Heartburn: Difference between revisions

Jump to navigation Jump to search
(39 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
'''For patient information on heartburn, click [[Heartburn (patient information)‎‎|here]]'''.
{{Heartburn}}
{{Heartburn}}
'''For patient information on heartburn, click [[Heartburn (patient information)‎‎|here]]'''.
{{CMG}}
{{CMG}}


==Overview==
==[[Heartburn overview|Overview]]==
'''Heartburn''' or '''pyrosis''' is a painful or burning sensation in the [[esophagus]], just below the [[Sternum|breastbone]] caused by regurgitation of gastric acid.<ref>http://www.nlm.nih.gov/cgi/mesh/2005/MB_cgi?mode&term=heartburn</ref> The pain often rises in the [[chest]] and may radiate to the [[neck]], [[throat]], or angle of the [[jaw]]. Heartburn is also identified as one of the causes of chronic [[cough]], and may even mimic [[asthma]].
Heartburn actually has nothing to do with the [[heart]]. It is so called because of a burning sensation of the breastbone where the heart is located although some heart problems do have a similar sensation to heartburn. The term "heartburn" may come from the fact that hydrochloric acid from the stomach comes back up the esophagus because of a problem with the cardiac sphincter, a valve which misleadingly contains the word "cardiac" (an adjective referring to the heart) in its name.


== Pathophysiology ==
==[[Heartburn historical perspective|Historical Perspective]] ==
The sensation of heartburn is caused by  exposure of the lower esophagus to the [[acid]]ic contents of the stomach. Normally, the lower esophageal [[cardia|sphincter]] (LES) separating the stomach from the esophagus is supposed to contract to prevent this situation. If the sphincter relaxes for any reason (as normally occurs during swallowing), stomach contents, mixed with [[gastric acid]], can return into the esophagus. This return is also known as ''reflux'', and may progress to [[gastroesophageal reflux disease]] (GERD) if it occurs frequently. [[Peristalsis]], the rhythmic wave of muscular contraction in the esophagus, normally moves food down and past the LES and is responsible for ultimately clearing refluxed stomach contents. In addition, gastric acid can be neutralized by [[buffer solution|buffer]]s present in [[saliva]].


== Diagnosis ==
==[[Heartburn classification|Classification]] ==
===Biochemical===
;Ambulatory pH Monitoring : A probe can be placed via the nose into the esophagus to record the level of [[acidity]] in the lower esophagus.  Because some degree of variation in acidity is normal, and small reflux events are relatively common, such monitors must be left in place for at least a 24-hour period to confirm the diagnosis of [[Gastroesophageal_reflux_disease|GERD]].  The test is particularly useful when the patient's symptoms can be correlated to episodes of increased esophageal acidity.
; Upper Gastrointestinal (GI) Series : A series of x-rays of the upper digestive system are taken after drinking a [[barium]] solution.  These can demonstrate reflux of barium into the esophagus, which suggests the possibility of gastroesophageal reflux disease.  More accurately, [[fluoroscopy]] can be used to document reflux in real-time.


===Mechanical===
==[[Heartburn pathophysiology|Pathophysiology]] ==
; [[Manometry]] : In this test, a pressure sensor ([[manometer]]) is passed through the mouth into the esophagus and measures the pressure of the lower esophageal sphincter directly.
; [[Endoscopy]] : The esophageal mucosa can be visualized directly by passing a thin, lighted tube with a tiny camera attached (an endoscope) through the mouth to examine the esophagus and stomach.  In this way, evidence of esophageal inflammation can be detected, and biopsies taken if necessary. Since an endoscopy allows a doctor to visually inspect the upper digestive track the procedure may help identify any additional damage to the tract that may not have been detected otherwise.
; [[Biopsy]] : A small sample of tissue from the esophagus is removed. It is then studied to check for inflammation, cancer, or other problems.


==Differential Diagnosis of Heartburn==
==[[Heartburn causes|Causes]]==
* [[Angina]] / ischemia
* [[Ascites]]
* [[Asthma]]
* [[Barrett's Esophagus]]
* Cardiotomy
* Caustic agent ingestion with resultant mucosal injury
* [[Chagas Disease]]
* [[Cholelithiasis]]
* Clothes (elevated internal stomach pressure)
* [[Constipation]]
* [[Coronary Artery Disease]]
* [[Coughing]]
* [[CREST syndrome]] (Calcinosis Raynaud's phenomenon Esophagus Sclerodactyly Telangiectasias)
* Direct irritation of esophagus:
:[[Aspirin]]
:[[Cigarette smoke]]
:Citrus fruits, juice
:[[Ibuprofen]]
:Spicy foods
:Tomatoes
:Tomato sauce


* [[Diabetes]]
==[[Heartburn differential diagnosis|Differentiating Heartburn from other Diseases]]==
* [[Drugs]]:
:[[Albuterol]]
:[[Anticholinergic]]s
:[[Caffeine]]
:[[Calcium channel blockers]]
:[[Cigarette smoking]]
:[[Nitrates]]
:[[Progesterone]]
:[[Theophylline]]  


* Esophageal atresia or fistula
== [[Heartburn epidemiology and demographics|Epidemiology and Demographics]] ==
* [[Esophageal carcinoma]]
* [[Esophageal diverticulum]]
* [[Esophageal varices]]
* Foods:
:[[Alcohol]]
:Chocolate
:Coffee
:Fatty foods
:Peppermint
:Soft drinks with caffeine
:Tea


* Fundectomy (postoperative)
== [[Heartburn risk factors|Risk Factors]] ==
* [[Gastrectomy]] (postoperative)
* [[Gastritis]]
* [[Gastroesophageal Reflux Disease]] ([[GERD]])
* [[Hiatal hernia]]
* Infectious [[esophagitis]]
* Lifting
* [[Mallory-Weiss Tear]]
* Motility disorders
* Muscle strain
* [[Myasthenia gravis]]
* [[Myocardial Infarction]]
* [[Obesity]]
* [[Peptic Ulcer Disease]]
* [[Pericardial Disease]]
* [[Pregnancy]]
* Primary reflux [[esophagitis]]
* [[Pulmonary Embolism]]
* [[Raynaud's Phenomenon]]
* [[Scleroderma]]
* Strictures, webs, or rings
* [[Vagotomy]] (postoperative)


== Causes ==
== [[Heartburn screening|Screening]] ==
Foods that may cause heartburn:
* [[Soft drink|Soda]]s (including cola), and other carbonated beverages
* [[Chocolate]]
* [[Citrus]] fruits and juices
* Tomatoes and tomato sauces (such as pizza and pasta sauce)
* [[Spicy food]]s
* [[Capsicum|Red pepper]] (capsicum)
* [[Peppermint]] and spearmint
* Dry foods such as [[peanut]]s
* [[Fat]]ty foods such as [[ice cream]]
* [[Garlic]]
* [[Bread]] and other foods derived from [[grain]]s
* [[Wine]]


Drugs are also known to cause or trigger heartburn symptoms.
== [[Heartburn natural history, complications and prognosis|Natural History, Complications and Prognosis]] ==


* [[Tobacco]] products ([[cigarettes]], [[Snuff (tobacco)|snuff]], etc.)
== Diagnosis ==
* [[Cocaine]], and especially [[Methamphetamine]] is known to trigger heartburn.
[[Heartburn history and symptoms|History and Symptoms]] | [[Heartburn physical examination|Physical Examination]] | [[Heartburn laboratory findings|Laboratory Findings]] | [[Heartburn MRI|MRI]] | [[Heartburn ultrasound|Ultrasound]] | [[Heartburn other imaging findings|Other Imaging Findings]] | [[Heartburn other diagnostic studies| Other Diagnostic Studies]]
* [[Alcohol]]
* [[Caffeine]], as found in [[Coffee]], [[tea]], cola, and other beverages
 
It can also be [[psychosomatic]], primarily in relation to [[Stress (medicine)|stress]] and [[fatigue (medical)|fatigue]]


==Treatment==
==Treatment==


=== Prevention ===
[[Heartburn medical therapy|Medical Therapy]] | [[Heartburn surgery|Surgery]] | [[Heartburn primary prevention|Primary Prevention]] | [[Heartburn secondary prevention|Secondary Prevention]] | [[Heartburn cost-effectiveness of therapy|Cost Effectiveness of Therapy]] | [[Heartburn future or investigational therapies|Future or Investigational Therapies]]
If heartburn occurs when lying down, raising the head of the bed, or raising the upper body with pillows or sleeping sitting up frequently provides relief.  Avoid pillows that raise the head only, as this does little for heartburn and places continuous strain on the neck. To minimize attacks, a sufferer may find benefit in avoidance of certain foods that relax the opening between the stomach and esophagus, such as chocolate, peppermint, and chamomile tea shortly before bedtime.
 
=== Medications ===
[[Antacid]]s, [[H2-receptor antagonist]]s, alginates and [[proton pump inhibitor]]s are used (in that order) to treat heartburn.
 
==== Antacids ====
Antacids work by neutralizing excess stomach acid. So although stomach acid will still splash up into the esophagus (acid reflux) the stomach acid will be neutralized and therefore will lead to lesser or no heartburn symptoms (the burning feeling). Antacids provide fast relief of symptoms, but relief typically last for just 30-60 minutes.
 
==== Sodium bicarbonate ====
A simple and relatively harmless way to treat a one-off heartburn is to drink a solution of a small amount of [[Sodium bicarbonate]] mixed with water, which quickly neutralizes the acid that causes the pain.  Excess [[sodium]] intake does, however, raise blood pressure and cause other undesirable health effects if resorted to with any frequency.
 
==== H2-receptor antagonists ====
Often called H2 Blockers, H2-receptor antagonists work by decreasing the amount of acid the body releases into the stomach. H2s are systemic, meaning they require absorption into the bloodstream in order to work. Therefore, H2s can often take 30 minutes or longer before they start working, and therefore are often taken to prevent heartburn rather than for fast relief of symptoms.
 
==== Alginates ====
Alginates work differently than antacids and H2 Blockers, by forming a protective barrier in the stomach that prevents stomach acid from refluxing back up into the esophagus. Alginic acid is naturally derived (from brown seaweed) and is non-systemic. Alginates provide faster relief than H2-receptor antagonists and PPIs and longer-lasting relief than antacids.
 
==== Proton-pump Inhibitors ====
[[Proton pump inhibitor]]s, called PPIs, are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors are systemic and directly block acid production in the stomach cells. In order to prevent heartburn the medication disfigures and disables the proteins (proton pumps) that control the pH of the stomach, allowing the body to digest them. Proton-pump inhibitors are not fast-acting, but provide long-lasting relief. PPIs are intended to be short-term medications only.


=== Restricting Diet ===
==Case Studies==
Restricting diet is very important, since 90-95% of sufferers of heartburn or esophageal disorder can link their symptoms to specific foods. Therefore, it is important that heartburn sufferers manage their diets as a way to treat their heartburn. Sufferers should choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers.


=== Bananas ===
[[Heartburn case study one|Case #1]]
Are a natural antacid so eat one for instant relief of heartburn. The inside of the banana skin is also good  for soothing mosquito bites.


== See also ==
==Related Chapters==
*[[Acid indigestion]]
*[[Acid indigestion]]
*[[Gastroesophageal reflux disease]]
*[[Gastroesophageal reflux disease]]
==References==
{{reflist|2}}
==External links==
* [http://www.heartburnalliance.org National Heartburn Alliance]
* [http://www.mediprimer.com/Gastroenterology/heartburn/ Heartburn and Gastroesophageal Reflux Disease Primer]
* [http://www.gastroview.com Indigestion analysis]


{{Symptoms and signs}}
{{Symptoms and signs}}


[[Category:primary care]]
[[Category:Primary care]]
 
[[Category:General practice]]
[[Category:General practice]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Digestive disease symptoms]]
[[Category:Digestive disease symptoms]]
[[Category:Symptoms]]
[[Category:Symptoms]]
{{WH}}
{{WS}}


[[de:Sodbrennen]]
[[de:Sodbrennen]]
Line 178: Line 60:
[[ru:Изжога]]
[[ru:Изжога]]
[[fi:Närästys]]
[[fi:Närästys]]
{{WH}}
{{WS}}

Revision as of 15:36, 29 May 2013

For patient information on heartburn, click here.

Heartburn Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Heartburn from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT-Scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Heartburn On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Heartburn

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onHeartburn

CDC on Heartburn

Heartburn in the news

Blogs on Heartburn

Directions to Hospitals Treating Heartburn

Risk calculators and risk factors for Heartburn

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Heartburn from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WH Template:WS

de:Sodbrennen he:צרבת lt:Rėmuo no:Halsbrann fi:Närästys