Heart burn is the most common presenting symptoms to medical out patient departments worldwide, reported prevalence is 24% in Pakistan as per data of 2005.

Heart burn - Copyright gutcare


What is heartburn:

Heart burn in medical terminology is referred to as GERD or Gastro-oesophageal reflux disease, Heartburn is felt when stomach acid flows back up into the esophagus, the pipe that carries food from the mouth to the stomach. Occasional occurrences are usually not problematic and resolve by themselves. But frequent episodes lead to the unpleasant symptoms of burning in chest or upper abdomen.

The stomach combines food, acids and enzymes to begin digestion. There are protective layers that line the stomach to prevent the acid from causing inflammation. The esophagus, however, does not have the same protection, and if stomach acid juices go back into the esophagus, they can cause inflammation and damage to its unprotected lining of food pipe.

What are the causes:

The most important aspect of management of this condition is to know what are the causes that aggravate this condition and only then corrective measures can be taken.

  • Obesity 
  • Fast food/ processed foods
  • Smoking
  • Tea/Coffee/Energy drinks
  • Spicy foods
  • Chocolates
  • Lack of physical activity
  • Some medications 
  • Diseases e.g. scleroderma
  • pregnancy
Should I be concerned:
Usually heart burn if occurring occasionally is not significant concern, but persistent symptoms and some red flags need evaluation by a specialist as they can indicate some significant underlying disease
  • Significant weight loss
  • Anemia
  • Bleeding in vomitus or stool
  • difficulty in swallowing foods or liquids
  • pain in left side of chest or arm/ neck & sweating 
  • Cough with change in voice
How it is diagnosed and management options

GERD without any red flags or warning signs is usually diagnosed clinically and managed conservatively.
For persistent symptoms or any alarm signs your doctor might recommend monitoring the PH in your esophagus or viewing your esophagus via camera attached to a flexible tube known as endoscopy. Management options include
  • Medications e.g. proton pump inhibitors & prokinetic agents
  • Diet modification
  • Avoiding aggravating agents e.g. smoking
  • weight loss & exercise
Why heart burn keeps getting back:

Now let's discuss why your heart burn keeps getting back despite treatment
  • Obesity- If you are obese there is high chance that your symptoms will return, this is perhaps the most important cause and reason for treatment failure, obesity causes dysfunction of the sphincter that blocks the stomach contents from getting back into the food pipe, apart from the direct pressure effect on the stomach leading to reflux, ensure that you develop an effective weight loss plan in consultation with your doctor & dietician if you want to prevent relapse.
  • Food- Fast food, fizzy drinks and increased consumption  of tea, coffee chocolate & spicy food due to our changing dietary habits has led to an increased incidence of gerd, moderating these items in your diet is a key step in ensuring you don't have to face heart burn. A Mediterranean diet with increased content of vegetable, fruits nuts and unprocessed food can help alleviate quite a number of digestion related issues.
  • Smoking- If you don't quit smoking, there is almost no chance that you will be able to get rid of your heart burn.
  • Lack of physical activity: Sedentary lifestyle and lack of physical activity also aggravates heart burn, ensure you get a 15-20 min walk after each meal, especially at night and have a gap of almost 2 hours between your meal & going to bed. Another necessary but often missed intervention is to raise the head end of the bed to about 4-6 inches.
  • Natural foods that can help with symptoms that should be included in daily diet, banana, almonds, peppermint & ginger tea.

References:

  • www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-disease-in-adults-the-basics?source=see_link

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