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Digestive Disorders

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Gastroesophageal Reflux (Heartburn)

Symptoms

Burning sensation (heartburn) in the chest behind the sternum, or breastbone. In rare cases, pain may radiate to the neck and arms, mimicking a heart attack.

Difficulty swallowing liquids or foods.

Regurgitation of food, usually tasting sour or bitter, when lying down or bending forward.

Pain upon swallowing.

Hoarseness or wheezing from regurgitation into the throat and lungs.

Chest pain, thought to be due to an esophageal spasm set off by acid irritating the esophagus.

When To Call Your Doctor

Call a doctor if symptoms of heartburn persist or recur frequently despite self-treatment.

Emergency: Call an ambulance if you experience severe chest pain—this may signal a heart attack.


What Is It?

Gastroesophageal reflux, the most common cause of heartburn (which actually has nothing to do with the heart), is the regurgitation of the contents of the stomach and duodenum (the first portion of the small intestine) into the esophagus, the muscular tube through which food travels from the mouth to the stomach. Because the esophagus lacks the protective lining of the stomach, it is easily irritated by digestive juices; the irritation causes a "burning" sensation in the chest.

The lower esophageal sphincter (LES), a circular band of muscle located at the junction of the esophagus and stomach, is usually clenched but opens when a person swallows to permit food or liquid to enter the stomach. Reflux occurs when, for a variety of possible reasons, the LES allows stomach contents to pass upward into the esophagus. Severe, long-standing reflux can cause esophageal inflammation (esophagitis), which leads to scarring that can cause considerable swallowing difficulty.

What Causes It?

Weakness or inappropriate opening of the LES.

Hormonal changes and increased abdominal pressure during pregnancy.

Smoking.

Overeating and obesity.

Excessive consumption of alcohol.

Fatty, spicy, or acidic foods and drinks; chocolate; and mints (such as spearmint and peppermint).

Excessive consumption of caffeinated beverages, which weaken the LES pressure and also stimulates acid secretion. For uncertain reasons, decaffeinated coffee also stimulates acid secretion and can increase the severity of reflux.

Prevention

Avoid overeating or eating within two or three hours of going to bed, and avoid napping after a meal. Also don’t exercise immediately after eating.

Avoid tight pants, girdles, and belts.

Lose weight if you are overweight.

Avoid excessive consumption of alcohol.

Don’t smoke.

Decrease your consumption of coffee and caffeinated beverages.

Diagnosis

Patient history usually indicates the diagnosis. Frequent episodes of a burning sensation in the chest or of sour or bitter liquid or food coming back to the mouth are hallmarks of gastroesophageal reflux.

X-rays are taken after the patient swallows barium, which clearly outlines the esophagus and stomach and may demonstrate reflux.

Monitoring of pH, in which a small acid-sensitive catheter is placed through the nose and into the esophagus to confirm and measure the severity of reflux.

Endoscopy (the insertion of a lighted scope into the esophagus through the mouth) may be performed to look for evidence of esophagitis.

How To Treat It

Follow preventive measures.

Elevate the head of the bed by six to nine inches to reduce reflux at night.

Take an over-the-counter antacid that does not contain calcium or an over-the-counter histamine (H2) blocker such as cimetidine, ranitidine, famotidine, or nizatidine on an as-needed basis, according to the label instructions. Frequent and long-term need for these drugs suggests severe reflux, so check with a doctor if you need more than occasional relief.

Your doctor may prescribe medication to suppress the secretion of stomach acids or to speed the passage of food from the stomach to the small intestine. Medications include proton pump inhibitors (such as omeprazole and lansoprazole), histamine (H2) blockers, and prokinetic drugs (such as bethanechol, metoclopramide, and cisapride). These drugs are usually very effective and are the treatment of choice when simple self-care methods fail.

In severe cases, surgery may be necessary to tighten the LES.

 

From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.

 

 


 


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2005
WHITE PAPERS
Digestive Disorders

The Digestive Disorders White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.


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Johns Hopkins Symptoms and Remedies
An easy-to-use reference work that can help you pinpoint the cause of hundreds of symptoms, from abdominal pain to skin rash to swollen glands.

 

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