Heartburn, also known as pyrosis, is a painful, burning sensation that occurs in either the chest or the throat. Heartburn occurs when stomach acid travels up into the esophagus, which is the portion of the digestive tract that transports food from the mouth to the stomach. Although heartburn is usually temporary, for some individuals it may develop into a chronic problem.
While heartburn can exist as a condition on its own, it is also a common symptom of a more serious condition known as gastroesophageal reflux disease, or GERD. Patients who experience heartburn more than twice a week may suffer from GERD, a chronic disorder that occurs when stomach acid, used for digestion, regurgitates or refluxes into the esophagus, causing inflammation and damage to the lining of the esophagus. If symptoms such as heartburn are ignored, GERD may eventually cause extensive damage to the esophagus.
Causes of Heartburn
Heartburn occurs when the acid of the stomach travels back up into the esophagus. Normally, once a person swallows food, the lower esophageal sphincter, or LES, a circular band of muscles located at the bottom of the esophagus, allows food to flow into the stomach. However, if the LES becomes weakened or abnormally relaxed, the stomach acid will flow back up into the esophagus, resulting in heartburn.
There are a number of risk factors that may contribute to heartburn, including the following:
- Taking certain medications
- Eating spicy or acidic foods
- Drinking alcohol
- Dry mouth
- Hiatal hernia
- Connective tissue disorders, such as scleroderma
Symptoms of Heartburn
Heartburn is characterized by a burning pain experienced in either the middle of the chest or the throat. Usually, this pain occurs immediately after eating.
However, heartburn itself is considered the primary symptom of GERD. If a patient experiences heartburn more than twice a week, along with additional symptoms such as hoarseness, dry cough, vomiting, nausea and difficulty swallowing, he or she may be suffering from GERD.
Diagnosis of Heartburn
When episodes of heartburn occur frequently in a patient, it may be an indication of GERD. To determine whether heartburn is related to GERD, the patient will need to undergo a series of diagnostic tests. The testing may include:
- Esophageal acid testing
- Esophageal motility test, to determine the amount of pressure placed on the esophagus
- X-ray of the upper digestive system
- Esophageal manometry
- Esophagogastroduodenoscopy, or EGD
- Upper gastrointestinal endoscopy
Since there is no one clear test for diagnosing GERD, several of these methods may be conducted to confirm a diagnosis.
Treatment of Heartburn
Heartburn, as a symptom of GERD, is a chronic condition that cannot be cured. Once a patient has already experienced heartburn, he or she will be more likely to face a recurrence of it in the future. However, there are numerous treatment options that may reduce the severity and frequency of heartburn symptoms.
A treatment plan to relieve heartburn usually begins with over-the-counter medications, such as antacids, which are formulated to control stomach acids. Medications that help reduce the quantity of acid produced and those that help heal the esophagus can also be effective in reducing symptoms. Making permanent lifestyle changes, such as quitting smoking, losing weight and adopting healthier eating habits, may be recommended to control heartburn as well as other symptoms of GERD.
If the patient is experiencing heartburn related to GERD, surgery may benefit those patients who are not relieved of symptoms through more conservative measures. Surgery can provide more long-term relief for heartburn, as well as other symptoms. The surgical procedure typically performed to alleviate heartburn in cases of GERD is known as nissen fundoplication, which involves tightening the LES, effectively preventing acid from refluxinig into the esophagus.
Gastroesophageal Reflux Disease FAQs
What is gastroesophageal reflux disease?
During normal ingestion and digestion, food travels from the mouth through a tube of muscle called the esophagus to the stomach, where it remains until it moves into the intestine. Muscles in the lower part of the esophagus, known as the lower esophageal sphincter, or LES, tighten keeping food and digestive acids in the stomach. For patients who have gastroesophageal reflux disease, the LES muscles are loose allowing acid to escape, or reflux, into the esophagus, damaging or burning the sensitive esophageal lining.
Prolonged acid reflux, known as gastroesophageal reflux disease, or GERD, reduces the ability of the LES muscle to contract, causing acid to remain in the esophagus longer, leading to extended complications. These complications include scarring, nerve damage, tightening of the esophagus, the formation of ulcers, and bleeding.
What are the symptoms of GERD?
The primary symptom of GERD is heartburn, which occurs as the stomach acid travels through the esophagus and stimulates the nerve fibers. Heartburn is felt as a burning pain in the middle of the chest. It can stretch from the abdomen to the neck and can even extend into the back. Heartburn from acid reflux occurs most often after eating or while lying down, when reflux is more likely to occur. Symptoms can be triggered by spicy foods, caffeine or alcohol. Other more common symptoms of GERD may include the following:
- A dry cough
- Trouble swallowing
- A hoarseness or change in the voice
- Sore throat
When is heartburn worrisome?
Heartburn affects almost everyone at some point in their lives. Heartburn that is experienced several times in a 24-hour period, that occurs many times a month, or that causes hoarseness, coughing, bleeding or swallowing difficulties, is not normal and should be examined.
What are the preventative treatments for GERD and heartburn?
GERD is a chronic condition that cannot be cured. There are numerous treatment options that may reduce the severity and frequency of the symptoms of GERD. They include lifestyle changes, such as:
- Diet modification
- Cessation of smoking and alcohol consumption
- Eating small, frequent meals
- Stress reduction techniques
- Loss of excess weight
- Avoidance of tight clothing and frequent bending
- Sleeping with the head of the bed elevated
Are medications helpful?
Medications are also helpful in reducing acid production or relieving the symptoms of GERD. These medications include antacids, foaming agents, H2 blockers. proton pump inhibitors and pro-motility drugs. A combination of medications that work to address different symptoms may help to relieve the symptoms of GERD.
What are the tests for GERD?
Testing for the presence of GERD include the following:
- Esophageal manometry
- Esophageal acid testing
What is involved in laparoscopic surgery for GERD correction?
A laparoscopic Nissen fundoplication is a surgical procedure to tighten the lower sphincter muscle of the esophagus. A Nissen fundoplication is used in the treatment of gastrointestinal reflux disease, also known as GERD. During the procedure the top of the stomach, known as the fundus, is wrapped around the lower esophagus to strengthen the barrier between the stomach and esophagus.
During a laparoscopic Nissen fundoplication three to four small incisions are made in the patient's abdomen where a laparoscope and tiny surgical instruments are inserted. With video guidance, the physician is able to repair the valve. Most patients see an improvement in their GERD symptoms after this procedure, and are less likely to need daily medication for their condition.
How long does recovery take?
Patients usually return home in a day or two and can resume normal activities within a week.
What are the risks & complications of GERD correction surgery?
A laparoscopic Nissen fundoplication is considered safe for most patients, yet there are certain risks associated with any kind of surgical procedure. Some of these risks may include the following:
- Recurring heartburn
- Difficulty swallowing
- Esophagus sliding out of place