Heartburn

For the hopeless romantic, heartburn occurs only on Valentines Day (wink).  For some people, it occurs almost everyday.  It is a common symptom but this should not be taken lightly.  Heartburn may be a sign of heart attack.  Consultation to a doctor should be done if you feel the symptom for the first time.  Chronic heartburn could lead to esophageal cancer.  Some patients will also experience asthma-like symptoms.

This condition is caused by acid from the stomach which goes up to the esophagus.  This result to burning pain in the chest which sometimes radiates to the back of the throat.  Pain is worse when lying down and the patient may have chronic cough.  Almost everyone has this kind of symptom but frequent attacks in a month can be a sign of GERD (Gastroesophageal Reflux Disease).

Let me give you a little bit of anatomy and physiology.  The food that we eat goes down to the pharynx, then to the esophagus then to the stomach.  The lower esophagus has a valve or a sphincter which prevents acid from the stomach to go up to the esophagus.  When the lower esophageal sphincter relaxes abnormally or weakens then the acid goes up.  The stomach has a protective lining which prevents the destructive effects of acid to take effect.  However, the esophagus do not have this kind of protection, so, the acid will irritate the esophageal lining.  This can cause inflammation, bleeding and eventually cancer.  When the acid reflux becomes so severe, it will reach up to the pharynx and then go to the air tubes.  The acid will cause irritation of the airways and the patient will have asthma symptoms - cough, dyspnea (difficulty of breathing), tachypnea (fast breathing) and wheezing.

Coffee can trigger heartburn.

If you have this symptom, it is best to avoid food and substances which trigger the attack.  Spicy foods, onions, citrus products, ketchup, fatty or fried foods, chocolate, alcohol, carbonated beverages, coffee and large meals will trigger the symptom.  Some drugs can also precipitate heartburn namely ibuprofen, naproxen, aspirin, antihypertensives and antidepressant meds.

Smoking can decrease the ability of the lower esophageal sphincter to function properly.  So, stop smoking, please.  It is good to elevated the head when lying down with pillows and not to eat large meals 3 hours prior to sleeping.  Midnight snacks is definitely out.

This disease, like any other illness, can be diagnosed through complete history and physical examination by a physician.  Adjunctive laboratories include endoscopy, monometry, barium swallow and ambulatory acid probe test.  In endoscopy, a tube will be inserted into the mouth and into the esophagus to see the damaged cells.  A biopsy is also taken to rule out cancer.  Monometry measures the pressure of the lower esophageal sphincter.

There are many over-the-counter antacids which can offer quick relief of symptoms.  Moderate-severe symptoms warrant the use of drugs like ranitidine or omeprazole.  All of these drugs reduce acid production which eventually allows the damaged esophageal cells to heal on its own.  If the symptoms are not controlled by intensive medical therapy then surgery is indicated.  A part of the stomach is wrapped around the lower esophagus to strengthen the sphincter to prevent acid reflux. This is called fundoplication.

As I have mentioned before, heartburn can also be a sign of impending heart attack.  An examination of the heart should be done to rule out this deadly disease especially in patients in the 4th - 6th decade of life.  

-Dr. A