Heartburn And Acid Reflux  

I KEEP GETTING CHEST PAINS, DOCTOR!" is a common enough complaint from patients.

The pain they are most worried about is the one that strikes them in the centre of the chest underneath the breastbone because they think they are having a heart attack.

The good news is that it is usually heartburn, which has nothing to do with the heart itself. It is a special type of indigestion where acid from the stomach is regurgitated upwards into the food pipe or oesophagus.

Heartburn or pyrosis is a painful and burning sensation in the esophagus, just below the breastbone usually associated with regurgitation of gastric acid . The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw.

Heartburn is a major symptom of gastroesophageal reflux disease; acid reflux is also identified as one of the causes of chronic cough, and may even mimic asthma.

What are the symptoms of acid reflux?

• Asthma - gastric juices seep upwards into the throat, mouth and air passages of the lungs
• Chest pain - part of the heartburn sensation
• Dental erosion
• Dysphagia - difficulty swallowing
• Heartburn - a burning feeling rising from the stomach or lower chest towards the neck
• Hoarseness
• Regurgitation - bringing food back up into the mouth

10 Most Frequent Causes of Heartburn

There are several causes of heartburn / acid reflux. There are several that are the most frequent causes of heartburn. Finding out what these are can help you make changes in your lifestyle and habit so you can prevent the acid reflux from happening:

Coffee, tea, and other drinks that contain caffeine
Caffeine can relax the LES, allowing stomach contents to reflux into the esophagus.

Chocolate
Chocolate contains concentrations of theobromine (a compound that occurs naturally in many plants such as cocoa, tea and coffee plants), which relaxes the esophageal sphincter muscle, letting stomach acid squirt up into the esophagus.

Fried and fatty foods
These foods tend to slow down digestion, keeping the food in your stomach longer. This can result in increases pressure in the stomach, which in turn puts more pressure on a weakened LES, allowing reflux of stomach contents.

Tomatoes and tomato-based products
These foods relax the lower esophageal sphincter (LES).

Alcohol
Alcohol relaxes the lower esophageal sphincter, allowing the reflux of stomach contents into the esophagus. It also increases the production of stomach acid.

Tobacco
The chemicals in cigarette smoke weaken the LES as they pass from the lungs into the blood.

Large meals
A full stomach can put extra pressure on the lower esophageal sphincter (LES), which will increase the chance that some of this food will reflux into the esophagus.

Citrus fruits and juices
These foods relax the lower esophageal sphincter (LES).

Eating within 2 to 3 hours prior to bedtime
Lying down with a full stomach can cause stomach contents to press harder against the LES, increasing the chances of refluxed food.

Wearing tight fitting clothing
Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the LES, and cause food to reflux into the esophagus. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.

What is the difference between acid reflux and heartburn?

Acid reflux is the action, while heartburn is the sensation. The pain is heartburn, while the movement of acid into the esophagus from the stomach is acid reflux.

Treatment for Heartburn:

Heartburn symptoms can often be relieved with good heartburn treatment, including a few lifestyle changes. Follow these suggestions to significantly reduce the occurrence of acid reflux symptoms:

Eat smaller, more frequent meals.
Large meals expand your stomach and increase upward pressure against the esophageal sphincter.

Limit your intake of acid-stimulating foods and beverages.
Eat foods that rarely cause heartburn and avoid those foods that will often cause heartburn.

Don't lie down for about two hours after you eat.
Gravity helps to keep the stomach juices from backing up into the esophagus and assists the flow of food and digestive juices from the stomach to the intestines.

Elevate your head a few inches while you sleep.
Lying down flat presses the stomach's contents against the LES. With the head higher than the stomach, gravity helps reduce this pressure. You can elevate your head in a couple of ways. You can place bricks, blocks or anything that's sturdy securely under the legs at the head of your bed. You can also use an extra pillow, or a wedge-shaped pillow, to elevate your head.

Maintain a reasonable weight.
Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. According to some statistics, approximately 35% of overweight persons experience heartburn. The good news is that for many people, as little as a 10% decrease in weight will improve their heartburn symptoms.

Don't smoke.
Nicotine relaxes the esophageal sphincter. Smoking also stimulates the production of stomach acid.

Don't drink alcohol.
If you still want to drink alcoholic beverages at your own risk.

Relax.
While stress hasn't been linked directly to heartburn, it is known that it can lead to behaviors that can trigger heartburn.

Don't wear belts or clothes that are tight fitting around the waist.
Clothing that fits tightly around the abdomen will squeeze the stomach, forcing food up against the LES, and cause food to reflux into the esophagus. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.

Keep a heartburn record.
Record what triggered your acid reflux episodes, the severity of each episode, how your body reacts, and what gives you relief. The next step is to take this information to your doctor so the both of you can determine what lifestyle changes you will need to make and what treatments will give you maximum relief.

Further on Treatment Options

•  Antacids

•  H2 Blockers

•  Proton Pump Inhibitors

Medication

Histamine Receptor Antagonists
This type of drug works by decreasing the amount of acid the stomach produces, and is used to treat conditions where the stomach produces too much acid or where acid comes up into the esophagus and causes heartburn.

Antacids
Antacids work by neutralizing acid in the stomach on contact to provide heartburn relief.

Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are a group of prescription medications that prevent the release of acid in the stomach and intestines. Doctors prescribe PPIs to treat people with heartburn, ulcers of the stomach or intestine, or excess stomach acid.

Promotility Agents
Promotility agents are used to improve GERD symptoms for patients with slow gastric emptying. They speed digestion, which prevents acid from staying in the stomach too long. A doctor may also prescribe this medication for patients with GERD if H2 blockers or PPIs do not work effectively for them.

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