What is heart burn?
Heart burn is a burning sensation you experience in your upper stomach, or just below your breastbone. Most of us would have experienced the symptom of heart burn at some point of time in our life. The name 'heart burn' appears to be closely related to the heart. But in reality, it has nothing to do with your heart. However, a couple of symptoms of a disease, related to chronic heart burn, are similar to a heart condition.
The name 'retrosternal burn' or 'behind-the-breastbone burn' will be the more appropriate name for this sensation, as it has no relation at all to your heart. This feeling of 'burning' is a common experience for almost all of us, especially after a fat-rich heavy meal. You do not have to bother about it at all, if it is an occasional occurrence.
But if you undergo this discomfort too frequently to bear, and if it interferes with your day-to-day activities, it needs early medical attention: it may be a symptom indicative of a deeper and more serious problem - a disease called gastroesophageal reflux disease (GERD).
Basic human anatomy for the understanding of GERD
The food pipe (medical term: esophagus) is a vital part of your body; it serves to carry from the throat to your stomach the food you eat, and the liquids you drink. At the top of the food pipe you have a bunch of muscles called the upper esophageal sphincter (UES); you use them consciously when you breathe, eat, belch, or vomit; also, you use them to prevent food, drink, and secretions from entering your wind pipe, which you use for breathing air in and out.
At the lower end of the esophagus you have another door-like structure of muscles, called the lower esophageal sphincter (LES); this bunch of muscles can open to let pass food and drink into the stomach; they can close tightly to prevent stomach acid and other contents from traveling backwards from the stomach into the food pipe.
Unfortunately you cannot control consciously the LES muscles. If the LES does not close when it should, stomach acid and other contents can travel back into the food pipe; this upward splash of acid causes the burning sensation of what is commonly known as 'heart burn'. In medical terminology, it is called 'acid reflux'.
(Stomach acid and other contents travel back into the food pipe through open LES)
When acid reflux becomes chronic and assumes bothersome proportions, it becomes gastroesophageal reflux disease (GERD); it can cause many complications such as: narrowing of the food pipe; ulcer in the food pipe leading to bleeding, severe pain and difficulty in swallowing; in extreme cases, even cancer.
Well-known causes of GERD
The following are well-known reasons for GERD:
Stomach abnormality , pregnancy, smoking and acid reflux foods (alcohol, carbonated beverages, chocolate, citrus fruits like oranges or lemons, coffee or tea, fatty or fried foods, foods prepared with tomato - spaghetti sauce, salsa, pizza - garlic and onions, mint, and spicy foods prepared with chili or curry).
There are a few other reasons as well for GERD: obesity; sleeping with your face up after a heavy snack or meal; some medications like muscle relaxers, or blood pressure prescriptions.
You will do well, therefore, to consult a gastroenterologist (physician for the digestive system), if you experience frequently and for long the following symptoms: burning sensation with a sour taste in your mouth, difficulty in swallowing, sore throat, dry cough or feeling of a lump in your throat.
There are excellent medications available to treat the condition. In fact the treatment of GERD involves mid-term to long-term therapy with a specific class of medication called proton pump inhibitors. These medications have been found to be safe over the past two decades with excellent results.
Along with medical therapy, dietary and life style measures including exercise and weight reduction are important in the management of the disease.
Also you need to be aware of what are called 'red flag symptoms' such as difficulty in swallowing, weight loss, and anemia. If you experience any of these symptoms, you need to consult a gastroenterologist at the earliest; prompt detection and treatment of complications related to the disease would save you a lot of avoidable bother.
Article by Dr. M.A.Arvind, MBBS., M.D., DM (Gastroenterology/Hepatology)
Consultant Medical Gastroenterologist, Kauvery Hospital