Heartburn is a very unpleasant condition. Many patients must have felt the characteristic burning behind the breastbone when bending down and after a hearty lunch. What causes heartburn and what does this symptom result from? How to deal with heartburn and what are the therapeutic options in this case?
Heartburn is an unpleasant burning sensation behind the sternum in the esophagus. This may be accompanied by a sour taste in the mouth and the burning sensation may extend up to the throat. Heartburn is caused by abnormal reflux of acid in the stomach into the esophagus. The esophagus is not adapted to the acid content and causes irritation and in some cases even deeper damage.
Chest pain and heartburn – differentiation
Heartburn may be accompanied by chest pain which in some cases resembles the angina of a heart attack. It is worth being aware of this, as these causes of chest pain should be differentiated.
In the event of the regurgitation of gastric contents, pain is provoked by a copious meal, bending, and lying down – these activities increase the regurgitation of irritating contents into the stomach. In the case of angina symptoms, the pain worsens under the influence of stress, physical exertion, cold air, but also – a heavy meal, and disappears after the cessation of physical exertion.
However, in the case of a heart attack, the pain lasts longer (more than 20-30 minutes) and does not go away after the end of physical activity. It may be accompanied by other symptoms, such as shortness of breath, weakness, nausea, vomiting, as well as profuse sweating.
If a patient develops chest pain, it is necessary to conduct a thorough medical history and perform an ECG test, which will initially help to differentiate the causes of chest pain.
Heartburn – causes of heartburn
Heartburn is the most important symptom of gastro-oesophageal reflux disease – that is, the regurgitation of acidic gastric contents into the esophagus, which leads to unpleasant symptoms for the patient. What is the result of the appearance of this symptom? The most important causes of heartburn are:
Hiatus sliding hernia – this condition consists in the fact that part of the stomach moves from the correct anatomical position, i.e. from the abdominal cavity to the chest cavity. The hernia causes the gastroesophageal barrier to be weakened, which allows the contents of the stomach to flow back into the esophagus,
Slower gastric emptying – prolonged gastric content in the stomach and its accumulation promotes heartburn, slower gastric emptying may accompany diabetes and some neurological diseases,
Smoking – affects the symptoms in such a way that it reduces the tension of the lower esophageal sphincter (LES in short), which is a specific anti-reflux barrier, too low its tension predisposes to reflux gastric contents into the esophagus,
Alcohol – its abuse also predisposes to reflux, because, like cigarettes – it reduces LES tension,
High-fat diet – fatty foods release the hormone cholecystokinin – a substance that lowers LES tension. Symptoms of reflux are also aggravated by acidic and spicy foods,
obesity, overweight – excess body weight increases the pressure in the stomach and changes the position of the LES, which predisposes to reflux,
Pregnancy – this condition also contributes to acid reflux. This is because the pressure in the abdomen increases during pregnancy, as well as the concentration of estrogen (sex hormones), which reduces the tone of the LES, so heartburn often affects women during pregnancy.
taking medications that lower the LES tension – these include, among others: calcium channel blockers (commonly used in the treatment of hypertension), nitrates, oral contraceptives, or β2-agonists (used in the treatment of asthma).
Heartburn – pharmacological treatment of gastro-esophageal reflux disease
Medicines that reduce the secretion of hydrochloric acid are the mainstay of pharmacological treatment of heartburn . The first-line drugs are proton pump inhibitors, which we refer to as PPIs for short. The following should be mentioned here:
- omeprazole _
- rabeprazole,
- lansoprazole,
- esomeprazole,
- pantoprazole,
- dexlansoprazole.
These drugs are used in the morning, on an empty stomach, at the beginning of the therapy with one capsule / tablet – taken once a day. Sometimes drugs that block histamine receptors are also used – more precisely, H2 blockers, which include ranitidine and famotidine. These drugs reduce gastric secretion, but by a different mechanism than proton pump inhibitors (these drugs inhibit histamine-dependent secretion of gastric acid).
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