What Is Heartburn? What Causes Heartburn?

Heartburn is an uncomfortable warm and burning sensation in the chest, usually just behind the sternum (breastbone) that typically comes in waves. The pain may start in the chest area and make its way up to the neck, throat and jaw. The pain usually gets worse when the patient lies down or bends over, and is more common immediately after eating.

The condition is medically known as pyrosis or acid indigestion.

The word "heartburn" is a popular lay term that has nothing to do with the heart.

Heartburn is usually linked to gastric reflux - the regurgitation of gastric acid; one of the main symptoms of GERD (gastroesophageal reflux disease).

As heartburn may also be a symptom of ischemic heart disease, it is important that doctors bear this in mind and do not jump to a GERD diagnosis too rapidly.

Some people use the terms "dyspepsia" and heartburn interchangeably. There is a difference: Dyspepsia is a combination of heart burn and epigastric pain, which is from the sternum to just above the umbilicus (navel, belly-button).

It is common for people to have heartburn occasionally, and it is usually nothing to worry about. With some lifestyle changes, and perhaps an OTC medication you can manage the discomfort without having to seek medical help.

If heartburn symptoms are experienced frequently and start affecting a person's daily routine, they should check with a doctor in case it is a sign of something more serious.

According to Medilexicon's medical dictionary:

Pyrosis (heartburn) is "Substernal pain or burning sensation, usually associated with regurgitation of acid-peptic gastric juice into the esophagus."

What are the signs and symptoms of heartburn?

A symptom is something the sufferer feels and describes, such as a headache or dizziness, while a sign is something other people can detect, such as a rash.

Signs and symptoms of heartburn include:

• An uncomfortable sensation of warmth or burning in the chest. This tends to occur after eating, or during sleep. It can last from a few minutes to several hours.
• When bending over or lying down the pain gets worse
• Some patients may experience a burning sensation in the throat
• Sometimes there is a chronic cough, sore throat or hoarseness
• When swallowing, there may be a sensation of food sticking in the middle of the chest or throat

Many of the heartburn symptoms may overlap with those of GERD, simply because heartburn is one of the symptoms of GERD.

What are the causes of heartburn?

Heartburn is the result of gastric acids backing up into the esophagus.

When we swallow, the lower esophageal sphincter relaxes, this allows foods and drinks to make their way to the stomach, after which the sphincter closes again.

If the lower esophageal sphincter does not close properly, gastric acids can seep back up into the esophagus, causing heartburn. When a person bends over or lies down the heartburn sensation may be worse, because the lack of gravity encourages more reflux.

Diagnosing heartburn

Physicians can usually diagnose heartburn by asking the patient to describe his/her symptoms.

A doctor may wish to determine whether the heartburn is a symptom of a wider condition, such as GERD. If so, the following tests may be ordered:

• X-ray - the patient drinks a liquid that coats the inside lining of the digestive track. When X-rays are taken of this area, the liquid shows up in the images. The physician is able to make out a silhouette of the esophagus, duodenum and stomach, and determine their shape and condition. This type of X-ray is called a barium swallow.
• Endoscopy - a thin, flexible tube with a light and camera at the end - an endoscope - is inserted through the throat and down to the esophagus and stomach. The doctor can see the esophagus and stomach on a monitor. This type of internal examination is useful for determining whether there are any complications of reflux, such as Barrett's esophagus. The doctor can also take a biopsy using an endoscope.
• Ambulatory acid (pH) probe tests - a device is used to determine when gastric acid seeps back into the esophagus and how long for. It may be a catheter that is threaded through the patient's nose into his/her esophagus. The catheter (tube) is connected to a computer that is worn around the patient's waist or strapped over their shoulder. Signals are transmitted to the computer for a period of about two days.
• Esophageal motility testing - this measures the movement of the esophagus as well as its pressure. A catheter is threaded through the patient's nose, down to his/her esophagus.
• Manometry - this assesses how well the LOS (lower esophageal sphincter) works by measuring the pressure inside the sphincter muscle. Doctors may order this test if an endoscopy finds no evidence of damage to the esophagus. A small tube is threaded through the nose into the esophagus to where the LOS is. It contains several pressure sensors, which send data to a computer.
  
  The patient is asked to swallow some food and liquid to determine how well the LOS is functioning. The whole test takes about thirty minutes to complete. Manometry is useful to confirm a diagnosis of GERD, as well as detecting rarer conditions related to the functioning of the LOS, such as achalasia or muscle spasms.

What are the treatment options for heartburn?

There are some steps patients can take themselves to reduce their risk of developing heartburn:

• Lose weight - obese or overweight individuals may experience fewer bouts of heartburn if they lose weight, because there will be less pressure on the stomach.
• Quit smoking - smoking irritates the digestive system and can worsen symptoms of heartburn and GERD
• Eat smaller meals - people who eat more smaller meals each day rather than three large ones may find their heartburn symptoms either improve or go away altogether
• The evening meal - have it at least three hours before going to bed
• Avoid food triggers - some foods and drinks may trigger heartburn in some patients. Typical ones include coffee, alcohol, tomatoes, fatty or spicy foods, and chocolate. Identify your triggers and avoid them.
• Your bed - if you raise the head end of your bed, your heartburn symptoms might improve

Symptoms of heartburn can usually be effectively treated with OTC (over-the-counter) medications.

• Antacids - these neutralize stomach acid and provide rapid relief. It is important to follow the manufacturer's instructions and not to overuse them. Overuse can lead to constipation or diarrhea.
• H-2-receptor blockers - they work more slowly than antacids, but provide longer relief. There are two types, OTC ones and stronger prescription ones.
• Proton pump inhibitors - these block the production of acid, giving damaged esophageal tissue time to repair itself. Patients over 50 should be careful not to use proton pump inhibitors for extended periods - according to the US Food and Drug Administration (FDA), they may increase the risk of hip, wrist or spine fractures.