Avoid foods that are high in fats, spicy, high in artificial flavors. Avoid reclining 3–4 hours after a meal, heavy NSAID use, heavy alcohol consumption. Decrease peppermint consumption. Chew foods thoroughly between bites, consume meals with plenty of liquid, and ensure adequate time to eat meals in a non-hurried fashion
Other common descriptors for heartburn (besides burning) are belching, nausea, squeezing, stabbing, or a sensation of pressure on the chest. The pain often rises in the chest (directly behind the breastbone) and may radiate to the neck, throat, or angle of the arm. Because the chest houses other important organs besides the esophagus (including the heart and lungs), not all symptoms related to heartburn are esophageal in nature.[7]
The cause will vary depending on one's family and medical history, genetics, if a person is pregnant or lactating, and age. As a result, the diagnosis will vary depending on the suspected organ and the inciting disease process. Work-up will vary depending on the clinical suspicion of the provider seeing the patient, but generally includes endoscopy and a trial of antacids to assess for relief.[citation needed]
Treatment for heartburn may include medications and dietary changes.[3] Medication include antacids. Dietary changes may require avoiding foods that are high in fats, spicy, high in artificial flavors, heavily reducing NSAID use, avoiding heavy alcohol consumption, and decreasing peppermint consumption.[3] Lifestyle changes may help such as reducing weight.
The term indigestion includes heartburn along with a number of other symptoms.[8] Indigestion is sometimes defined as a combination of epigastric pain and heartburn.[9] Heartburn is commonly used interchangeably with gastroesophageal reflux disease (GERD) rather than just to describe a symptom of burning in one's chest.[10]
Heartburn-like symptoms and/or lower chest or upper abdomen may be indicative of much more sinister and/or deadly disease.[11] Of greatest concern is to confuse heartburn (generally related to the esophagus) with a heart attack as these organs share a common nerve supply.[12] Numerous abdominal and thoracic organs are present in that region of the body. Many different organ systems might explain the discomfort called heartburn.[7]
The most common symptom for a heart attackischest pain.[13] However, as many as 30% of people who receive cardiac catheterization for chest pain have findings that do not account for their chest discomfort. These are often defined as having "atypical chest pain" or chest pain of undetermined origin.[14] Women experiencing heart attacks may also deny classic signs and symptoms[15] and instead complain of GI symptoms.[13][16][17] One article estimates that ischemic heart disease may appear to be GERD in 0.6% of people.[12]
Mallory-Weis tears – tears of the superficial mucosa of the esophagus that are subsequently exposed to gastric acid commonly due to vomiting and/or retching
Intestinal ulcers – generally secondary to other conditions such as H. pylori infection or cancers of the gastrointestinal tract. Pain often improves with eating.
Heartburn is common during pregnancy having been reported in as many as 80% of pregnancies.[22] It is most often due to GERD and results from relaxation of the lower esophageal sphincter (LES), changes in gastric motility, and/or increasing intra-abdominal pressure.[23][22] The onset of symptoms can be during any trimester of pregnancy.
Hormonal – related to the increasing amounts of estrogen and progesterone and their effect on the LES
Mechanical – the enlarging uterus increasing intra-abdominal pressure, inducing reflux of gastric acid
Behavioral – as with other instances of heartburn, behavioral modifications can exacerbate or alleviate symptoms
Functional heartburn is heartburn of unknown cause.[24] It is commonly associated with psychiatric conditions like depression, anxiety, and panic attacks. It is also seen with other functional gastrointestinal disorders like irritable bowel syndrome and is the primary cause of lack of improvement post treatment with proton pump inhibitors (PPIs).[24] Despite this, PPIs are still the primary treatment with response rates in about 50% of people.[24] The diagnosis is one of elimination, based upon the Rome III criteria. It was found to be present in 22.3% of Canadians in one survey.[24]
Heartburn can be caused by several conditions and a preliminary diagnosis of GERD is based on additional signs and symptoms. The chest pain caused by GERD has a distinct 'burning' sensation, occurs after eating or at night, and worsens when a person lies down or bends over.[25] It also is common in pregnant women, and may be triggered by consuming food in large quantities, or specific foods containing certain spices, high fat content, or high acid content.[25][26] In young persons (typically <40 years) who present with heartburn symptoms consistent with GERD (onset after eating, when lying down, when pregnant), a physician may begin a course of PPIs to assess clinical improvement before additional testing is undergone.[27] Resolution or improvement of symptoms on this course may result in a diagnosis of GERD.[citation needed]
Other tests or symptoms suggesting acid reflux is causing heartburn include:
Onset of symptoms after eating or drinking, at night, and/or with pregnancy, and improvement with PPIs
Endoscopy looking for erosive changes of the esophagus consistent with prolonged acid exposure (e.g. - Barrett's esophagus)[27]
Relief of symptoms 5 to 10 minutes after the administration of viscous lidocaine and an antacid increases the suspicion that the pain is esophageal in origin.[29] This however does not rule out a potential cardiac cause[30] as 10% of cases of discomfort due to cardiac causes are improved with antacids.[31]
Esophageal pH monitoring: a probe can be placed via the nose into the esophagus to record the level of acidity in the lower esophagus. Because some degree of variation in acidity is normal, and small reflux events are relatively common, esophageal pH monitoring can be used to document reflux in real-time.[32] Patients are able to record symptom onset to correlate lower esophageal pH with time of symptom onset.
Manometry: in this test, a pressure sensor (manometer) is passed via the mouth into the esophagus and measures the pressure of the LES directly.[33]
Endoscopy: the esophageal mucosa can be visualized directly by passing a thin, lighted tube with a tiny camera known as an endoscope attached through the mouth to examine the oesophagus and stomach. In this way, evidence of esophageal inflammation can be detected, and biopsies taken if necessary. Since an endoscopy allows a doctor to visually inspect the upper digestive tract the procedure may help identify any additional damage to the tract that may not have been detected otherwise.[34]
Biopsy: a small sample of tissue from the oesophagus is removed. It is then studied to check for inflammation, cancer, or other problems.[33]
Symptoms of heartburn may not always be the result of an organic cause. Patients may respond better to therapies targeting anxiety and symptoms of hyper-vigilance, through medications aimed towards a psychiatric etiology, osteopathic manipulation and acupuncture.[24]
Psychotherapy may show a positive role in treatment of heartburn and the reduction of distress experienced during symptoms.[24]
Acupuncture – in cases of idiopathic heartburn, acupuncture may be as effective if not more than PPIs alone.[38]
In the case of GERD causing heartburn symptoms, surgery may be required if PPI is not effective.[39] Surgery is not undergone if functional heartburn is the leading diagnosis.[40]
^Sajatovic, Loue S, Koroukian SM (2008). Encyclopedia of aging and public health. Berlin: Springer. p. 419. ISBN978-0-387-33753-1.
^Bautz B, Schneider JI (May 2020). "High-Risk Chief Complaints I: Chest Pain-The Big Three (an Update)". Emergency Medicine Clinics of North America. 38 (2): 453–498. doi:10.1016/j.emc.2020.01.009. PMID32336336. S2CID216556980.
^Waller CG (December 2006). "Understanding prehospital delay behavior in acute myocardial infarction in women". Critical Pathways in Cardiology. 5 (4): 228–234. doi:10.1097/01.hpc.0000249621.40659.cf. PMID18340239.
^Patel H, Rosengren A, Ekman I (July 2004). "Symptoms in acute coronary syndromes: does sex make a difference?". American Heart Journal. 148 (1): 27–33. doi:10.1016/j.ahj.2004.03.005. PMID15215788.
^Kawamoto KR, Davis MB, Duvernoy CS (December 2016). "Acute Coronary Syndromes: Differences in Men and Women". Current Atherosclerosis Reports. 18 (12): 73. doi:10.1007/s11883-016-0629-7. PMID27807732. S2CID40109195.
^ abRichter JE (March 2003). "Gastroesophageal reflux disease during pregnancy". Gastroenterology Clinics of North America. 32 (1): 235–261. doi:10.1016/s0889-8553(02)00065-1. PMID12635418.
^ abcdefgFass R (January 2009). "Functional heartburn: what it is and how to treat it". Gastrointestinal Endoscopy Clinics of North America. 19 (1): 23–33, v. doi:10.1016/j.giec.2008.12.002. PMID19232278.
^Johnson LF, Demeester TR (October 1974). "Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux". The American Journal of Gastroenterology. 62 (4): 325–332. PMID4432845.
^Dickman R, Schiff E, Holland A, Wright C, Sarela SR, Han B, et al. (November 2007). "Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn". Alimentary Pharmacology & Therapeutics. 26 (10): 1333–1344. doi:10.1111/j.1365-2036.2007.03520.x. PMID17875198. S2CID23118600.
^Kushner PR (April 2010). "Role of the primary care provider in the diagnosis and management of heartburn". Current Medical Research and Opinion. 26 (4): 759–765. doi:10.1185/03007990903553812. PMID20095795. S2CID206964899.
