HEARTBURN
There are many terms to describe heartburn, a very common complaint. It is a sensation of burning, sourness, or bitterness in the middle of the chest and the back of the throat. Heartburn is also known as water brash, pyrosis, or acid indigestion.
Acid is normally produced by the stomach to help in the digestion of food. The connection between the esophagus and stomach is guarded by a valve (sphincter) that prevents acid from going out of the stomach into the esophagus and up into the throat or mouth. When the valve does not work properly, some excess acid may enter the esophagus, causing heartburn. Some older individuals produce an increased amount of acid. They often suffer from acid-peptic disease, which may cause stomach or duodenal ulcers or aggravate a hiatus hernia. In the latter, a part of the stomach is displaced above the diaphragm (the breathing muscle that separates the chest from the abdomen) and prevents the valve from keeping the acid in the stomach, thereby allowing it to regurgitate into the esophagus.
There are a number of ways to treat heartburn. In some people it is aggravated by various foods or stimulants, such as alcohol, caffeine, and cigarettes. You may learn that certain foods intensify your heartburn and other foods relieve it. Milk products and other bland foods often improve the symptoms but probably have no effect on the actual cause of the heartburn.
If you suffer heartburn from a hiatus hernia, you know that it is aggravated by overeating, lying down, bending over, or wearing excessively tight clothing or girdles. You may have noticed that when you are overweight the symptoms of heartburn are worse and when you lose weight there is relief.
In most instances people suffer from heartburn only occasionally. You usually can treat yourself with a dose of a liquid or tablet antacid, a glass of milk, or by avoiding foods that make your symptoms worse. For some, heartburn may be intolerable. It can interfere with the enjoyment of food, sleep, and the activities of daily life. If this is so, you should find out if the symptoms are related to ulcer disease or to a symptomatic hiatus hernia with acid regurgitation or reflux. Tests and X-rays of the esophagus and stomach are usually done to determine the cause. You may be X-rayed with your head down to show that the stomach acid refluxes (passes through the sphincter) and passes from the stomach into the esophagus.
Sometimes your physician will use a gastroscope to look into the stomach to see whether stomach acid is backing up into the esophagus. In severe cases relief may be achieved with frequent doses of liquid antacids. Medications decrease the acid production by the stomach (cimetidine, ranitidine and famotidine) or improve the closure of the valve that separates the stomach from the esophagus (metoclopramide and motilium). These drugs often improve the symptoms, and they can be used alone or with antacids.
Rarely does an older person with severe heartburn from a hiatus hernia require surgery for the relief of symptoms. Surgery is usually necessary only if the medications are not effective or you become severely disabled and no longer enjoy food or routine activities.
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