Heartburn

Heartburn means an unpleasant feeling of burning chest pain that is often related to food intake. It is rather an annoying problem that can be, however, related to some complications of gastroesophageal reflux disease.

Causes

Heartburn is tightly connected to gastroesophageal reflux disease and it is its most common symptom. Reflux disease occurs when acid gastric juice returns back into esophagus and damages its mucosa. Heartburn may exist alone or be associated with complications of reflux such as reflux esophagitis (inflammation of esophagea mucosa), Barrett's esophagus, and luckily only rarely with a certain type of esophageal cancer. It is important to mention that severity of heartburn doesn't have to be proportional to severity of reflux disease. Many people with subjectively strong heartburn have practically no objective finding and vice versa.

 

Note: Burning chest pain very similar to heartburn may be caused by an acute heart attack.

Diagnostic approach

Heartburn as a symptom must be evaluated individually. In a young person with heartburn without other symptoms therapeutic diagnostic test is appropriate. We administer a drug that reduces gastric acidity (usually a PPI) and when problems fade away, the diagnosis is done. In older people, usually male, who have heartburn connected with other symptoms such as weight loss, dysphagia or pain during swallowing, it is advisable to perform an upper GI endoscopy to rule out severe complications of reflux disease including lower esophageal cancer.

 

It is very wise to do an ECG in every patient complaining about sudden burning chest pain to rule out acute coronary syndrome.

Treatment

Change of diet is important as certain substances tend to worsen the acid reflux. It is recommended to avoid spicy food, reduce alcohol beverages and beverages containing caffeine (especially coffee) and stop smoking. There is a variety of efficient stomach acid drugs; quick relief is assured by antacids. Stronger drugs like proton pump inhibitors are administered for chronic use usually in reflux complications.