example, sodium bicarbonate antacids are high in sodium and should not be used by people with high blood pressure. Other products contain calcium and should not be taken by anyone with kidney stones.

Other Causes of Heartburn

Stomach ulcers, gallbladder disease, and other gastrointestinal disorders may bring about discomfort similar to heartburn. A hiatal hernia can result in an esophageal reflux. Esophageal spasm or stricture can cause difficult or painful swallowing and a burning sensation in the upper chest. A heart attack can easily be confused with heartburn. Any chest pain that radiates to the jaw or an arm should be investigated by a doctor, especially when accompanied by other symptoms, such as sweating, nausea, dizziness, shortness of breath, and fainting. Do not take a chance, as prompt action may save your life. Go immediately to the nearest hospital emergency room, or call your local emergency number for assistance.