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 ]
- 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 – 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
Burning retrosternal discomfort
Elimination of heart attack and GERD as the cause
No esophageal motility disorders
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)
- Upper GI series looking for the presence of acid reflux
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.
- 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.
- Acupuncture – in cases of functional heartburn (eg – heartburn of unknown origin) acupuncture may be as effective if not more than PPIs alone.
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 ]
- ICD-10: R12
- ICD-9-CM: 787.1
- MeSH: D006356
- MedlinePlus: 003114