60 million American experience hearburn monthly and approximately 15-25 million have daily heartburn. About 19 million take medications for their heartburn at least twice weekly. (National Digestive Diseases Clearinghouse, National Institutes of Health, and American College of Gastroenterology)

Heartburn is the classic symptom of the condition called Gastroesophageal reflux (GERD), the term used to describe a backflow of acid from the stomach into the esophagus(swallowing tube). However, many other symptoms such as chest pain, trouble swallowing, chronic cough, asthma and recurrent laryngitis can be caused by GERD.

Everyone occasionally has heartburn. People usually experience heartburn after meals or when the stomach is empty, and it feels like a burning sensation or pain behind the breastbone. Often, regurgitation of food and bitter-tasting stomach acid accompanies heartburn. Antacids or food temporarily relieve heartburn for some people. Many people require occasional use of stronger medication, and many others require aggressive medical therapy to control symptoms and prevent complications of the disorder (see below)

Why Does Heartburn Occur?

The esophagus carries food and liquid to the stomach. A muscular valve called a sphincter is located at the end of the esophagus. Known as the lower esophageal sphincter (LES), this muscle contracts and functions as a one-way valve, preventing backflow. The pressure of the LES is designed to keep the end of the esophagus closed so that stomach contents are not pushed up (or refluxed) the into esophagus. The LES muscle should only open when food is passed into the stomach.

Several mechanisms exist that allow reflux to occur:

Transient relaxations of the LES in the presence of normal resting pressure.

Spontaneous reflux in the presence of low LES pressure (from a hiatus hernia or because the LES is defective).

Transient increases in intra-abdominal pressure that overwhelms a low LES resting pressure.

Certain factors can cause decreases in LES pressure which predispose to reflux, and these include:

1.Nicotine

2. Coffee and other caffeinated beverages

3. Peppermint

4. Fried or fatty foods

5.Citrus fruits and juices; acidic foods like tomato sauce

6. Chocolate

7.Pregnancy

8.Lying flat

9.Hiatus hernia

10.Certain prescription medications

Complications of chronic reflux

If not treated appropriately, serious complications can result in patients who have reflux esophagitis, which include:

Scar formation, or stricture, which can block the passage of food and cause the food to get stuck (called a food impaction).

Barrett’s Esophagus, a change in the lining of the foodpipe from a normal lining to an abnormal, or metaplastic, lining. This type of esophageal lining carries with it the risk of precancerous changes (dysplasia) which can lead to cancer of the esophagus.

Anemia from chronic blood loss

Pulmonary complications such as asthma and pulmonary fibrosis.

Chronic cough and laryngitis

Unexplained chest pain.

Diagnosis

The primary tests used to diagnose reflux are:

Upper GI Series- The patient drinks liquid barium and x-rays are taken of the esophagus and stomach showing how they function. This may show the presence of a hiatus hernia and may show reflux, but gives no information on the presence of Barrett’s esophagus, and thus is limited in value.

Upper GI Endoscopy- The patient is mildly sedated and a flexible videoendoscope is inserted into the esophagus to visually inspect it and the stomach. It gives very accurate information about whether there is significant damage in the esophagus and whether Barrett’s esophagus is present.

Esophageal manometry- This test measures the pressure within the esophagus, especially the LES pressure. It is very useful for patients with chest pain and for preoperative evaluation to determine a patient’s suitability for endoscopic or laparascopic repair.

24 Hour pH Monitoring — Using a very thin, flexible tube, the pH or acid level of the esophagus is monitored for 24 hours on an ambulatory basis, thus determining how much reflux is present. It can also be used to monitor response to therapy.

TOP

Please note: We do not answer questions regarding individual medical problems on this website. We advise you to contact your physician for your specific health related concerns.

©2007 Syracuse Gastroenterological Associates, P.C.

Site designed and hosted by Internet Host Services