Heartburn is a burning pain in your chest, just behind your breastbone. The pain is often worse after eating, in the evening, or when lying down or bending over.
Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own with lifestyle changes and over-the-counter medications. But if heartburn is more frequent or interferes with your daily activities, then it may be a more serious condition and requires medical care.
Heartburn happens when your stomach acid flows back into your esophagus or food pipe. This causes an uncomfortable burning feeling in your chest that can move up to your neck and throat. You may also have a bitter or sour taste in the back of your throat. Heartburn can last from a few minutes to several hours, and often feels worse after you eat.
If you have heartburn often and it is severe, you may have gastroesophageal reflux disease (GERD). If this is the case, you should consult a specialist.
Several factors may lead to heartburn or make it feel worse. These include:
Even though heartburn is common, it can sometimes lead to more serious health problems. Severe, chronic heartburn/GERD has been linked to inflammation and narrowing of the esophagus, respiratory problems, chronic cough, and Barrett’s esophagus, which may lead to esophageal cancer.
Initially, the specialist doctor can diagnose Acid reflux disease from your symptoms and can prescribe medications and advised lifestyle modifications. Tests or Investigations are needed when we want to confirm the diagnosis and assess the severity of the problem. Usually, an endoscopy is suggested if you need medications for more than a few weeks or you have not benefited from medications.
Investigations are done to determine if your heartburn is a symptom of GERD, has it led to complications like ulcers, narrowing or Barret’s esophagus. Tests also help to give us the information weather this problem is likely to get prolonged and need long term medications or not. Your doctor may recommend:
Upper G I endoscopy
The test is done to check for abnormalities in your esophagus. This is the first and the most routinely done investigation. By an endoscopy, we can know if there are ulcers if there is a hiatus hernia and if there are some more serious problems like narrowing and Barret’s ulcer. A tissue sample (biopsy) may be taken for analysis.
24 hr pH with Impedance study
Ambulatory 24 hr pH and Impedance tests, to identify when, and for how long, stomach acid backs up into your esophagus. An acid monitor that is placed in your esophagus connects to a small device that you wear around your waist or on a strap over your shoulder. To watch the video about why and when it should be done click this link. To watch the video about how this test is done, watch the video below.
It is done to measure movement and pressure in your esophagus. It gives information about the weakness of the valve and the proper functioning of the food-pipe. This test actually a part of the pH and Impedance test.
X rays are taken after you swallow a liquid called Barium or a dye, to view the shape and condition of your esophagus and stomach. Although in today’s time its role has become limited and is advised only in selected patients, especially when surgery is required.
GERD and Acid reflux is a lifestyle disease, and hence we are noticing a massive increase in the incidence of heartburn. Hence, Lifestyle change is the key to prevent this problem, as well as to have good and long term outcome with treatment.
In many early cases, it itself can sort out the problem. When the disease has progressed further, you may need medications or surgery, but still, need to modify your lifestyle for better outcomes.
To watch our video on diet and lifestyle modifications for patients having heartburn click here.
Many over-the-counter medications can help relieve heartburn. The options include:
If over-the-counter treatments don’t work or you rely on them often, see your doctor. You may need prescription medication and further testing.
May patients who have a more severe problem with their LES valve, may need long term medications. There are a large number of such patients who are taking antacid medications for years. Proper investigations, including an endoscopy and pH study can help predict if you would need long term medications or not. For many such patients, a laparoscopic surgery may be a more preferred option of treatment.
There are a small number of GERD patients, who have a more pronounced mechanical problem with LES valve and hiatus hernia. Due to the mechanical problem, either they are dependent on PPI antacid medications or they face problems even with medications. For such patients, a laparoscopic surgery to repair the hiatus hernia and creating a new valve is the ideal option. Done after thorough evaluation, this surgery gives excellent results. It improves the quality of life and the antacid medications are no more required. This surgery is certainly a very specialized surgery and should be done after a manometry and pH study test, and should be done by a surgeon who has the required skill and knowledge.