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The patient has just eaten a big meal and leaned back in his favorite chair. As he begin to relax, his chest starts to hurt so much it feels like it's on fi re. Heartburn is common, and an occasional episode is generally nothing to worry abo ut. However, many people battle heartburn — a burning sensation in the food pipe (eso phagus), just below or behind the breastbone — regularly, even daily. Frequent heartburn can be a serious problem, and it deserves medical attention. Frequent or constant heartburn is the most common symptom of gastroesophageal re flux disease (GERD) — a disease in which stomach acid or, occasionally, bile flows back (refluxes) into your esophagus. Most people can manage the discomfort of heartburn with lifestyle modifications and over-the-counter medications. But if heartburn is severe, these remedies may offer only temporary or partial relief. Symptoms The primary symptom of heartburn is a burning pain in your chest, under your bre astbone. This pain may worsen when you bend over, lie down or eat. It may also be more fr equent or worse at night. Causes How heartburn occurs
caffeine. stomach acid can flow back up into your esophagus. However. This hormone relaxes many of your muscles. Doctors aren't certain of the exact relationship between asthma and heartburn. such as fatty foods. including sedatives. Excess weight puts extra pressure on your stomach and diaphragm — the large muscle that separates your chest and abdomen — forcing open the lower esophageal sphincter and allowing stomach acids to back u p into your esophagus. Hiatal hernia. Asthma. part of your stomach protru des into your lower chest. a hiatal hernia can worsen heartburn by further weak ening the lower esophageal sphincter muscle. spicy foods. In this condition. to mato sauce. Frequent heartburn is usually a symptom of GERD. triggering regurgitation of stomach acid into your esophagus. Some asthma medications that widen (dilate) airways may also relax the lower eso phageal sphincter and allow reflux. Eating very large meals or meals high in fat may cause similar effects. chocolate. Pregnancy Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. . If this protrusion of part of your stomach into your lower chest is large. if this valve relaxes abnormally or weakens. your lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to al low food and liquid to flow down into your stomach. Then it closes again. also called diaphragmatic hernia. including the lower esophageal sphinc ter.When you swallow. it can worsen heartburn by further weakening the lower esophageal sphincter musc le. causing heartburn. If the protrusion is large. although other conditions such as hiatal hernia also are related to heartburn. onions. carbonated beverages and mint Alcohol Large meals Lying down too soon after eati ng Certain medications. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen. These include: Obesity. Some other factors that can make heartburn worse include: Certain foods. The acid backup is worse when you're bent over or lying down. antidepressants and calcium channel blockers for high blood pressure Cigarette smoking Risk factors Conditions that cause difficulty with digestion can increase the risk of heartbu rn.
For example. damaging lung airways.Or it's possible that the acid reflux that causes heartburn may worsen asthma s ymptoms. . you may inhale small amounts of the digestive juices from your esop hagus and pharynx.
Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should. if you experience any of these: . One of the many complications of diabetes is gastroparesis. causing stomach acid to build up and back up into your esophagus. Gastric outlet obstruction. stomach contents can regurgitate into your eso phagus and cause heartburn. allowing acid reflux. causing acid backup into the esophagus. One of the complications of this rare disorder is that your stomach produces ext remely high amounts of acid. increasing the risk of acid reflux. If left in your stomach too long. a disorder in which your stomach takes too long to empty. These include narcotics. This is a partial blockage caused by scarring. Connective tis sue disorders. If you experience any of these signs and symptoms. abnormal nerve or muscle functions can delay emptying of your stomach. difficulty eating. When to seek medical advice Most problems with heartburn are fleeting and mild. you may be developing complicatio ns that need more intensive medical treatment and prescription medications. Delayed stomach emptying. This usually causes more signs and symptoms than just heartburn.Diabetes. Zollinger-Ellison syndrome. In addition to diabetes or an ulcer. some antidepressants and antihistamines. It can keep this valve from working properly or can obstruct the release of foo d from the stomach. Medications may also lead to delayed sto mach emptying. Talk to your doctor if you have: Heartburn several times a week Heartburn that returns soon after your antacid wears off Heartburn that wakes yo u up at night You may need further medical care. possibly even surgery. an ulcer or a growth near the valve (pylorus) in the stomach that controls the f low of food into the small intestine. But if you have severe or frequent discomfort. weight loss. Food doesn't empty from your stomach as fast as it should. such as abdomin al pain. nausea and vomiting. consult your doctor.
However.Symptoms that persist even though you're taking prescription heartburn medicatio ns Difficulty swallowing Regurgitated blood or black material Stool that's black Weight loss Tests and diagnosis Usually a description of your symptoms will be all your doctor needs to establish the diagnosis of heartburn. don't . if your symptoms are particularly severe.
These tests use an acid-measuring (pH) probe t o identify when. After the probe is in place. you go about your business andthen come back one or two days later to have the device removed. Then a thin. . Another benefit of the Bravo test is that you can shower and sleep more comforta bly than with the standard test. The probe is positioned just above the lower esophageal sphincter. Endoscopy. pylori) bacterium that may cause peptic ulcers. or a growth. During an EGD. It records acid measurements. The coating allows your doctor to see a silhouette of the shape and condition of your esophagus. Ambulatory acid (pH) probe tests. A more direct test for diagnosing the cause of heartburn is esophagog astroduodenoscopy (EGD). A test called a Bravo pH probe may be more comfortable than the standard test. and for how long. flexible tube (catheter) is threaded through your nose into your es ophagus to insert the probe. the probe is attached to the lower portion of your esophagus during endoscopy. stomach and upper intestine (duodenum). Rather than measuring acid. In the Bravo test.respond to treatment. In this test your doctor inserts a thin. It's helpful for people who have regurgitation or reflux of materials in the eso phagus that aren't acidic and wouldn't be detected by a pH probe. you may need to undergo other tests. flexible tube equipped with a light and camera (endoscope) down your throat. or your doctor suspects GERD or another condition. X-rays can then reveal whether a hiatal hernia may be contributing to your heartburn. stomach acid regurgitates into your esophagus. and then the probe falls off to be passed in your stool. which ma y cause difficulty swallowing. two potential complications of severe heartburn. This information can help your doctor determine how best to treat your conditio n. Attached to the other end of the catheter is a small computer that you wear arou nd your waist or with a strap over your shoulder during the test. Barium X-ray. The endoscope allows your doctor to see if you have an ulcerated or inflamed es ophagus (esophagitis) or stomach (gastritis). Analysis of these samples may also reveal the presence of the Helicobacter pylo ri (H. The probe transmits a signal to a small computer that you wear around your waist for about two days. This procedure requires you to drink a chalky liquid that coats and fills the ho llows of your digestive tract. In the standard tube test. They can also reveal an esophageal narrowing or stricture. It can also reveal a peptic ulcer. this test can measure whether gas or liquids reflux back into your esophagus. your doctor can take tissue s amples to test for Barrett's esophagus — a condition in which precancerous changes occur in cells in your esophagus — or esophageal cancer. A second probe may be placed in your upper esophagus. Esophageal impedance. b ecause it eliminates the need for a tube in your nose. a nurse or technician sprays your throat with a numb ing medication while you're seated.
Complications Most heartburn is only occasional. because the test is new. If your heartburn is severe or chronic.The test works by placing a catheter through your nose and into your esophagus. it may suggest you have GERD. However. its role in helping people with GERD hasn't been clearly defined. similar to a standard pH probe tube test. Complications of GERD include irritation and inflammation .
OTC remedies include: Antacids. Gelusil. Overuse of some antacids can cause side effects such as diarrhea or constipation . In rare instances they can also react dangerously with other medications. such as cimetidine (Tagamet HB). Excess pounds put pressure on your abdomen. Instead of neutralizing the acid. Rolaids and Tums. Being overweight is one of the strongest risk factors for h eartburn. Over-the-counter H-2-receptor blockers. such as Maalox. leading to an inflamed esophagus. They're also effective in reducing reflux at night if taken at bedtime. neutralize stomach acid and can provide quick relief. Some H2-receptor blockers can cause infrequent side effects. kidney problems and temporary breast e nlargement in men. but they provide longer relief. headache. Take these medications before a meal that you think may cause heartburn because it takes them about 30 minutes to work. including dizziness. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. nizatidine (Axid AR) or ranitidine (Zantac 75). are available at half the strength of their prescription versions. mild heartburn. These medications block acid production and allow time for damaged esophageal ti ssue to heal. you may have GERD. Proton pump inhibitors. narrowing of your esophagus (stricture) and a slightly increased risk of esopha geal cancer. diarrhea.of your esophagus (esophagitis). these medications reduce the production of aci d. Antacids. famoti dine (Pepcid AC). but now is available in an over-thecounter form for the short-term treatment of heartburn. Lifestyle and home remedies You may eliminate or reduce the frequency of heartburn by making the following l ifestyle changes: Control your weight. pushing up your stomach and causing . H-2-receptor blockers. Treatments and drugs If you experience only occasional. Omeprazole (Prilosec) was previously available only by prescription. GERD usually requires prescription-strength medication or medical treatment and sometimes surgery. you may get relief from an ov erthe-counter (OTC) medication and self-care measures. If you have frequent and persistent heartburn. Mylanta. They don't act as quickly as antacids.
alcohol. Eat smaller meals. tomatoes. peppermint. onion. Common triggers such as fatty or fried foods. caffeine and nicotine may make heartburn worse. helping to prevent the valve from opening and acid from washing back into your esophagus. Eliminate heartburn triggers. This reduces pressure on the lower esophageal sphincter. ga rlic. Loosen your belt. chocolate. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.acid to back up into your esophagus. . Everyone has specific triggers.
If it's not possible to elevate your bed. and don't lie down right after eating. Although these liquids create temporary relief by neutralizing. Don't lie down soon after a meal. smoking and alcohol increase your risk of esophageal cancer. you can insert a foam wedge between yo ur mattress and box spring to elevate your body from the waist up. Alternative medicine Several home remedies exist for treating heartburn. Raising your head only by using pillows is not a good alternative. adding more sodium to your diet may increase your blood pressure and ad d stress to your heart. increasing pressure and causing more acid reflux. but they provide only tempor ary relief. talk to your doctor beca use it may indicate GERD and require stronger medication and evaluation. Don't smoke. Wait at least two to three hours after eating before going to bed. eventually they aggravate the situation by adding gas and fluid to your stomach . In addition. You can do this by placing wooden or cement blocks under the feet of your bed at the head end.Avoid stooping or bending. washing away or buffering acids. Raise the head of your bed. They include drinking baking soda (sodium bicarbonate) added to water or drinki ng other fluids such as baking soda mixed with cream of tartar and water. If you need to raise the head of your bed most nights. The swallowing of air during smoking may also aggravate belching and acid reflux . especially soon after eating. and excessive bicarbonate ingestion can alter the acid-base balance in your body . Further. Bending over for longer periods to weed your garden isn't . Smoking may increase stomach acid. . T ying your shoes is OK. An elevation of about six to nine inches puts gravit y to work for you. Wedges are available at drugstores and medical supply stores.
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