heartburn

• Heartburn complaints
• Anatomy esophagus

Definition of heartburn

At the heartburn (Reflux disease) there is excessive reflux of acidic stomach contents (Stomach acid) in the esophagus (Esophagus). The persistent chemical irritation from stomach acid causes inflammation of the esophageal lining (Reflux esophagitis).

Synonyms

Reflux esophagitis, reflux disease, reflux, gastro-oesophageal disease

English: gastro-esophageal reflux disease (abbreviation: GERD)

Epidemiology

In gastroenterological practice (gastrointestinal diseases), heartburn is the most common clinical picture.
6-20% of the population suffer from reflux disease (heartburn). 10% of heartburn patients develop reflux esophagitis over time.

Of these patients with reflux esophagitis, 10% develop a severe esophageal ulcer (Beret ulcer)
An esophageal tumor develops from 10% of ulcers (Esophageal carcinoma).

Cause of heartburn

Heartburn is a common symptom. With some sufferers it occurs chronically - i.e. always recurring -, with others only rarely.
Heartburn occurs when stomach acid travels back up into the esophagus from the stomach. This happens either through an excess of gastric acid through overproduction or through insufficient occlusion of the lower esophageal muscle that normally seals the esophagus from the stomach.
Typical triggers for heartburn are alcohol and nicotine abuse, the consumption of fatty, spicy, very sweet meals, excessive coffee consumption, obesity and stress. These stimulate gastric acid production, more gastric acid is produced than is actually necessary and the excess acid flows back into the esophagus.
In contrast to the esophagus, the stomach is designed to come into regular contact with the acid, as the mucous membrane is structured differently from that of the esophagus. This means that if stomach acid gets into the esophagus, it leads to a significant irritation of the mucous membrane. If this happens more often, the esophageal mucous membrane becomes inflamed, referred to as reflux oesophagitis.

Read more on the subject at: Causes of heartburn

Heartburn from stress

Stress is a common cause of heartburn. The exact connections are unclear. So far, two connections have been observed in studies: on the one hand, stress causes the lower sphincter of the esophagus to relax. The way for the stomach acid into the throat is opened. On the other hand, stress leads to increased gastric acid production.

The neural connections (i.e. based on the nerve tracts) have not yet been conclusively clarified. More and more, however, the focus is on the fact that the vegetative (autonomous) nervous system, which controls the digestive system, has probably been greatly underestimated in all previous medical considerations. A similar mechanism in stress-induced diarrhea has been known for a long time, but there is no scientific justification.

If stress in a patient can be identified as a trigger, a therapeutic approach can be considered here. Together with their family doctor, a psychotherapist or physiotherapist, the person affected can identify and reduce stress triggers in order to find relief. If this does not lead to freedom from symptoms, physical (somatic) causes should again be considered.

Heartburn while exercising

Changes in position such as bending over and lying down often worsen heartburn because more pressure is exerted on the lower esophageal sphincter by the contents of the abdomen. If such body positions are taken during exercise, they also worsen heartburn. Strong abdominal breathing or tense abdominal muscles also cause increased pressure.

At the same time, the gastric juice “spills” more and more to the upper part of the stomach due to repeated up and down movements, so it can also trigger heartburn if the sphincter muscles are insufficient. To avoid this, two to three hours after eating and any heartburn, sporting activities in the form mentioned should be avoided, as well as more gentle movements (walking, cycling).

Heartburn after alcohol

Alcohol consumption can worsen the symptoms of gastritis because, firstly, it contains many simple sugars that stimulate gastric acid production and, secondly, because it is a drink with an acidic pH. So it potentiates the acidic environment of the stomach. Especially high-proof, spicy alcoholic beverages (schnapps) should therefore be avoided.

Heartburn from coffee

Coffee is an acidic drink that, like alcohol, usually makes heartburn worse. A shot of milk in the coffee and preferably no sugar can help. However, if symptoms such as heartburn and nausea occur immediately after consuming coffee, this food should be avoided entirely until the symptoms have improved sustainably. A more stomach-friendly alternative would be black or green tea with low-fat milk.

Heartburn symptoms

The leading symptoms (symptoms) of reflux disease are heartburn (acid regurgitation), bloating, belching of air and possibly stool irregularities. The sour or bitter taste in the throat usually occurs about 30-60 minutes after the meal.
The patients with heartburn typically complain of increased symptoms after large and / or sweet meals, when lying flat or when lifting heavy loads. Severe reflux can lead to chest pain, throat irritation, chronic bronchitis and bronchial asthma.

Read more about this under:

• Heartburn symptoms
• Burning in the esophagus
• Burning in the upper abdomen

Heartburn and nausea

Nausea and heartburn often appear as a symptom of inflammation of the stomach lining (gastritis). It often occurs after the phase of boring hunger and is only alleviated by taking basic gels or basic food. Seldom does nausea occur with gastritis even without heartburn.

Heartburn and chest pain

Heartburn is felt as a biting or burning pain in the middle of the upper chest, behind the breastbone (sternum). The stronger the heartburn, the higher it pulls down the throat and can even lead to a visibly reddened throat and a sour taste in the mouth. If the chest pain is sudden, persistent, and causes chest tightness, a heart attack must also be considered. If the pain comes in increasing waves, after a stressful situation or after eating food, and can be relieved by a glass of milk, a heart attack is unlikely.

Also read our article: Burning behind the breastbone.

Heartburn and gas

Flatulence and heartburn usually do not occur as a sign of inflammation of the stomach lining. So they are to be assigned to a different complex of causes. The cause can be an unhealthy diet or a food intolerance (e.g. to lactose). A conversation with your family doctor will help.

Heartburn complaints

1. Esophagus (esophagus)
2. stomach

The detail shows the leaky gastric entrance, which allows acidic porridge to flow back through the esophagus.

Heartburn at night

Heartburn sufferers often complain about the symptoms especially at night occur. For example, this may be due to the fact that consumed large fatty meals in the evening become. Another reason is that flat beds in bed, this makes gravity more likely to flow back from the stomach into the esophagus. Accordingly, it is recommended for patients with heartburn to sleep with the upper body slightly elevated.

Cough for heartburn

Not infrequently, a cough is a symptom that occurs in the context of inflammation of the mucous membrane of the esophagus and heartburn. This is believed to be due to the fact that it is in the esophagus gastric acid flowing back irritates the mucous membrane, which in turn leads to an urge to cough.

Heartburn and back pain

Although back pain is not a typical symptom of heartburn, it can occur as an accompanying symptom. Heartburn occurs when gastric acid passes from the stomach into the esophagus, the acid then irritates the mucous membrane, which can lead to burning pain. This can occasionally also radiate into the back.

Heartburn with nausea and diarrhea

There is a combination of heartburn with nausea and diarrhea rather seldom. heartburn can occasionally make you feel sick because the gastric acid that has passed from the stomach into the esophagus irritates the mucous membrane and can lead to nausea. Diarrhea usually has nothing to do with heartburn.

Risk of confusion with heart problems / heart attack

Reflux esophagitis, an inflammation of the esophagus, can manifest itself through several symptoms. Acid belching (heartburn) and a burning sensation behind the breastbone, which sometimes also radiates into the upper abdomen and the left half of the chest, are typical. Coughing is also not a rare symptom of reflux disease.
Due to the burning sensation in the chest area, which can sometimes also be localized in the left half of the chest, the symptoms can also be confused with the symptoms of a heart attack. In the case of a heart attack, many patients describe pressure or burning pain in the area of ​​the heart, which often radiates into the arm, neck or upper abdomen, often accompanied by shortness of breath.
If it cannot be ruled out with certainty that the symptoms indicate a heart attack, a doctor should be contacted, who can differentiate between the two possible diagnoses by taking a blood sample and an ECG (electrocardiogram).

Read more on the topic: Symptoms of a heart attack

Heartburn therapy

The first step in the treatment of heartburn should be to consider the risk factors for heartburn to occur. These include the consumption of alcohol, nicotine, coffee, fatty, spicy, sweet foods, obesity and excessive stress. First of all, the person affected should try to eliminate possible risk factors as far as possible. This is not always easy - for example with stress, but also with addictions such as nicotine consumption and obesity - but if the risk factor persists, the probability that heartburn will recur is very high.
This helps many sufferers who complain of heartburn, especially at night Sleep with your upper body slightly elevated. Also should large meals just before bedtime should be avoided.
There are numerous home remediesthat are supposed to help against heartburn. However, there is no proven benefit, so you should try out what helps you individually. There are from stomach-friendly teas over To chew bubble gum up to Consume a handful of nuts, Milk consumption or Soda intake numerous tips.
If heartburn cannot be adequately contained with the above measures, an effective treatment for heartburn is with the Taking so-called proton pump inhibitors to reach. These are drugs that significantly inhibit acid production in the stomach. Typical representatives are for example Pantoprazole and Omeprazole. In the case of heartburn without actual inflammation of the gastric mucosa, it is often sufficient to take one tablet if necessary. If there is already an inflamed mucous membrane of the esophagus, regular intake for a few weeks can help.
If heartburn recurs, it may be necessary to have one Gastroscopy to have carried out. However, this is far from having to be done in every patient with heartburn. Persistent or increasing symptoms, vomiting blood, discontinuation of black stools and the presence of an unexplained anemia (anemia) may be indications that further diagnostics may be helpful or necessary.

What helps immediately?

Riopan ® (an antacid) is often advertised as an acute therapy for heartburn. This is a remedy that is supposed to neutralize the stomach acid, i.e. to make it less acidic / corrosive. The effect should be quick and last for a few hours. Riopan® is available as a tablet or gel that can be swallowed.
However, proton pump inhibitors such as pantoprazole or omeprazole are considered the most effective drugs against frequent heartburn with inflammation of the mucous membrane of the esophagus. The effect occurs relatively quickly and lasts for a long time.

Read more about this at: Antacids

What to eat for heartburn?

Since heartburn can be traced back to increased gastric acid production, it is advisable to consume foods that do not depend on stomach acid for digestion. The acid-producing cells in the stomach react primarily to fats and simple sugars, and to a minor extent also to proteins.

Those affected should avoid high-fat meals (e.g. fatty steak with gravy) and not consume sugary drinks. Coffee and alcohol should also be avoided because they potentiate the acidic environment inside the stomach. It is advisable to consume basic foods, such as low-fat dairy products (attention, often with extra sugar!) And potatoes, rice and whole wheat pasta. The total amount of a meal should also be reduced. Heartburn patients should eat small, frequent meals rather than large, large servings. In the case of pain caused by stomach movements, pulpy foods are also beneficial, as they do not stress the stomach's activity too much (mashed potatoes, soft noodles, rice pudding, soups). It is also advisable to ban hot spices from the menu, as these can further damage the stomach lining, which is already irritated.

Read more about this at: Diet for heartburn

Heartburn medication

When it comes to heartburn and the resulting damage (e.g. inflammation of the esophagus), there is one group of active ingredients that is said to be effective with relatively few side effects: the proton pump inhibitors. They attack certain cells and there certain pumps and thus reduce acid production in the stomach.
The stomach acid becomes less acidic and therefore less "caustic". The two main representatives pantoprazole and omeprazole belong to this group of drugs. With occasional heartburn, one intake is sufficient. Daily therapy for a few weeks is recommended for regular symptoms and existing inflammation of the esophagus. If the symptoms persist, you should see your doctor in charge. Pantoprazole and omeprazole can be purchased from pharmacies without a prescription.

Read more on the subject at: Heartburn medication

Home remedies for heartburn

There are numerous home remedies that are said to help relieve heartburn. Overall, however, there is no reliable proof of effectiveness for any of these home remedies. In the end, one remedy helps the one better than the other; it is best for those affected to try out what will get the best result. Possible home remedies for heartburn include warm tea (for example chamomile), a handful of nuts, chewing gum, milk, baking soda dissolved in warm water, and others.
Ultimately, however, more important than these home remedies is prevention BEFORE the symptoms appear by avoiding alcohol, nicotine and, for sensitive people, coffee. Sleeping with your torso slightly elevated and eating only a small meal with dinner can also help.

Read more on the subject at:

• Home remedies for heartburn
• Homeopathy for heartburn

Milk for heartburn

Milk is one of the home remedies that is said to have beneficial effects on heartburn. Allegedly, gastric acid should be neutralized. Overall, it has to be said that the therapeutic benefit of milk for the treatment of heartburn is rather questionable, but those affected can of course try out what helps them, it varies greatly from person to person.

Diet for heartburn

The wrong diet can lead to an increased incidence of heartburn. In particular, spicy, fatty and very sweet foods can stimulate acid production in the stomach and thus trigger reflux into the esophagus. Alcohol also increases gastric acid secretion, but at the same time it lowers the tone of the lower obstruction muscle of the esophagus so that the return flow into the esophagus is made even easier.

Read more on the subject at: Diet for heartburn

Baking soda for heartburn

A teaspoon of baking soda dissolved in a glass of lukewarm water is said to work wonders against heartburn. This is due to the fact that baking soda is alkaline, but stomach acid is acidic, Soda is supposed to help neutralize stomach acid. This is not scientifically proven. However, many sufferers notice a positive effect. Certainly, soda should not be taken permanently in the case of heartburn, so if heartburn recurs, the treating doctor should be consulted, who can then decide whether further diagnostics are necessary.

homeopathy

Since the art of homeopathy is based on empirical medicine and includes the entire organism in its considerations, no general recommendation from a conventional medical point of view can be made here. The homeopathic remedies that are used particularly frequently are the following: Nux vomica D6, Robinia pseudoacacia, Arsenicum album, Bismutum subnitricum, Chamomilla and Lycopodium.

Schüssler salts

The effect of the Schüssler salts is based on the theory that diseases can be traced back to an imbalance in the acid-base balance of the body. However, since the body has an excellent system (kidneys and lungs), a systemic imbalance only occurs in severe diseases, e.g. Renal failure. Only then does systemic therapy with certain salts make sense. If a certain Schüssler salt is exclusively alkaline in nature, it can be very helpful to compensate for the acidic environment of a symptomatic stomach for a short time. Similar to homeopathy, these are empirical values ​​apart from conventional medicine. The Schüssler salt No. 9, sodium phosphoricum, is often used.

What helps in pregnancy?

In principle, drugs such as riopan and omeprazole are also allowed during pregnancy, but each drug intake should be weighed and first discussed with the attending gynecologist. For pregnant women, the focus should initially be on other options, for example sleeping with an elevated upper body and avoiding large meals in the evening, and home remedies can also be tried here, such as warm chamomile tea or a handful of nuts.

Read more on the subject at: Heartburn during pregnancy

Can heartburn be a sign of pregnancy?

About half of all pregnant women develop heartburn in the advanced stages of pregnancy. This is due to the increased pressure inside the abdomen, i.e. the space that the growing child takes up.

It is not an early sign of pregnancy, such as pregnancy-induced nausea, which is particularly typical in the first three months of pregnancy.

Read more about this at: Nausea in pregnancy

Complications

The constant chemical irritation of the stomach acid on the esophageal lining caused by heartburn can lead to inflammation of the esophagus (reflux esophagitis) over time. Severe inflammation heals through scarring. In turn, large hubs can narrow the esophagus (scar stenosis), which impairs the transport of food to the stomach.

In 10% of cases of reflux esophagitis, a beret esophagus develops (synonym endobrachy esophagus = shortening of the esophagus). This leads to a change in shape and function of some of the esophageal cells due to the chronic irritation of the mucous membrane (metaplasia). In the case of the esophagus, metaplasia is a transformation of the natural squamous epithelium of the esophagus (inner cell layer, protective layer) into a columnar epithelium. This transformed tissue is less resistant, so that it can easily lead to an ulcer of the esophagus if the irritation persists.

This esophageal ulcer (beret ulcer), which crosses several cell layers, can lead to life-threatening blood loss. In the worst case, such a beret ulcer can develop into a malignant esophageal tumor (esophageal carcinoma). In principle, however, there is the possibility of cell hollowing, i.e. the metaplasia is reversible when the chronic irritation of the mucous membrane disappears.

The vagus nerve (Nervus Vagus), which runs in the direct vicinity of the esophagus and supplies all organs (lungs, heart, etc.) parasympathetically (part of the autonomic nervous system) up to the diaphragm, can be irritated during heartburn (reflux). It is not uncommon for some patients to report a chronic cough or that their pre-existing asthma has worsened. This is because the irritated vagus nerve causes the bronchi to contract (bronchoconstriction).

Often, however, chronic coughing and hoarseness are also caused by disease-related irritation of the throat and vocal cords. There may be a mixed picture from both causes.

The irritation of the vagus nerve can also lead to a spasmodic contraction of the coronary arteries (coronary spasm). The heartache triggered by this is very similar to heart attack pain (angina pectoris), so that it can be difficult to distinguish it from a heart disease.

In very rare cases of heartburn, reflux of bile acids or secretions from the pancreas (alkalis) into the esophagus can occur. Caustic chemical burns are more damaging than acid burns, since they spread more easily in the tissue. Treacherously, this can result in far greater tissue damage despite fewer symptoms compared to acid burns.

In addition, heartburn can narrow the esophagus, as the lining of the esophagus is irritated by stomach acid and it can become inflamed.

Read more on the topic: Narrowing of the esophagus

Heartburn diagnosis

A suspected diagnosis of heartburn can be made quickly on the basis of the symptom complex described above. In unclear cases or to determine the extent of the damage, additional diagnostics are necessary:

Sonography (ultrasound):
It is a simple and quick examination method to assess individual reflux episodes, gastric emptying and to detect a hiatal hernia. The sonography is radiation-free, so no side effects are to be expected and the ultrasound examination can be repeated as often as required.

Long-term esophageal pH-metry:
The heartburn diagnosis is measured using a pH electrode for acid measurement, which is placed through the nose into the esophagus for 24 hours. The electrode records the ph value in the esophagus near the stomach every 4-6 seconds. A portable recorder that creates a long-term profile records how often reflux events occur and how strong the acid is. If pH values ​​are measured below 4, it is very likely that a reflux event has occurred. This examination method does not provide any information about the extent of any damage to the mucous membranes that has already occurred.

X-ray swallow (upper gastrointestinal passage):
To avoid complications such as scars and narrowing (Stenoses) the X-ray swallow is suitable as a non-invasive imaging procedure. If there are stenoses (constrictions), hourglass-like constrictions of the esophagus can be seen in the X-ray. In addition, statements about transport disorders of the esophagus and gastric emptying are possible.

Endoscopy (esophago-gastro-duodenoscopy):
The "endoscopy" of the esophagus, stomach and upper parts of the small intestine is the method of choice for the direct assessment and classification of damage to the mucous membranes in the correct diagnosis of heartburn. Images are transmitted to a monitor via a tube camera (endoscope). During the endoscopy, tissue samples (biopsy) can then be taken from suspicious areas of the mucous membrane. The tissue examination under the microscope (histological finding) is more meaningful than the (macroscopic) finding with the naked eye. Only in the histological examination can the evidence of a tissue change (Metaplasia) or the evidence and type of tumor can be provided. Therapy can also take place, e.g. the stopping of bleeding ulcers in the mucous membrane.

Also read:

• Endoscopy
• Sternum pain.

Anatomy esophagus

1. Windpipe (trachea)
2. Right lung (lung)
3. Diaphragm
4. throat
5. Esophagus (esophagus)
6. left lung
7. stomach

Classification of mucosal damage according to Savary and Miller

Grade I: Circumscribed, individual, superficial damage to the mucous membrane (erosions)

Grade II: Longitudinal, connected mucosal damage (longitudinally confluent erosions)

Grade III: Circular damage to the mucous membrane (circular erosions)

Grade IV: Ulcer (ulcer), stenosis (narrow), brachyesophagus (see above)

Amber test:
If, despite the pioneering symptoms, an inconspicuous endoscopic finding does not confirm the suspected diagnosis of reflux disease (10-15% of patients), the Bernstein test can help to confirm the diagnosis. This test simulates the effects of acid on the lining of the esophagus. A slightly caustic acid is dripped onto the esophageal mucosa from the outside via a probe. If this causes symptoms that match those of the underlying disease, reflux disease (reflux esophagitis) is very likely. In these cases there is chemical hypersensitivity of the esophagus.

Esophageal manometry:
In rare cases, the function of the lower sphincter must be checked with the help of the pull-through pressure measurement. A thin tube (catheter) is first placed through the nose into the stomach and then slowly pulled back towards the mouth, whereby the patient has to swallow some water regularly. When the catheter is withdrawn, the internal esophageal pressure is continuously measured at the end of the catheter. A computer graphic shows the pressure conditions in the course of the esophagus. Functional disorders of the esophagus can thus be diagnosed. A reflux disease is only detected indirectly via the evidence of an esophageal dysfunction.