(heartburn) in the chest behind the sternum, or breastbone.
In rare cases, pain may radiate to the neck and arms, mimicking
a heart attack.
swallowing liquids or foods.
of food, usually tasting sour or bitter, when lying down
or bending forward.
or wheezing from regurgitation into the throat and lungs.
pain, thought to be due to an esophageal spasm set off by
acid irritating the esophagus.
When To Call Your Doctor
a doctor if symptoms of heartburn persist or recur frequently
an ambulance if you experience severe chest painthis
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?
inappropriate opening of the LES.
and increased abdominal pressure during pregnancy.
or acidic foods and drinks; chocolate; and mints (such as spearmint
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
or eating within two or three hours of going to bed, and avoid
napping after a meal. Also dont exercise immediately after
pants, girdles, and belts.
if you are overweight.
consumption of alcohol.
consumption of coffee and caffeinated beverages.
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.
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.
insertion of a lighted scope into the esophagus through the mouth)
may be performed to look for evidence of esophagitis.
How To Treat It
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.
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.
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