What is the Heartburn?
Heartburn is a pain behind the breast bone, often
described as ‘burning’ in quality. Pain can also be felt at the same level in
the mid-line of the back. Most people suffer from heartburn at one time or another. In
fact heartburn has nothing to do with the heart - it is a digestive problem. Heartburn is
generally related to meals and posture and can often be relieved by remedies for
indigestion.
Pain from the heart is also felt in the chest and
sometimes in the upper abdomen. There are two kinds of heart pain. The first, angina, is a
pain in the chest due to a temporary shortage of oxygen being carried in the blood to the
heart muscle. Angina should be suspected if the chest pain is brought on by exercise and
relieved by rest. The second is the more severe and prolonged pain of a heart attack. A
heart attack should be suspected if the pain is felt intensely in the centre of the chest,
spreading perhaps to one or both arms (especially the left) and into the lower jaw; or
feels like a heavy pressure or is ‘vice-like’.
Potentially dangerous confusion can arise when someone
neglects their heart pain believing it to be heartburn.
What Causes Heartburn?
Acid is present in the stomach to digest food. Heartburn
occurs when small amounts of this acid rise up into the gullet (oesophagus) - the tube
which carries food from the mouth to the stomach. This is called reflux.
The gullet, unlike the stomach, does not have a protective
lining. So when it is exposed to the acid, it can become inflamed and painful.
Why Doesn't Everyone get Heartburn?
At the bottom of the gullet there is a muscle which, by
its contraction, acts as a barrier to keep the acid in the stomach. If this doesn’t
work properly, reflux occurs. The reason why this muscle fails to work properly is not
fully understood.
Some known factors that can lead to heartburn include:
pregnancy
smoking
eating large meals, especially near bedtime
being overweight
bending a lot
wearing tight clothing around the waist.
In most of these cases, it is the increased pressure which
overcomes the normal muscle contraction and causes heartburn. Smoking, on the other hand,
relaxes the muscle around the gullet, with the same result.
What is Hiatus Hernia?
A sheet of muscle (called the diaphragm) separates the
stomach from the chest. If a small part of the stomach rises into the opening where the
gullet passes through the diaphragm (called the hiatus), this is called a hiatus hernia.
Many people who suffer from frequent heartburn have a
hiatus hernia, which can be shown on an X-ray. However, not everyone with a hiatus hernia
suffers from heartburn.
What Complications can Occur?
If acid reflux leads to inflammation (oesophagitis), the
gullet can become scarred and narrowed (stricture). Difficulty in swallowing, especially
lumpy foods, may result. If you have difficulty in swallowing, you should consult your
doctor.
How Can I Avoid Heartburn?
The most important and helpful aspects of treatment are
those which you can do for yourself.
Stop Smoking
After a meal, when the stomach is full, smoking increases the chances that you will suffer
from heartburn.
Avoid becoming overweight
For many patients weight reduction is the most important remedy. It is worth trying to
improve your eating habits. Include more fruit, vegetables and high-fibre foods in your
diet. Regular exercise can also help you to lose weight.
Diet
You may find particular foods can make your symptoms worse. These might include:acidic
fruit drinks, drinks which are too hot, spirits (such as whiskey and brandy), or fatty and
spicy meals. It is better to eat ‘little and often’, fill but do not over-fill
the stomach. Food should be eaten slowly and chewed well.
Sleeping
Let your evening meal digest well before
you go to bed. Night-time symptoms can also be reduced by raising the head of the bed on
blocks by 6 inches. Gravity helps to keep the acid in the stomach where it should be. Some
people are helped by sleeping on their left side.
Posture
Avoid bending from the waist or stooping just after meals. Instead, try and bend from the
knees, keeping the back straight. Meals are better taken while sitting on an upright chair
rather than slumped in front of the television.
Clothing
Avoid tight belts and underclothes as they increase pressure on the stomach.
Pregnancy
It is common for pregnant women to suffer from heartburn. By eating sensibly and keeping
your weight increase within the recommended limits, you can lessen the severity of
heartburn.
What Medical Treatment is
Available?
Many people who suffer from occasional heartburn take
antacids either in tablet or liquid form, which are available from the chemist.
Some antacid preparations relieve symptoms by forming a
layer on top of the stomach contents.
If you find that you have to take these medicines
regularly or you don’t get any relief, it is best to visit your doctor. He or she can
decide if tests are needed to find the cause of the problem.
Your doctor can also prescribe stronger medicine which
will reduce or prevent the production of acid in the stomach and allow the inflamed gullet
to heal.
Alternative medical remedies are also a possible option
but the DDF recommends that you discuss this with your doctor.
What Surgical Treatment is
Available?
When symptoms are severe, or there are complications and
medical treatment does not help, your doctor may recommend surgery to correct a hiatus
hernia and prevent heartburn (reflux). This surgical procedure, called fundoplication,
involves replacing the stomach back to its original position under the diaphragm. The
surgeon then wraps and stitches the upper few centimetres of the stomach around the
oesophagus (gullet) to prevent heartburn (reflux) recurring. This operation can be carried
out either by traditional open surgery or by keyhole (laparoscopic) surgery.
This procedure may also be advised for patients without a
hiatus hernia who suffer from severe reflux.
The Need for Research
Heartburn affects about 40% of the population, at some
time. We need to know more about the way in which reflux occurs so that effective
treatment to prevent this very common problem can be developed.
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