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Most of us suffer the odd symptom of heartburn every now and again - after a big meal or perhaps when eating too fast. However, if the symptoms are more frequent, it could be a sign of something more serious.
What is Heartburn?
Heartburn is no stranger to most of us. Remember that burning feeling inside your chest after eating half a turkey and a plate full of Brussel sprouts last Christmas? It's more than likely that it was heartburn. Heartburn, otherwise known as gastro-oesophageal reflux, is in fact, nothing to do with the heart.
When you eat, the food travels from your mouth to your stomach via a tube called the esophagus. At the lower end of the esophagus, is a tight valve called the lower esophageal sphincter (LES) which the food must pass through before reaching the stomach. The LES is designed to prevent food, once in the stomach, to enter back into the esophagus. However, occasionally, for a number of possible reasons, the LES does not close completely as it should. This leaves the esophagus vulnerable to food traveling back up it. As the food, at this stage, has already entered the stomach, it is mixed with the stomach acids that are used to break it down and aide in digestion. This acid however, is very strong and can damage the esophagus when it is accidentally allowed in via the LES. This process is what can lead to the feeling of heartburn.
Heartburn is very common and affects 60 million Americans each year and around 40% of the population of the UK. Most of us experience it at some point in our life. However if heartburn becomes a regular occurrence and is experienced, perhaps every week or every month, this could be a sign of gastro-oesophageal reflux disease (GORD), which is sometimes spelt gastro-esophageal reflux disease (GERD). GERD is a result of the lower esophageal sphincter valve relaxing more than it should and thus regularly allowing food and stomach acid back into the esophagus.
If the tissue lining of the esophagus becomes damaged as a result of the repeated exposure to stomach acids which is associated with GERD, then this is called esophagitis or erosive GERD. If the symptoms of GERD are present with no evidence of tissue damage, this is referred to as non-erosive GERD.
What are the Symptoms of GERD/GORD?
The most common symptom of GERD is chronic heartburn. This is when heartburn recurs periodically and can be anything from every week to every month. Heartburn leaves a tight, burning pain behind the breastbone and can be very uncomfortable. The symptoms of heartburn can last as long as 2 hours.
Another common symptom of GERD is described as acid 'regurgitation'. This occurs when stomach acid travels all the way up through the esophagus into the throat and mouth. This can leave a burning sensation in the throat or a bitter, sour taste in the mouth.
There is no standard set of symptoms that can lead to the positive diagnosis of GERD in every person. Symptoms can vary between each case of GERD and it is possible for people who have GERD not to experience any heartburn at all. Below are a few other symptoms that could suggest the presence of GERD:
- A constant dry cough.
- A tight throat or the feeling that a piece of food is stuck in the throat (Dysphagia).
- A bitter or sour taste in the mouth (especially when lying down or bending over).
- Difficulty in swallowing.
- Persistent belching.
- Hoarseness (especially in the morning)
- Bad breath.
The symptoms of heartburn can often be mistaken for that of a heart attack. However, if you experience these symptoms suddenly, you should seek immediate medical attention as any heart problems should first be excluded.
What Causes Heartburn/GERD/GORD?
The burning pain that is commonly associated with heartburn is caused by the reflux of stomach acid back into the esophagus. A valve called the lower esophageal sphincter (LES), situated at the bottom of the esophagus is meant to prevent food mixed with stomach acids from entering back up the esophagus after it has reached the stomach. However, when the LES relaxes, food and stomach acid is able to travel back up the esophagus and thus cause the burning sensation associated with heartburn. This process is very common in most people at some point in their lives. However, it is still unknown why the LES relaxes more frequently in sufferers of GERD. Below are a few possible contributing factors to the presence of GERD or heartburn:
- The use of alcohol - Alcohol can increase the presence of stomach acid and can relax the LES.
- Smoking - The chemicals in tobacco can weaken the LES.
- Overweight/obese - Being overweight can increase the chances of hiatal hernia occurring.
- Pregnancy - pregnancy also, can increase the chances of a hiatal hernia occurring.
- Hiatal Hernias - The diaphragm, which is a thin muscle underneath the lungs, has an opening where the esophagus connects to the stomach. It is believed that this diaphragm opening reinforces the LES and helps keep the stomach acid from traveling back up the esophagus. When a hiatal hernia occurs, the stomach pushes up through the opening in the diaphragm thus misaligning the LES which in turn, weakens it. It is thought that increased pressure in the abdomen can cause a hiatal hernia - from straining during bowel movements, coughing and delivery a baby etc.
- Tight Clothing - Tight clothing, fitted around the abdomen, can force food up against the LES as it squeezes the stomach. This can result in a reflux of stomach acids into the esophagus.
- Eating Just Before Bedtime - If your stomach is full when you come to lie down for bed, then it can press-up against the LES and increase the chances of an acid reflux.
- Caffeine - Drinks with caffeine in them can lead to the LES becoming relaxed.
- Fatty Foods - Fatty foods can slow down digestion and which keeps the food in your stomach for longer. This can put pressure on the LES which may leave it vulnerable to allowing stomach acid to travel back up the esophagus.
If left untreated, GERD can cause other medical complications due to its persistent irritation of the esophagus with stomach acid. Complications could involve ulcers, bleeding or anemia. As time passes, it is possible to develop a stricture, which is where the esophagus becomes narrow due to continued scarring. This can make it difficult to swallow. It is possible to develop Barrett's esophagus which is a change in the cells lining the esophagus and can be a sign of esophageal cancer.
How Can I Treat Heartburn/GORD/GERD?
To avoid experiencing heartburn, there are certain lifestyle choices you can make. Try to eat small, frequent meals instead of eating just one or two big meals. Below are some foods to avoid:
- Citrus fruits.
- Spicy foods.
- Foods with caffeine content.
- Garlic and onions.
- Fatty foods.
- Foods with mint flavourings.
Try not to lie down soon after eating as this can increase the pressure on the LES. There are other lifestyle changes that you may be able to make to reduce your chances of experiencing heartburn. For example, if you are a smoker, then stop. If you drink a lot of alcohol, try to cut down or stop altogether.
If adjusting your lifestyle to reduce the affects of heartburn does not work, there are certain medications available to alleviate some of the symptoms associated with heartburn. These medications include over-the-counter products such as, antacids and H2-blockers that help suppress the amount of acid produced by the stomach. Prescription drugs available include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. These also help in reducing acid production in the stomach.
If the symptoms of heartburn persist and are of a severe nature, then it is likely that you have GERD. If medication has not worked in controlling your symptoms, or you do not wish to take medication, your doctor may suggest surgery as an option. An example procedure is fundoplication. This involves the stomach being wrapped around the esophagus to increase the pressure of the muscle at the opening of the stomach which can help reduce the chances of stomach acid traveling back up the esophagus.
Living with Heartburn, GERD/GORD.
Heartburn affects most of us at some point in our lives. Heartburn can leave a burning feeling in the chest which can be very uncomfortable and quite simply, a nuisance. However, if you experience heartburn as a frequent occurrence, it could mean more than just being a nuisance. Chronic heartburn can be categorised as GERD and if this is what you have, it needs to be treated.
Heartburn and its symptoms can sometimes be avoided by making some lifestyle changes. However, this may be easier said than done. Before making any dramatic dietary changes, you should always consult your doctor. If you are used to eating fatty foods then it may not be easy to change your diet to a healthier option. You should keep in mind the pain that may be a result of not living a healthy lifestyle. The same applies to smoking and drinking. If they have been present in your life for a while, it will not be easy to stop them altogether. But remember, there is plenty of help and support out there to aide you in living a healthier lifestyle.
How Can I Help?
The precise reason why GERD occurs is not yet known by researchers. There are various treatments available to help alleviate some of the symptoms associated with heartburn and GERD. These treatments have been made possible because of medical research and medical trials. Medical research holds paramount importance in the development of understanding of heartburn. Medical trials allow researchers to test new medications for their effectiveness and safety. By participating in a clinical trial, you could be the key to the next treatment or even cure for GERD. Have a look through the studies section of BioTrax to see if there is a heartburn/GERD medical trial that you can get involved in.
Medical research studies may be conducted and are carefully designed to answer specific medical questions while protecting participants´ safety. Well conducted medical trials are the fastest and safest way to find improved treatments and preventions for diseases. Clinical trials or interventional trials determine whether experimental preventions, treatments, or new ways of using known therapies are safe and effective under controlled conditions. Observational or natural history studies examine health issues and disease development in groups of people or populations. For more information on current medical trials or to register on the BioTrax database, view the study section at
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