Heartburn
Heartburn is a type of indigestion. It occurs when acid and
digestive juices flow back up (reflux) from the stomach to the
gullet (oesophagus). The gullet is the tube connects your mouth
to your stomach. It runs down inside the chest behind your heart.
Here the acid and digestive juices can irritate the lining of the
gullet causing pain. If symptoms are severe and prolonged over
months or years they sometimes cause damage.
Most people suffer from heartburn at some stage. It is usually
self limiting and not serious and often settles without treatment.
The medical term for heartburn is reflux oesophagitis.
What are the symptoms of heartburn?
Symptoms include a burning sensation in the centre of the
chest, which travels up the breastbone to the throat. Sufferers
may also experience a taste of acid at the back of the throat and
occasionally small food particles re-entering the mouth.
Symptoms occur after eating and get worse on bending or lying
down. Symptoms may be worse at night and improve on belching or
on drinking milk. It may hurt to consume some food and drink,
particularly hot drinks and spicy foods. Simple antacids like
magnesium trisilicate or aluminium hydroxide, available over the
counter from the chemist, may help ease symptoms. Sometimes
symptoms are so severe that they cause considerable anxiety and
distress. They can be confused with pain from the heart. See some
of our earlier newsletters for more information about heart pain.
When and why do people get heartburn?
There is a circle of muscle at the bottom of the gullet, which
acts as a valve. This keeps food and acid down in the stomach. If
there is a lot of pressure on your stomach from outside this can
force acid up into your gullet. This might happen if you are
pregnant, you wear tight clothes or a belt, or if you are
overweight. You can also bring on heartburn if you bend over, or
you lie down.
If your stomach becomes too full (for example if you eat a
huge meal, or eat very spicy food or drink large amounts of beer)
this can also push acid up through the valve into the gullet.
If you have a hiatus hernia, part of your stomach gets pulled
up into your chest. When this happens the valve no longer works
properly. Smoking can also cause the muscle valve to relax.
The lining of the gullet is not as tough as the stomach lining.
When acid touches it, it burns and gives you pain. Once the acid
is in the gullet it may get stuck there where it causes damage
and may over a period of time cause narrowing of the gullet.
What tests might be done?
Your doctor will usually make the diagnosis from the symptoms
alone. If, however, your doctor is unsure of the exact diagnosis
or your symptoms do not ease with treatment he/she will
investigate further. There are two main diagnostic tests, both of
which require referral to hospital. A barium swallow or meal, is
an X-ray where you swallow a white compound. This can be seen on
X-ray film as it passes through your digestive system.
Alternatively an endoscopy can be performed where a small
flexible fibre-optic tube with a light on the end is inserted
down your throat. A camera at the other end allows the doctor to
examine your gullet and stomach. The doctor may take a biopsy (a
small tissue sample).
What treatment is available?
The most important treatment is for you to change your
lifestyle, as shown below. Help yourself by these measures:
 | Stop smoking. Cutting down is
not enough. You will also lessen your risk of heart
disease, lung disease and cancer. |
| If you are overweight, lose weight. Symptoms often stop
when normal body weight is achieved. |
| Avoid large meals and large amounts of alcohol. |
| Avoid fatty or spicy foods, hot drinks, and fruit juice. |
| Drink milky drinks. |
| Keep an upright posture for about an hour after eating.
Eat a few hours before going to bed rather than
immediately before. |
| Raise your bed head by 4-6 inches (use bricks, books or
blocks) or sleep with two or three pillows. |
| Avoid tight clothes and belts around your stomach. |
| Avoid bending and stooping, instead squat or kneel. |
| Take your medication exactly as recommended by your
doctor. |
| Tell your doctor if you are taking any other medicine. |
Exceptionally, surgery is required, usually when a hiatus
hernia is present and treatment has not reduced the symptoms.
Are there side-effects?
The side-effects depend on the type of medication you are
prescribed. Common side-effects include diarrhoea, constipation,
flatulence, fluid retention, dizziness and loss of balance. If
you can stop your symptoms using the lifestyle changes mentioned
above, this is preferable.
