Saanichton, BC

Dr. Miguel A. Lipka

Heartburn

This is categorized under:

Heartburn is a burning pain in the lower breastbone that may travel toward your neck. It also is associated with regurgitation of food and liquid into your mouth and a bitter or acidic taste.

Cardiac and esophageal causes of heartburn may share similar symptoms as these two structures have the same nerve supply.

Relief of heartburn is often found by raising the head of the bed, raising the upper body with pillows, or sleeping sitting up. Avoid pillows that raise the head only, as this does little for heartburn and places continuous strain on the neck.

Eating a big meal causes excess stomach acid production, and attacks can be minimized by eating small frequent meals instead of large meals, especially for dinner. To minimize attacks, a sufferer may benefit from avoiding foods that may trigger their symptoms. These may include:

  • Acidic fruit or juice
  • Fatty foods
  • Pretzels
  • Coffee
  • Tea
  • Onions
  • Peppermint
  • Chocolate
  • Highly spiced foods

Tight clothing around the waist can also increase the risk of heartburn because it puts pressure on the stomach, which can cause the food and acids in the stomach to reflux to the lower esophageal sphincter.

The treatment of heartburn depends on the underlying cause. Medicines such as H2 receptor antagonists or proton pump inhibitors are effective for gastritis and GERD, the two most common causes of heartburn.

Gastroesophageal Reflux

Heartburn, also known as acid indigestion, is actually a common symptom of an underlying condition called gastroesophageal reflux (GERD) or acid reflux. GERD is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of stomach acid to the esophagus. This is commonly due to changes in the barrier between the esophagus and the stomach, which can be transient or permanent.

In addition to heartburn, symptoms of GERD may include:

  • Persistent sore throat
  • Hoarseness
  • Chronic cough
  • Asthma
  • Chest pain
  • Feeling like there is a lump in your throat

Functional Heartburn

Functional heartburn is heartburn with no known cause. It is associated with other functional gastrointestinal disorders like irritable bowel syndrome and is the primary cause of lack of improvement post treatment for heartburn with proton pump inhibitors (PPIs). PPIs are however still the primary treatment with response rates in about 50% of people.

The criteria for Functional Heartburn are:

  • Burning retrosternal discomfort
  • Absence of GERD as the cause
  • No esophageal motility disorders

Cardiac

Heartburn is recognized as a symptom of an acute myocardial infarction and angina. A description of burning or indigestion like pain non significantly increases the risk of acute coronary syndrome. In a group of people presenting to a hospital with GERD symptoms 0.6% may be due to ischemic heart disease.