20 May 2015

Heartburn more information

Heartburn is a common problem seen in general population. It is a burning sensation felt behind the central part of upper chest (retrosternal area), usually seen after meals or awaken the patient from sleep. This is due to regurgitation of small amout of acid and undigested food, and not associated with act of vomiting or retching. Other sumptoms include increased salivation and sensation of lump in the throat.

Mimickers of heartburn
Due to the presence of discomfort in the upperchest and the presence of symptoms at neck and shoulder it may be mistaken for heartdisease.
Pain at night that is relieved by food or antacid is seen in peptic ulcer disease.
Pain on swallowing indicate malignancy or active inflammation.
Pain that is aggrevated by meals and not interfering with daily activities is seen in nonulcer dyspepsia.

Conditions where you get heartburn
Upper gut (gastrointestinal) disorders
• Peptic ulcer disease
• Acute gastritis
• Gall bladder stones
• Oesophageal spasm
• Non-ulcer dyspepsia
• Irritable bowel syndrome
Other gut  disorders
• Pancreatic disease (cancer,chronic pancreatitis)
• Colonic carcinoma
• Hepatic disease (hepatitis,metastases)
Systemic disease
• Renal failure 
• Hypercalcaemia
• Non-steroidal antiinflammatory drugs(NSAIDs)
• Corticosteroids
• Iron and potassium supplements
• Digoxin
• Psychological (anxiety,depression)

Conditions associated with heartburn
Reflux esophagitis is more in the lying down posture (supine position), and is increased by bending forward and after large meals.Patients also experience chest discomfort, nocturnal cough, hoarseness of voice , repeated clearing of throat and frothy mucus in the throat.
Drugs-There is relaxation of muscle of the lower part of esophagus which is increased by anticholinergics, theophylline, meperidine, calcium-channel blockers, chocolate, peppermint, tobacco and alcohol.
Direct injury to mucosa may be caused by Tetracycline, aspirin, iron.
Gastritis is associated with constant epigastric discomfort relieved by food or antacids.
Pregnancy -Heart burn is more common in pregnancy because of increased pressure in the abdomen and relaxation of lower esophageal sphincter due to hormonal change in pregnancy.
Aerophagia there is recurrent burping due to swallowed air due to anxiety, carbonated beverages, gum chewing

Indicators of early evaluation of heartburn are the following
1. Difficulty in swallowing 
2. Severe nausea 
3. Vomiting 
4. Weight loss 
5. Bleeding
6. Lack of response to treatment ,
7. Aggrevation of  symptoms with exertion ( seen in heartdisease )

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