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Heartburn is often, not very fortunately, called hyperacidity, because it can be accompanied by acid regurgitation or the sensation of acid in the mouth. Heartburn, a burning or burning sensation behind the breastbone, radiates upwards from the abdomen, to the neck and sometimes to the back, shoulders, neck and jaws. More and more people are looking for a way to get rid of it.
It was found that this ailment of the gastrointestinal tract occurs daily in 5-10 percent. residents of highly developed countries, and every fifth person complains about it once a week. Contrary to popular belief, heartburn (pyrosis in Latin) is usually not caused by excessive production of hydrochloric acid in the stomach, i.e. acidity. Most patients presenting with heartburn show normal gastric secretion. Moreover, diseases related to the overproduction of hydrochloric acid are actually relatively rare. So what causes this bothersome ailment?
Gastroesophageal reflux disease
The cause may be neurotic disorders, but in the vast majority of cases the ailment is a consequence of the backflow of acid stomach contents into the esophagus, and even in the oral cavity. This phenomenon, known as gastroesophageal reflux, is caused by impaired function of the natural barrier between the esophagus and the stomach (primarily the lower esophageal sphincter).
In the last few decades, an increase in the incidence of this disease has been observed, which is accompanied by a decreased incidence of gastric ulcer disease. It is estimated that acid reflux disease is responsible for approximately 75% of cases of heartburn.
A revision of physiology
It is worth realizing that in all of us, the esophageal mucosa is in contact with hydrochloric acid periodically, and not all reflux is abnormal. There is a so-called physiological reflux, which occurs in healthy people as an expression of a temporary decrease in the tension of the lower esophageal sphincter, especially after heavy, hard-to-digest meals or carbonated drinks. Since the pH of gastric juice is very low (it may periodically be 1,0), the question arises why such acidic content does not damage the esophagus and stomach in healthy people? This is determined by protective factors. In the case of the stomach, a layer of mucus covering its walls and limiting the penetration of hydrogen ions, the integrity of the epithelial cells and the blood flow necessary for the supply of oxygen and nutrients is essential.
On the other hand, the mucosa of the esophagus, although covered with a thicker epithelium, is more sensitive to the damaging effects of gastric contents, which, apart from hydrochloric acid, also contain digestive enzymes, and sometimes also bile, if only because the amount of mucus here is small. Fortunately, the esophagus is not defenseless against the so-called. aggression factors contained in the alleged content. A normal pressure difference between the thoracic and abdominal cavities would result in an almost constant regurgitation of gastric contents into the esophagus, were it not for the anti-reflux mechanisms, the most important of which is the lower esophageal sphincter pressure. At rest, it exceeds the pressure in the stomach and decreases as swallowing-induced contractions reach the distal esophagus. Even then, however, it remains higher than the pressure in the stomach lumen.
It also has a protective role in cleansing the esophagus of acid, which is influenced by the secretion of saliva and bicarbonate, esophageal contractility and the force of gravity. Following an episode of reflux, gastric contents are neutralized by compounds in the saliva and esophageal mucosa, and then returned to the stomach due to its contractions. It is worth emphasizing that at night, motor activity and salivation decrease, and the contact time of the gastric contents with the esophageal mucosa is extended.
One complaint – many causes
The key factor contributing to the development of heartburn is the reduction of the pressure of the lower esophageal sphincter and impaired contractility of the esophagus due to certain congenital diseases, inflammation and systemic diseases such as diabetes and systemic sclerosis. Its occurrence is also influenced by obesity, hiatal hernia, disorders of saliva secretion and gastric motor function. Heartburn is felt more often when the stomach is distended and its contractility is impaired, which contributes to the retention of food contents. It should be remembered that the likelihood of the appearance of this ailment is increased by many popular drugs used in the treatment of hypertension, coronary artery disease, bronchial asthma, as well as oral contraceptives.
Heartburn can also be a symptom of functional dyspepsia, malignant neoplasm, biliary tract diseases or gastritis. The latter develops as a result of an imbalance between protective factors and aggression factors, including Helicobacter pylori infection, alcohol, bile, smoking, certain medications and spicy spices. It should be remembered that the burning sensation behind the breastbone does not have to be a consequence of gastrointestinal diseases and may accompany ischemic heart disease or inflammation of the cartilaginous part of the ribs.
When does he tease?
Heartburn usually worsens when you bend your body forward (e.g. when tying shoelaces, lifting objects from the floor), while pushing, and lying down. That is why many people only see the problem after going to bed, especially after a hearty, late dinner.
In addition, by increasing gastric secretion and / or reducing the tone of the lower esophageal sphincter, heartburn is caused or exacerbated by certain drinks and nutrients, such as fats, chocolate, peppermint, coffee and alcohol. Occasionally, patients cannot tolerate high-fiber raw foods and small-seed fruits.
Change in diet and bad habits
Treatment of heartburn should be directed at the cause of this condition. In non-pharmacological management, attention is paid to avoiding situations and factors that contribute to reflux. In overweight and obese people, weight loss is recommended. Patients with pathological reflux should not work in a bent position and wear too tight clothing. The head of the bed should be raised about 15 cm to help clear acid from the esophagus at night. It is necessary to quit smoking and avoid alcohol.
A large role is also assigned to changing eating habits, consisting not only in reducing the caloric content and volume of meals, but also limiting the consumption of fats, chocolate and bloating foods. High-protein foods are recommended, and meals should be eaten no later than 2-3 hours before bedtime. It is unfavorable to lie down immediately after a meal. Coffee, strong tea and carbonated drinks, especially the cola type, are discouraged. Citrus fruits and tomato juice can also aggravate the symptoms. In addition, medications that disrupt the esophagus and stomach should be avoided whenever possible.
Help from the pharmacy
Unfortunately, in many people, even strict adherence to these recommendations does not eliminate the ailments. In this situation, drugs are used, many of which are available over the counter. This group includes antacids (antacids) with the longest history of symptomatic treatment of heartburn. They are most often calcium, magnesium and aluminum preparations, also available in the form of effervescent tablets or suspensions, which increases the contact surface with the esophagus and stomach mucosa. Newer formulations additionally contain alginic acid, which creates a foam on the surface of the liquid gastric contents in the esophagus. The so-called mucoprotective drugs, i.e. drugs that protect the mucosa, increase tissue resistance, neutralize hydrochloric acid and bind irritating bile salts.
These measures bring quick relief and are considered safe preparations, which does not mean that they have no disadvantages. Firstly, they show side effects, which are manifested especially when used in high doses and for a long time, especially in patients with arterial hypertension, heart, liver or kidney failure. Preparations containing magnesium can cause diarrhea, aluminum – constipation, and sodium bicarbonate – an increase in blood pressure and flatulence. An unquestionable disadvantage of the above-mentioned drugs is the necessity to take the preparations frequently, the short-term effect and the risk of recurrence of symptoms soon after discontinuation of their use, and the lack of significant influence on the secretion of hydrochloric acid.
Against their background, drugs that inhibit the secretion of hydrochloric acid by blocking histamine receptors and proton pump inhibitors are more favorable. The latter group is characterized by particularly valuable properties, such as: reduction in the production of hydrochloric acid regardless of the type of secretory stimulus, high efficiency, convenient use (usually once a day) and the rare occurrence of side effects.
In addition, if symptoms persist, medications may be given periodically to support gastrointestinal contractility and reduce the likelihood of regurgitation. If this is unsuccessful, surgical treatment may be required.
Read how to deal with exhausting heartburn in pregnancy?
Text: Dorota Ksiądzyna, MD, PhD
Source: Let’s live longer