Heartburn

Burning sense chiefly due to gastric acid in the esophagus
This article is about the medical condition. For other uses, see Heartburn ( disambiguation ) “ Cardialgia ” redirects here. For the meaning “ trouble in or near the heart ”, see Heart pain and Chest annoyance checkup condition
Heartburn, besides known as pyrosis, cardialgia or acid indigestion, [ 2 ] is a burning sensation in the cardinal chest or amphetamine central abdomen. [ 3 ] [ 4 ] [ 5 ] Heartburn is normally due to vomit of gastric acerb ( gastric reflux ) into the esophagus. It is the major symptom of gastroesophageal ebb disease ( GERD ). [ 6 ] other common descriptors for heartburn ( besides burn off ) are belching, nausea, squash, stabbing, or a sense of press on the thorax. The trouble frequently rises in the thorax ( directly behind the sternum ) and may radiate to the neck, throat, or angle of the arm. Because the breast houses early important organs besides the esophagus ( including the heart and lungs ), it is important to remember that not all symptoms related to heartburn are esophageal in nature. The cause will vary depending on one ‘s family and medical history, genetics, if a womanhood is fraught or breastfeed, and age. As a leave, the diagnosis will vary depending on the suspected electric organ and the motivate disease process. Work-up will vary depending on the clinical intuition of the provider seeing the affected role, but broadly includes endoscopy and a trial of antacids to assess for easing .

definition [edit ]

The term indigestion includes heartburn along with a number of other symptoms. [ 7 ] Indigestion is sometimes defined as a combination of epigastric pain and heartburn. [ 8 ] Heartburn is normally used interchangeably with gastroesophageal reflux disease ( GERD ) preferably than precisely to describe a symptom of burning in one ‘s chest. [ 9 ]

differential diagnosis [edit ]

Heartburn-like symptoms and/or lower chest or upper abdomen may be indicative of much more sinister and/or baneful disease. [ 10 ] Of greatest concern is to confuse heartburn ( broadly related to the esophagus ) with a heart attack as these organs contribution a common nerve provide. [ 11 ] Numerous abdominal and pectoral organs are present in that region of the body. many unlike organ systems might explain the discomfort called heartburn .

affection [edit ]

The most common symptom for a affection attack is chest trouble. [ 12 ] however, ampere many as 30 % of chest pain patients undergo cardiac catheterization have findings that do not account for their chest discomfort. These are much defined as having “ atypical thorax trouble ” or chest annoyance of indeterminate beginning. [ 13 ] Women experiencing heart attacks may besides deny classical signs and symptoms [ 14 ] and rather complain of GI symptoms alternatively. [ 12 ] [ 15 ] [ 16 ] One article estimates that ischemic heart disease may appear to be GERD in 0.6 % of people. [ 11 ]

esophagus [edit ]

  • GERD
  • Eosinophilic esophagitis – a disease commonly associated with other atopic diseases such as asthma, food allergies, seasonal allergies, and atopic skin disease
  • Mallory-Weis tears – tears of the superficial mucosa of the esophagus that are subsequently exposed to gastric acid commonly due to vomiting and/or retching
  • Chemical esophagitis – related to the intake of caustic substances, excessive amounts of hot liquids, alcohol, or tobacco smoke
  • Infections may explain heartburn symptoms. These especially include CMV and certain fungal infections, most common in immunocompromised persons

stomach [edit ]

  • Peptic ulcer disease[19] – can be secondary to H. Pylori infection or heavy NSAID use that weakens stomach mucosal layer. Pain often worsens with eating.
  • Stomach cancer

Intestines [edit ]

  • Intestinal ulcers – generally secondary to other conditions such as H. Pylori infection or cancers of the GI tract. Pain often improves with eating.
  • Duodenitis – inflammation of the small intestine. May be the result of several conditions

gallbladder [edit ]

Pancreas [edit ]

  • Pancreatitis – can be autoimmune, due to a gallstone obstructing the lumen, related to alcohol consumption.

pregnancy [edit ]

heartburn is common during pregnancy having been reported in a high as 80 % of pregnancies. [ 20 ] It is most much due to GERD and results from rest of the lower esophageal sphincter ( LES ), changes in gastric motility, and/or increasing intra-abdominal coerce. [ 21 ] [ 20 ] The attack of symptoms can be during any shipshape of pregnancy .

  • Hormonal – related to the increasing amounts of estrogen and progesterone and their effect on the LES
  • Mechanical – the enlarging uterus increasing intra-abdominal pressure, inducing reflux of gastric acid
  • Behavioral – as with other instances of heartburn, behavioral modifications can exacerbate or alleviate symptoms

Unknown Origin [edit ]

functional heartburn is heartburn of unknown campaign. [ 22 ] It is normally associated with psychiatric conditions like low, anxiety, and panic attacks. It is besides seen with early running gastrointestinal disorders like cranky intestine syndrome and is the elementary cause of lack of improvement post treatment with proton pump inhibitors ( PPIs ). [ 22 ] Despite this, PPIs are still the elementary treatment with response rates in approximately 50 % of people. [ 22 ] The diagnosis is one of elimination, based upon the Rome III criteria. It was found to be present in 22.3 % of Canadians in one survey. [ 22 ]

Rome III Criteria

1

Burning retrosternal discomfort

2

Elimination of heart attack and GERD as the cause

3

No esophageal motility disorders[22]

diagnostic approach path [edit ]

heartburn can be caused by several conditions and a preliminary diagnosis of GERD is based on extra signs and symptoms. The chest pain caused by GERD has a clear-cut ‘burning ‘ sense, occurs after eating or at night, and worsens when a person lies down or bends over. [ 23 ] It besides is common in fraught women, and may be triggered by consuming food in large quantities, or specific foods containing sealed spices, high fatten content, or high acerb message. [ 23 ] [ 24 ] In young persons ( typically < 40 years ) who present with heartburn symptoms reproducible with GERD ( onset after eat, when laying down, when fraught ), a doctor may begin a course of PPIs to assess clinical improvement before extra examination is undergo. [ 25 ] Resolution or improvement of symptoms on this course may result in a diagnosis of GERD. other tests or symptoms suggesting acidic ebb is causing heartburn include :

  • Onset of symptoms after eating or drinking, at night, and/or with pregnancy, and improvement with PPIs
  • Endoscopy looking for erosive changes of the esophagus consistent with prolonged acid exposure (eg – Barrett’s esophagus)[25]
  • Upper GI series looking for the presence of acid reflux[24][26]

GI cocktail [edit ]

respite of symptoms 5 to 10 minutes after the administration of syrupy lidocaine and an antacid increases the misgiving that the pain is esophageal in beginning. [ 27 ] This however does not rule out a likely cardiac lawsuit [ 28 ] as 10 % of cases of discomfort due to cardiac causes are improved with antacids. [ 29 ]

biochemical [edit ]

Esophageal ph monitor : a probe can be placed via the nose into the esophagus to record the grade of acidity in the lower esophagus. Because some degree of version in sourness is normal, and little reflux events are relatively common, esophageal pH monitor can be used to document ebb in real-time. [ 30 ] Patients are able to record symptom onset to correlate lower esophageal ph with time of symptom attack .

mechanical [edit ]

Manometry : in this test, a imperativeness detector ( manometer ) is passed via the mouth into the esophagus and measures the imperativeness of the LES directly. [ 31 ] endoscopy : the esophageal mucous membrane can be visualized immediately by passing a thin, lighted tube with a bantam television camera known as an endoscope attached through the mouth to examine the esophagus and stomach. In this way, attest of esophageal inflammation can be detected, and biopsies taken if necessary. Since an endoscopy allows a doctor to visually inspect the upper digestive tract the operation may help identify any extra damage to the tract that may not have been detected differently. [ 32 ] biopsy : a little sample of tissue from the esophagus is removed. It is then studied to check for excitement, cancer, or other problems. [ 31 ]

treatment [edit ]

discussion plans should be tailored to the specific diagnosis and etiology of the heartburn. management of heartburn can be sorted into assorted categories. Most examples provided hera are assuming a diagnosis of GERD or functional heartburn .

Pharmacologic Management [edit ]

Behavioral Management [edit ]

  • Taking medications 30–45 minutes before eating suppresses the stomach’s acid generating response to food
  • Avoiding spicy foods, foods high in fats, peppermint, and chocolate[ citation needed]
  • Avoiding reclining 2.5-3.5 hours after a meal to prevent the reflux of stomach’s contents

life style Modifications [edit ]

  • Early studies show that diets that are high in fiber may show evidence in decreasing symptoms of dyspepsia.[34]
  • Weight loss can decrease abdominal pressure that both delays gastric emptying and increases gastric acid reflux into the esophagus

alternative and complemental Therapies [edit ]

Symptoms of heartburn may not constantly be the solution of an organic induce. Patients may respond better to therapies targeting anxiety and symptoms of hyper-vigilance, through medications aimed towards a psychiatric etiology, osteopathic manipulation, and even acupuncture. [ 22 ]

  • Psychotherapy may show a positive role in treatment of heartburn and the reduction of distress experienced during symptoms.[22]
  • Acupuncture – in cases of functional heartburn (eg – heartburn of unknown origin) acupuncture may be as effective if not more than PPIs alone.[35]

surgical management [edit ]

In the case of GERD causing heartburn symptoms, surgery may be required if PPI is not effective. [ 36 ] Surgery should not be undergo if functional heartburn is the leading diagnosis. [ 37 ]

epidemiology [edit ]

about 42 % of the United States population has had heartburn at some point. [ 38 ]

References [edit ]

ClassificationD

  • ICD-10: R12
  • ICD-9-CM: 787.1
  • MeSH: D006356

External resources

  • MedlinePlus: 003114
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Category : Health

Vesicoureteral reflux – Symptoms and causes

Overview

Female urinary system

Female urinary system

Female urinary system

Your urinary system — which includes your kidneys, ureters, bladder and urethra — removes thriftlessness from your torso through urine. Your kidneys, located in the rise part of your upper abdomen, produce urine by filtering waste and fluid from your blood .

Male urinary system

Male urinary system

Male urinary system

Your urinary system — which includes your kidneys, ureters, bladder and urethra — removes lay waste to from your body through urine. Your kidneys, located in the back share of your upper abdomen, produce urine by filtering waste and fluid from your blood .
Vesicoureteral ( ves-ih-koe-yoo-REE-tur-ul ) ebb is the abnormal run of urine from your bladder bet on up the tubes ( ureters ) that connect your kidneys to your bladder. normally, urine flows from your kidneys through the ureters down to your bladder. It ‘s not supposed to flow back up .
Vesicoureteral reflux is normally diagnosed in infants and children. The disorder increases the risk of urinary tract infections, which, if left untreated, can lead to kidney damage .
Children may outgrow chief vesicoureteral ebb. Treatment, which includes medicine or surgery, aims at preventing kidney price .

Types

Symptoms

urinary tract infections normally occur in people with vesicoureteral reflux. A urinary nerve pathway infection ( UTI ) does n’t constantly cause detectable signs and symptoms, though most people have some .
These signs and symptoms can include :

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • The need to pass small amounts of urine frequently
  • Cloudy urine
  • Fever
  • Pain in your side (flank) or abdomen

A UTI may be unmanageable to diagnose in children, who may have alone nonspecific signs and symptoms. Signs and symptoms in infants with a UTI may besides include :

  • An unexplained fever
  • Lack of appetite
  • Irritability

As your child gets older, untreated vesicoureteral reflux can lead to :

  • Bed-wetting
  • Constipation or loss of control over bowel movements
  • High blood pressure
  • Protein in urine

Another indication of vesicoureteral ebb, which may be detected before birth by sonogram, is swelling of the kidneys or the urine-collecting structures of one or both kidneys ( hydronephrosis ) in the fetus, caused by the backing of urine into the kidneys .

When to see a doctor

Contact your sophisticate correctly aside if your child develops any of the signs or symptoms of a UTI, such as :

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Abdominal or flank pain

Call your doctor about fever if your child :

  • Is younger than 3 months old and has a rectal temperature of 100.4 F (38 C) or higher
  • Is 3 months or older and has a fever of 100.4 F (38 C) or higher and seems to be ill
  • Is also eating poorly or has had significant changes in mood

Causes

Your urinary system includes your kidneys, ureters, bladder and urethra. All play a character in removing waste products from your body via urine .
Tubes called ureters carry urine from your kidneys down to your bladder, where it is stored until it exits the body through another tube ( the urethra ) during micturition .
Vesicoureteral ebb can develop in two types, basal and secondary :

  • Primary vesicoureteral reflux. Children with elementary vesicoureteral ebb are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. primary vesicoureteral ebb is the more common type .
    As your child grows, the ureters lengthen and straighten, which may improve valve routine and finally correct the ebb. This type of vesicoureteral ebb tends to run in families, which indicates that it may be genetic, but the accurate cause of the defect is strange .
  • Secondary vesicoureteral reflux. The cause of this form of reflux is most often from failure of the bladder to empty properly, either due to a blockage or failure of the bladder muscle or damage to the nerves that control normal bladder emptying.

Risk factors

risk factors for vesicoureteral ebb include :

  • Bladder and bowel dysfunction (BBD). Children with BBD hold their urine and stool and experience recurrent urinary tract infections, which can contribute to vesicoureteral reflux.
  • Race. White children appear to have a higher risk of vesicoureteral reflux.
  • Sex. Generally, girls have a much higher risk of having this condition than boys do. The exception is for vesicoureteral reflux that’s present at birth, which is more common in boys.
  • Age. Infants and children up to age 2 are more likely to have vesicoureteral reflux than older children are.
  • Family history. Primary vesicoureteral reflux tends to run in families. Children whose parents had the condition are at higher risk of developing it. Siblings of children who have the condition also are at higher risk, so your doctor may recommend screening for siblings of a child with primary vesicoureteral reflux.

Complications

Kidney wrong is the primary refer with vesicoureteral ebb. The more severe the reflux, the more dangerous the complications are probable to be .
Complications may include :

  • Kidney (renal) scarring. Untreated UTIs can lead to scarring, which is permanent damage to kidney tissue. Extensive scarring may lead to high blood pressure and kidney failure.
  • High blood pressure. Because the kidneys remove waste from the bloodstream, damage to your kidneys and the resultant buildup of wastes can raise your blood pressure.
  • Kidney failure. Scarring can cause a loss of function in the filtering part of the kidney. This may lead to kidney failure, which can occur quickly (acute kidney failure) or may develop over time (chronic kidney disease).

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