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Tuesday, November 19, 2013

Causes Heartburn and remedy

 

What Is Heartburn? What Causes Heartburn?

GastroIntestinal / Gastroenterology

Heartburn is an uncomfortable warm and burning sensation in the chest, usually just behind the sternum (breastbone) that typically comes in waves. The pain may start in the chest area and make its way up to the neck, throat and jaw. The pain usually gets worse when the patient lies down or bends over, and is more common immediately after eating.
The condition is medically known as pyrosis or acid indigestion.

The word "heartburn" is a popular lay term that has nothing to do with the heart.
Heartburn is usually linked to gastric reflux - the regurgitation of gastric acid; one of the main symptoms of GERD (gastroesophageal reflux disease).

As heartburn may also be a symptom of ischemic heart disease, it is important that doctors bear this in mind and do not jump to a GERD diagnosis too rapidly.

Some people use the terms "dyspepsia" and heartburn interchangeably. There is a difference: Dyspepsia is a combination of heart burn and epigastric pain, which is from the sternum to just above the umbilicus (navel, belly-button).

It is common for people to have heartburn occasionally, and it is usually nothing to worry about. With some lifestyle changes, and perhaps an OTC medication you can manage the discomfort without having to seek medical help.

If heartburn symptoms are experienced frequently and start affecting a person's daily routine, they should check with a doctor in case it is a sign of something more serious.

According to Medilexicon's medical dictionary:
Pyrosis (heartburn) is "Substernal pain or burning sensation, usually associated with regurgitation of acid-peptic gastric juice into the esophagus."
What are the signs and symptoms of heartburn?
A symptom is something the sufferer feels and describes, such as a headache or dizziness, while a sign is something other people can detect, such as a rash.

Signs and symptoms of heartburn include:
•    An uncomfortable sensation of warmth or burning in the chest. This tends to occur after eating, or during sleep. It can last from a few minutes to several hours.
•    When bending over or lying down the pain gets worse
•    Some patients may experience a burning sensation in the throat
•    Sometimes there is a chronic cough, sore throat or hoarseness
•    When swallowing, there may be a sensation of food sticking in the middle of the chest or throat
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Many of the heartburn symptoms may overlap with those of GERD, simply because heartburn is one of the symptoms of GERD.
What are the causes of heartburn?
Heartburn is the result of gastric acids backing up into the esophagus.

When we swallow, the lower esophageal sphincter relaxes, this allows foods and drinks to make their way to the stomach, after which the sphincter closes again.

If the lower esophageal sphincter does not close properly, gastric acids can seep back up into the esophagus, causing heartburn. When a person bends over or lies down the heartburn sensation may be worse, because the lack of gravity encourages more reflux.

Diagnosing heartburn

Physicians can usually diagnose heartburn by asking the patient to describe his/her symptoms.

A doctor may wish to determine whether the heartburn is a symptom of a wider condition, such as GERD. If so, the following tests may be ordered:
•    X-ray - the patient drinks a liquid that coats the inside lining of the digestive track. When X-rays are taken of this area, the liquid shows up in the images. The physician is able to make out a silhouette of the esophagus, duodenum and stomach, and determine their shape and condition. This type of X-ray is called a barium swallow.
•    Endoscopy - a thin, flexible tube with a light and camera at the end - an endoscope - is inserted through the throat and down to the esophagus and stomach. The doctor can see the esophagus and stomach on a monitor. This type of internal examination is useful for determining whether there are any complications of reflux, such as Barrett's esophagus. The doctor can also take a biopsy using an endoscope.
•    Ambulatory acid (pH) probe tests - a device is used to determine when gastric acid seeps back into the esophagus and how long for. It may be a catheter that is threaded through the patient's nose into his/her esophagus. The catheter (tube) is connected to a computer that is worn around the patient's waist or strapped over their shoulder. Signals are transmitted to the computer for a period of about two days.
•    Esophageal motility testing - this measures the movement of the esophagus as well as its pressure. A catheter is threaded through the patient's nose, down to his/her esophagus.
•    Manometry - this assesses how well the LOS (lower esophageal sphincter) works by measuring the pressure inside the sphincter muscle. Doctors may order this test if an endoscopy finds no evidence of damage to the esophagus. A small tube is threaded through the nose into the esophagus to where the LOS is. It contains several pressure sensors, which send data to a computer.

The patient is asked to swallow some food and liquid to determine how well the LOS is functioning. The whole test takes about thirty minutes to complete. Manometry is useful to confirm a diagnosis of GERD, as well as detecting rarer conditions related to the functioning of the LOS, such as achalasia or muscle spasms.
What are the treatment options for heartburn?
There are some steps patients can take themselves to reduce their risk of developing heartburn:
•    Lose weight - obese or overweight individuals may experience fewer bouts of heartburn if they lose weight, because there will be less pressure on the stomach.
•    Quit smoking - smoking irritates the digestive system and can worsen symptoms of heartburn and GERD
•    Eat smaller meals - people who eat more smaller meals each day rather than three large ones may find their heartburn symptoms either improve or go away altogether
•    The evening meal - have it at least three hours before going to bed
•    Avoid food triggers - some foods and drinks may trigger heartburn in some patients. Typical ones include coffee, alcohol, tomatoes, fatty or spicy foods, and chocolate. Identify your triggers and avoid them.
•    Your bed - if you raise the head end of your bed, your heartburn symptoms might improve
Symptoms of heartburn can usually be effectively treated with OTC (over-the-counter) medications.
•    Antacids - these neutralize stomach acid and provide rapid relief. It is important to follow the manufacturer's instructions and not to overuse them. Overuse can lead to constipation or diarrhea.
•    H-2-receptor blockers - they work more slowly than antacids, but provide longer relief. There are two types, OTC ones and stronger prescription ones.
•    Proton pump inhibitors - these block the production of acid, giving damaged esophageal tissue time to repair itself. Patients over 50 should be careful not to use proton pump inhibitors for extended periods - according to the US Food and Drug Administration (FDA), they may increase the risk of hip, wrist or spine fractures.


What Is GERD? What Causes GERD?

Acid Reflux / GERD
GastroIntestinal / Gastroenterology
What Causes GERD?
Health Professionals:
       
GERD or Gastroesophageal Reflux Disease occurs when gastric acid from the stomach goes up into the esophagus, often causing inflammation of the esophagus - esophagitis. Reflux refers to the upward or reverse movement from the stomach upwards to the esophagus.

If the GERD remains untreated the patient can experience great discomfort and inflammation of the esophagus. This is sometimes linked to serious complications, such as the narrowing (stricture) of the esophagus, Barrett's esophagus (severe esophagus damage which is linked to the development of cancer), ulceration, and bleeding.

Complications are more likely to happen as a result of nocturnal reflux, than daytime reflux. However, daytime reflux can also lead to complications.
What is erosive esophagitis?
This is when the esophagus lining has been damaged or eroded away by long-term exposure to gastric acid - a common problem with untreated acid reflux.
How common are GERD and erosive esophagitis?
In industrialized nations between 20% and 40% of adults experience regular heartburn. Heartburn is the primary symptom of GERD.

Hospitalized patients commonly have GERD as a concomitant condition. A concomitant condition is one that accompanies another.

It is estimated that over half of GERD sufferers may have erosive esophagitis.
What are the symptoms of GERD?
Heartburn is usually the main symptom; a burning sensation that rises from the stomach or lower chest towards the neck and throat.

A bitter or sour taste at the back of the throat is sometimes experienced.

Most of us experience occasional heartburn. When this happens two or more times per week, it is then more likely to be a symptom of GERD.

The correlation between symptom severity and the presence/grade of esophagitis is poor, and cannot be used as diagnostic guidance.
What causes GERD?
GERD occurs when the anti-reflux mechanisms at the junction between the esophagus and the stomach do not work properly. This may be due to a weakness in the lower esophageal sphincter that is supposed to close off the esophagus from the stomach and stop acid reflux from happening.
How is GERD diagnosed?
•    If a patient experiences heartburn at least twice a week, GERD is usually suspected.

•    The doctor will carry out a careful review of symptoms.

•    History Endoscopy may be used to confirm suspected diagnosis. However, less than 50% of patients with GERD have diagnostic endoscopic abnormalities.
How are GERD and erosive esophagitis treated?
•    For GERD management to be effective the patient's gastric acidity must be reduced, while his intragastric pH must be above 4 - keeping it above 4 reduces the damage caused to the esophagus by refluxed gastric contents.

•    PPI (proton pump inhibitor) therapy is very effective in maintaining intragastric pH above 4, as it suppresses gastric acid secretion, and is the recommended first-line treatment for all GERD patients (Geneva Guidelines). PPIs inhibit the proton (acid) pumps of the cells that line the stomach wall - preventing the secretion of stomach acid.

•    By commencing treatment with the most successful therapy, the higher initial cost of medication will probably be offset by rapid symptom control for the patient and the reduced need for repeated consultations.
How is the endoscopic severity of GERD classified?
The severity of esophagitis can be categorized by endoscopy using the Los Angeles classification of disease severity:
•    Grade A
Definition - At least one mucosal break no longer than 5 mm, none of which extends between the tops of the mucosal folds.

•    Grade B
Definition - At least one mucosal break more than 5 mm long, none of which extends between the tops of two mucosal folds.

•    Grade C
Definition - Mucosal breaks that extend between the tops of two or more mucosal folds, but which involve less than 75% of the mucosal circumference.

•    Grade D
Definition - Mucosal breaks which involve at least 75% of the mucosal circumference.
Home Remedies for Heartburn

Natural heartburn remedies
By Caroline Murray

Nothing ruins a great meal as much as a painful bout of heartburn.

Although over-the-counter meds are often effective, home remedies might help without the trip to the pharmacy.

Whether you've overindulged in a spicy dish or a feast of fatty foods, these five natural remedies could help soothe heartburn and put your belly at ease.Chewing gum

Besides eliminating garlic breath, chewing gum after a meal might have other advantages, research suggests.

In a small study from the Journal of Dental Research, people with gastroesophageal reflux disease (GERD) symptoms experienced heartburn relief when they chewed a piece of sugar-free gum for 30 minutes after a meal.

"Chewing gum
stimulates the salivary flow rate," says study author Rebecca Moazzez, DPhil, clinical lecturer in King's College London's department of restorative dentistry. "Any acid that accumulates in the gut is washed away and cleared more quickly. The clearance of acid improves GERD symptoms."
Baking soda
Old wives' tales will tell you the best way to beat heartburn is with a little sodium bicarbonate (baking soda).

"Baking soda is OK for most people with heartburn," says Jacqueline Wolf, MD, associate professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. "Because it's a base, it helps neutralize [stomach] acid."

Dr. Wolf, author of A Woman's Guide to a Healthy Stomach, recommends mixing between 1/2 and 1 teaspoon of baking soda with a glass of water. But avoid making baking soda your go-to remedy if you regularly have heartburn—it is high in salt and could cause side effects like swelling and nausea.
Licorice
Although research is limited, licorice could ease heartburn and get to the source of the problem, says Susan Blum, MD, founder and director of the Blum Center for Health in Rye Brook, N.Y.

"The contents of your stomach are supposed to be acidic…which is why antacids are not the solution," Dr. Blum says. Instead, she says, licorice has natural stomach healing properties. Eating a lot of licorice, however, can also have serious side effects like high blood pressure, so look for DGL licorice. (It does not contain the potentially dangerous glycyrrhizic acid.)

Dr. Blum suggests trying chewable DGL licorice tablets before meals, which are available at most natural-food stores. There are even brands that do not taste like licorice.
Aloe
Aloe, a plant usually used to soothe burns, could do the same thing for stomachs, says Victor Sierpina MD, professor of integrative and family medicine at the University of Texas Medical Branch, in Galveston, and author of The Healthy Gut Workbook.

Aloe vera juice reduces inflammation so "it quiets down any inflammation that is in the esophagus as well as the stomach," Dr. Sierpina says.

He recommends drinking 1/2 cup before meals, but warns that the juice can be a laxative. Look for brands that say the laxative component has been removed, such as Aloe Vera Power.
Slippery elm
Despite limited research, slippery elm has been used in herbal remedies for centuries to treat a variety of illnesses, including GERD symptoms. This tree extract thickens the layer of mucous lining the stomach, says Dr. Blum, creating a stronger barrier against acid.

"[Slippery elm] is a demulcent that offers a coating or protective layer to the tissue [of the stomach]," Dr. Sierpina says. "The way slippery elm has traditionally been prescribed is a couple tablespoons in water after meals and at bedtime."
Surprising Heartburn Triggers
More than 60 million people get heartburn at least once a month. Sometimes the cause--say a chilidog--is obvious. Here are some less obvious heartburn triggers, including fish oil supplements, peppermint, and prescription medications.




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