Heartburn is a common condition and people often ask me: Dr. B, why do I have heartburn? What can I do about it?
Heartburn is a serious symptom that merits more attention from patients and physicians, says an editorial in the New England Journal of Medicine (NEJM).
The editorial says that heartburn is the hallmark of reflux from stomach to esophagus, a disorder that may lead to esophagitis (inflammation of the gullet), progressing in some patients to cancer of the esophagus. The cancer is preceded by a condition called Barretts esophagus.
Heartburn (also known as GERD or gastro-esophageal reflux disease) is a condition in which an individual experiences a sensation of burning from the stomach to the throat. This is due to the reflux of acid, sometimes mixed with bile and food. This is accompanied by bitter taste in the throat and the mouth. Sometimes coughing spells follow the reflux as the acid spills over into the wind pipe. This may also result in pneumonia.
Normally, below the diaphragm and in the abdominal cavity, there is a functional valve at the junction of the esophagus and the stomach (gastro-esophageal junction). This valve allows saliva and food to travel one way from mouth and esophagus to stomach. When the valve becomes incompetent, stomach contents reflux into the esophagus resulting in heartburn.
Heartburn is a very common condition. Four to nine percent adults have heartburn daily, and another 10 to 15 percent have heartburn at least once a week. That means about 20 percent of the adults have heartburn on a weekly basis.
Why does the valve become incompetent?
The valve loses its tone. The exact reason for this is not known. It may be associated with some medical condition, obesity or hiatus hernia a condition in which gastro-esophageal junction slides between the chest and the abdomen through the opening in the diaphragm a sliding hiatus hernia. Hiatus hernia may or may not be associated with reflux and vice versa.
How is it diagnosed?
Diagnosis is based on classical symptoms of heartburn. Difficulty swallowing food, liquids or even saliva signifies narrowing of the esophagus due to inflammation, scarring or cancer. Barium x-rays have a limited value in the assessment of esophagitis (inflammation of the esophagus) or Barretts esophagus. Endoscopy (gastroscopy) and biopsy is the best way to assess the lining of the esophagus for inflammation or pre-malignant Barretts changes.
Every person with heartburn does not require gastroscopy. The NEJM editorial says that there is no precise protocol to say when gastroscopy is warranted in patients with heartburn. The usual indication is when heartburn is severe enough to be the main symptom for which medical evaluation sought, and in patient who presents with difficult swallowing.
Heartburn can be prevented by change in life-style: lose weight, change eating habits, avoid bending or straining, sleep with head end of the bed elevated (maximum damage to the esophagus occurs at night), no smoking, no alcohol, and take appropriate medications to neutralize or reduce acid in the stomach. Surgery is also an option in patients with intractable problems or complications of reflux.
Remember, heartburn should not be ignored and must be given respect!
Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!