Health news of the week: Heart burn, Causes, Risk, Treatment and More.

What is Heartburn (Acid Reflux)?

Heartburn is a symptom rather than a disease. It is a symptom of Gastro-esophageal reflux disease or “acid reflux”. This is a common condition when the acid produced in the stomach leaks out and seeps back into the esophagus or food pipe.

The esophagus is a tube made up of muscles and lined with sensitive mucosal layer within that runs from the mouth to the stomach. As the stomach’s acid leaks into the esophagus, it leads to heartburn or burning chest pain or discomfort. Despite the fact that the pain has nothing to do with the heart, its location is the reason for the nomenclature.

The leakage of the acid into the esophagus also leads to a sour or bitter taste in the back of the mouth and in severe cases pain and difficulty swallowing. Most people have stomach acid reflux at some point in their lives, either as heartburn or acid regurgitation.

Causes of heartburn

Acid reflux or heartburn may be caused due to multiple factors. Normally the esophagus is guarded at its lower end by a valve like gate called the lower esophageal sphincter (LES). The LES acts like a valve, opening to allow food to be pushed into the stomach. It closes to prevent acid leaking out of the stomach and into the esophagus. In persons with acid reflux the muscle of this sphincter may not be working properly.

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In addition those who are smokers, alcoholics, take pain relievers like Ibuprofen and consume a spicy or high fat diet, are obese, overweight or pregnant, are at a greater risk of getting acid reflux and heartburn.

In addition caffeine containing foods like chocolates, coffee and peppermint also weaken the LES. Some people get heartburn when they bend over or lie down.

The frequency of stomach acid reflux varies from one person to another. The risk rises with age and may significantly decrease quality of life and overall well-being.

Risks associated with heartburn or acid reflux

If left untreated the stomach acid can irritate the inner lining of the esophagus. This may lead to esophagitis. In more severe cases this may lead to open sores or ulcers within the esophagus. This is called erosive esophagitis. Over time in rare cases this may turn into cancers (esophageal cancer).

Treatment

Treatment of acid reflux mainly relies on lifestyle changes that prevent attacks. Acid reflux is one of the commonest digestive disorders affecting millions of people worldwide at some point in their lives.

Lifestyle changes to relieve and prevent heartburn

Some of the lifestyle changes that can relieve and prevent attacks of heartburn and acid reflux include:-

Eating small and frequent meals

Eating a healthy, non-spicy, non-fatty and balanced meal. The last meal of the day should be taken at least 4 hours before bed. Lying down immediately after a meal may aggravate heartburn.

Avoidance of food and beverage triggers of heartburn including alcohol, coffee, chocolate, tomatoes, citrus fruits etc.

Maintaining a normal body weight.

Quitting smoking.

Avoidance of wearing tight clothes especially around the abdomen.

Raising the head end of the bed by about 20 cm (8 inches).

Medications for heartburn

For patients who do not respond to these measures diagnostic methods to evaluate the extent of esophagitis or esophageal damage and gastroesophageal reflux should be employed. Medication may be required in these patients.

Medications help in neutralizing the gastric acid or by reducing the acid production. There are another group of agents called prokinetics that increase the motility of the gastrointestinal system and thus allow food to be transmitted through the esophagus and gut faster.

Drugs used in acid reflux include:-

Antacids

These agents are available over the counter. They work by neutralizing the gastric acid and relieve the symptoms of heart burn and acid reflux. These drugs, however, cannot be taken along with other medications that reduce acid reflux and there may be significant interactions leaving these agents ineffective.

Alginates

These agents are also available over the counter without prescription. These agents work by producing a protective coating that shields the lining of the stomach and esophagus. This protects the vulnerable linings of mucosa from the acid.

Proton-pump inhibitors (PPIs)

These are prescription medications like Omeprazole, Pantoprazole, Rabeprozole and Lansoprazole. These work by reducing the acid produced by the stomach. Patients with gastroesophageal reflux disorder may require PPIs for a long duration.

H2-receptor antagonists

These include Ranitidine, Cimetidine and Famotidine. These agents block the effects of the chemical histamine that helps produce stomach acid. Thus these agents reduce the acid production.

Prokinetic agents

These include Bethanechol and Metoclopramide. These agents hasten movement of food via stomach to the intestines and reduce the risk of reflux.