Heartburn

Heartburn, also known as pyrosis, or acid indigestion.

Refers to a burning sensation in the central chest or upper central abdomen.

The discomfort radiates to the neck, throat, or angle of the jaw.

It is usually due to regurgitation of gastric acid, that is, gastric reflux into the esophagus and is the major symptom of gastroesophageal reflux disease (GERD).

Approximately 20% of adults regularly have symptoms gastroesophageal reflux disease.

In about 0.6% of cases it is actually a symptom of ischemic heart disease.

The terms indigestion includes heartburn.

Indigestion may be defined as a combination of epigastric pain and heartburn.

Heartburn is commonly used interchangeably with gastroesophageal reflux disease.

Symptoms can be confused with the pain that is a symptom of an acute myocardial infarction.

As many as 30% of chest pain patients undergoing cardiac catheterization have findings which do not account for their chest discomfort, studies based on ambulatory pH and pressure monitoring 25% to 50% of these patients have evidence of abnormal GERD.

Gastroesophageal reflux disease is the most common cause of heartburn, with acid reflux leading to inflammation of the esophagus.

Functional heartburn is heartburn of unknown cause.

PPIs are the primary treatment for heartburn with response rates in about 50%.

Chest pain caused by GERD described as burning sensation that occurs after eating or at night, and worsens when a person lies down or bends over.

Heartburn is common in pregnant women.

Heartburn may be triggered by consuming large amounts of food, or foods containing spices, high fat content, or high acid content.

Heartburn after eating or drinking and combined with difficulty swallowing may indicate the presence of esophageal spasms.

Relief of symptoms 5 to 10 minutes after the administration of viscous lidocaine and an antacid increases the likelihood the esophagus is the source of discomfort, but 10% of cases of discomfort due to cardiac causes are improved with antacids.

Esophageal pH monitoring with a probe that can be placed via the nose into the esophagus to record the level of acidity in the lower esophagus, and can be used to monitor reflux in real-time.

With manometry, a pressure sensor is passed via the mouth into the esophagus and measures the pressure of the lower esophageal sphincter directly.

Endoscopy: the esophageal mucosa can visualize evidence of esophageal inflammation, and biopsies taken if necessary.

Biopsy: a small sample of tissue from the esophagus is removed to Heb studied for inflammation, cancer, or other problems.

Antacids such as calcium carbonate are often taken to treat the immediate problem,
with further treatments depending 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.

Antibiotics are used if H. pylori is present.

About 42% of the population has had heartburn at some point.

Heartburn that persist despite the use of proton-pump inhibitors is a frequent clinical problem.

PPI Therapy fails to provide symptom relief and 40% of patients.

In refractory heartburn or PPRI-resistant GERD management has remained empirical and often unsatisfactory, therefore anti-reflux surgery is generally not recommended.

In such refractory patients surgery is superior to alternative medical treatments (Talley).

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