Heartburn. Causes, symptoms, diagnosis and treatment of heartburn

Gastroenterologist

Vinogradov

Dmitry Alekseevich

4 years of experience

Gastroenterologist

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Millions of people of all ages suffer from heartburn. And only a quarter of patients turn to doctors for medical help. Symptoms include a burning sensation in the esophagus, a feeling of fullness in the stomach, pain in the lower chest and is accompanied by a bitter, acidic taste in the throat and mouth. Heartburn is not so harmless in its clinical nature. It is periodic or chronic in gastroesophageal reflux disease (GERD) and can vary in frequency and intensity. Pharmacy medications provide only temporary relief, so a visit to a gastroenterologist and the prescription of adequate therapy is the main recommendation.

How does heartburn occur?

As a rule, severe heartburn appears in a person at the moment of reflux of stomach contents into the esophagus: acidic gastric juice affects the mucous membrane of the esophagus, which leads to heartburn. In the medical community, this process is called reflux of gastric contents into the esophagus.

How dangerous is heartburn for the mucous membrane?

Periodic heartburn not only reduces the quality of life, but also signals health problems. If unpleasant symptoms occur regularly and do not go away quickly, this may indicate the development of GERD. With each episode of heartburn, the walls of the esophagus are irritated by aggressive gastric juice, which can cause dangerous disorders of the mucous membrane, including the formation of ulcers, narrowing of the lumen of the esophagus, and degeneration of epithelial cells (precancerous condition)3.

Causes of heartburn

The cause of heartburn in this case is insufficiency of the sphincter, which is located between the esophagus and the stomach. The sphincter is a kind of flap: it closes to prevent gastric contents from entering the esophagus. If it does not close enough, then the reverse movement of food occurs and the person suffers from heartburn due to the fact that aggressive acidic gastric juice irritates the wall of the esophagus.

It often happens that the contents of the duodenum (the section of the small intestine that follows immediately after the stomach) reflux into the stomach and then into the esophagus. In this case, food that is saturated with pancreatic enzymes and bile also irritates the wall of the esophagus, which is an additional aggressive factor. Symptoms of heartburn with reflux from the duodenum may be more severe than with reflux of the contents of the stomach alone.

Constant heartburn has very specific causes. People often think: “What to drink for heartburn?”, but do not realize that the best remedy for heartburn is eliminating the main cause of its occurrence. Next, we suggest you figure out what conditions cause heartburn.

Hiatal hernia

The diaphragm is a large muscle in the human body that separates two anatomical structures: the chest and abdominal cavity. The esophagus passes through a special opening - the esophageal hiatus of the diaphragm. When it expands (congenital expansion or formed during life), part of the stomach protrudes into the chest cavity, forming a hernia. With a hiatal hernia, patients complain of heartburn after eating, at night, or after physical activity.

Pathology of the stomach - chronic gastritis with increased secretory function

The human stomach normally produces hydrochloric acid - special cells of the stomach produce this compound to digest and disinfect food. However, if the activity of these cells increases, the person develops hypersecretory dysfunction. Excessive amounts of hydrochloric acid have a negative effect on the wall, damaging it. The reflux of acidic contents into the esophagus provokes severe heartburn.

Excessive release of hydrochloric acid is a consequence of active consumption of fatty and fried foods, spicy foods, and too cold dishes. Often hypersecretion occurs due to rare but large meals. In this case, a person suffers from heartburn in the upper abdomen, immediately after eating.

Peptic ulcer of various parts of the gastrointestinal tract

Often, peptic ulcers of the stomach and duodenum cause heartburn. An ulcerative defect occurs on the mucous membrane of one of the sections of the digestive system (and sometimes both at once) - an area of ​​damage to the wall. The section of the gastrointestinal tract where the ulcer has formed cannot contract sufficiently to push food into the intestines. Therefore, either food is thrown in the opposite direction (into the esophagus), or food is retained in the affected section.

Both situations are quite complex and the patient may even feel heartburn in the stomach, as the main symptom of ulcerative damage.

Enzyme disorders

Sometimes heartburn occurs if a person has a disruption in the synthesis of hydrochloric acid and pepsin (an enzyme that is responsible for the breakdown of proteins) in the stomach. In this case, lactic and butyric acids are thrown into the esophagus. These compounds are formed in the stomach due to fermentation processes.

In the medical community, such a violation of the enzyme function of the stomach is called achylia (impaired pepsin production) and achlorhydria (pathology of hydrochloric acid production).

As a consequence of surgical interventions

Persistent heartburn may bother people who have had surgery to remove part of the stomach or small intestine - the duodenum. The reason for resection could be a tumor, extensive ulcerative damage, or damage to the gastrointestinal tract of another etiology. The cause of heartburn after surgery is digestive juice: it contains active pancreatic enzymes and bile. These components enter the esophagus, irritate its wall and cause heartburn.

Medicines and diet

Sometimes patients using aspirin and non-steroidal anti-inflammatory drugs (for example, paracetamol) in therapy complain of heartburn. The fact is that the mechanism of action of these drugs is associated with the cyclooxygenase system, which also exists in the stomach. Inhibition of cyclooxygenase activity reduces inflammation, but also negatively affects the production of prostaglandins, which protect the gastric mucosa. Natural protection is reduced, which threatens the formation of erosions and ulcers.

Dangerous drugs in this sense include nitrates, antispasmodics, sedatives, hypnotics, and tranquilizers. Foods can also cause heartburn. Even healthy people complain of the occurrence of this symptom after a heavy lunch or outright overeating, excessive consumption of sweet foods, fatty and fried foods, and spicy foods.

Characteristic symptoms

A feeling of heat in the chest is the main symptom of heartburn.

The main symptom of the disease in question is a burning/heating sensation in the esophagus (in the upper abdomen and behind the chest). An increase in the intensity of symptoms is observed during bending or lying down.

Single or rare manifestations of the problem can be solved on your own. Medical consultation is required if symptoms are accompanied by an intense cough. The same applies to situations where heartburn occurs after taking certain medications.

In some cases, emergency medical attention is required. In this case, the phenomenon under consideration is accompanied by the following complications:

Consequences of heartburn

Constant heartburn is a cause for alarm and immediate contact with a gastroenterologist. Often, the symptom occurs due to an established disease, the timely treatment of which will ensure the elimination of heartburn in the early stages.

The first important consequence of long-term reflux and heartburn is esophagitis - inflammation of the mucous membrane of the esophagus. Quite often, real ulcers can form, which pose a risk of bleeding. They are susceptible to scarring (overgrowth with connective tissue), which leads to the formation of scar narrowings (strictures) of the esophagus. The natural opening narrows and it becomes difficult for a person to eat food, because due to the narrowing it is difficult for it to pass through the esophagus.

A serious complication of both heartburn and esophagitis is Barrett's esophagus. With this disease, a restructuring of the epithelium of the mucous membrane of the esophagus occurs, which is a precancerous condition. In the medical community, this process is called metaplasia and every effort is made to treat heartburn in order to prevent the formation of cancer. Therefore, timely treatment of heartburn in the early stages is very important: quick and correct actions by a doctor will help prevent the development of inflammation and the oncological process.

What foods can trigger heartburn?

The likelihood of developing heartburn and belching after eating increases if you consume the following foods:

• all types of citrus fruits;
• products containing cocoa beans;
• coffee, tea, carbonated drinks;
• tomatoes;
• cabbage;
• legumes;
• dairy products (except low-fat fermented milk);
• fatty meats and fish and broths made from them;
• baked goods and sweets;
• sour berries;
• apples;
• hot sauces and almost all spices;
• alcohol3.

A healthy person does not need to completely eliminate these foods, but they do need to monitor their amounts. For those who often experience heartburn, it is recommended to remove the listed foods from their diet so as not to aggravate the condition2.

Heartburn during pregnancy

Often, expectant mothers complain of heartburn during pregnancy. Several mechanisms are involved in this process:

• Enlarged uterus. From the first month of pregnancy until the last week, a woman's uterus grows. It puts pressure on the stomach and can push it upward. The stomach finds itself in an unnatural position - this leads to the reflux of gastric contents into the esophagus.
• Hormonal influence. During pregnancy, a woman actively secretes progesterone, which has a relaxing effect on many smooth muscles. The sphincter, located between the esophagus and the stomach, is also a smooth muscle fiber. The synthesis of progesterone leads to incomplete closure of the sphincter, and food from the stomach enters the esophagus, damaging its wall.

Heartburn during pregnancy is a condition that a pregnant woman should definitely discuss with her doctor. The doctor will prescribe the necessary medications and help correct heartburn.

Features of treatment

How to get rid of heartburn? The first step is a consultation with a gastroenterologist. The doctor will conduct a diagnosis and determine the cause of heartburn. If a person is healthy and heartburn bothers him only in rare moments of overeating, then the doctor will recommend changing his diet and giving up heavy foods.

But what to do about heartburn if this symptom occurs too often? It is most likely that the person has a gastrointestinal disease that is causing the symptom. The doctor will make a diagnosis and begin treatment of the underlying pathology, which means the heartburn will go away. As a rule, the doctor prescribes medications for heartburn in accordance with the diagnosis that was made to the patient.

How to deal with heartburn with medication

An effective remedy for heartburn are certain groups of drugs that are prescribed exclusively by the attending physician when determining the patient’s treatment regimen.

As a rule, the patient takes pills for heartburn. Doctors claim that only complex therapy helps with heartburn - this means that a person must take all the medications prescribed to him. Complex therapy includes the following groups of drugs:

• Antacids . Medicines neutralize hydrochloric acid, which can be thrown into the esophagus. Antacids are the drugs of choice for diseases that are associated with intense pain (for example, gastroesophageal reflux disease, chronic gastritis). Doctors often choose to prescribe aluminum or magnesium preparations. Antacids have a quick but unstable effect. As a rule, they are prescribed not to treat the underlying disease, but to eliminate symptoms.
• Alginates . This group of drugs is capable of forming a special film with neutral acidity on the surface of the stomach. It turns out that even if gastric contents end up in the esophagus, they do not damage its wall due to neutral acidity.
• Gastroprotectors . The essence of the action of gastroprotectors is to protect the gastric mucosa by forming a special film. The drug covers damaged areas of the stomach, creating a special “coating” for them.
• Antisecretory agents . The mechanism of action of these drugs is to reduce the activity of hydrochloric acid synthesis in the stomach. H2 blockers of histamine receptors inhibit the production of pepsin, promote the formation of mucus and activate protective factors of the gastric mucosa, which resist aggression factors. Doctors often prescribe Ranitidine and Famotidine. The second group of antisecretory drugs is proton pump inhibitors (PPIs). They actively suppress the synthesis of hydrochloric acid, and the main representative of PPIs is Omeprazole.
• Prokinetics have a pronounced effect on the motor (motor) function of the gastrointestinal tract, which is actively used in the treatment of gastroesophageal reflux disease, reflux of stomach contents into the esophagus.

The prescription of any medications for heartburn is carried out exclusively by the attending physician. Remember that getting rid of heartburn at home can often be dangerous to your health.

4.Medicines and surgical treatment of the disease

You can also find medications to treat heartburn, many of which are sold without a doctor’s prescription and can help you get rid of heartburn very quickly:

• Antacids
  . Antacids neutralize excess stomach acid and thereby reduce heartburn. Sometimes antacids are also prescribed for ulcers to relieve pain. Some antacids contain the substance simethicone, which helps get rid of excess gas. The most popular example of an antacid is Maalox. These medications must be taken strictly according to the instructions. And if they are in tablet form, chew well before swallowing. This way the medicine will help faster. An overdose of antacids can cause serious side effects, including constipation, diarrhea, and stomach cramps.
• Acid blockers
  . These medications relieve heartburn and reduce stomach acid production. It is also important to take such drugs on the recommendation of a doctor and in no case exceed the daily dose. Overdose may cause serious side effects such as bleeding, sore throat, confusion, fever, irregular heartbeat, weakness and severe fatigue. Headache, dizziness, and diarrhea are also possible.
• H2 blockers
  . These heartburn medications also help by reducing the production of stomach acid. Prescription forms with higher dosages of the active substance usually work very well to relieve an attack of heartburn or GERD.
• Proton pump inhibitors
  are even more effective at blocking the production of stomach acid compared to drugs from previous groups.
• Medicines that speed up digestion
  . These heartburn medications work by speeding up digestion, thereby preventing acid from sitting in the stomach for too long. In addition, they strengthen the lower esophageal sphincter and reduce acid reflux into the esophagus.

For most patients, these medications work well in treating heartburn. But if these medications do not help cope with heartburn, or if heartburn has been constantly appearing for two weeks, and you have to constantly take medications, you should definitely consult a doctor. You may need more serious treatment.

Preventing heartburn

Reflux of gastric contents into the esophagus is an unpleasant sensation for the patient, which can be accompanied by intense pain. To prevent heartburn in the throat or stomach from bothering you, you should follow several recommendations from doctors.

The first step is to follow the rules of a healthy lifestyle. You will have to give up smoking, drinking alcohol, and also choose the right diet. You need to eat 4-5 times a day, in small portions; after eating, you should not take a horizontal position. The last meal should be 3 hours before bedtime.

The diet should not contain fatty, fried and spicy foods, or carbonated drinks. It is advisable to eat more cereals, vegetables and boiled meat.

Do not think that heartburn is a harmless condition that does not require treatment! If an alarming symptom occurs, you should consult a gastroenterologist. And to prevent heartburn, you should follow the recommendations of doctors.

Classification

Taking into account the predominant localization of discomfort, a distinction is made between the more common heartburn in the chest and the less common form with a burning sensation in the throat. To determine the severity of a symptom, the frequency and circumstances of its development, intensity, connection with food intake, and other features of the discomfort experienced are usually used. This approach is effective for conducting a diagnostic search and selecting optimal methods for correcting heartburn, taking into account the causes of its occurrence. Based on the proposed criteria, three degrees of severity of the disorder are distinguished:

• Mild heartburn
  . A retrosternal burning sensation appears no more than once a month, is usually provoked by dietary errors, and quickly goes away on its own after correcting the diet. May be accompanied by belching of air or acidic stomach contents. It is observed in 51.4% of men and 48.5% of women without chronic pathology of the digestive organs.
• Moderate (moderate) heartburn
  . Disturbs the patient 1 to 3 times weekly. It is observed after eating both irritating and familiar foods to the patient. It is often detected as part of a dyspeptic syndrome with nausea, sour or putrid belching. Usually indicates the development of gastroenterological pathology.
• Severe (severe) heartburn
  . It appears almost every day, combined with belching, nausea, sometimes vomiting, stool instability, and abdominal pain. Often associated with food, although it may occur on an empty stomach. Urgent diagnosis is necessary to determine the disease that caused the symptom. Found in 1.2% of men and 3.4% of women.