Heartburn is a painful, burning sensation in the chest, when there is reflux of food or acid from the stomach into the oesophagus (food pipe). It may be accompanied by sensation of nausea, bilious vomiting and or bloating of the abdomen. Everybody experiences heart burn at some point, but some people unfortunately experience it more frequently, which is troublesome. It occurs when the sphincter at the lower end of the oesophagus (food pipe) fails to prevent reflux of contents of the stomach in the oesophagus. Heart burn can occur due to excess consumption of food and or water. When in a hurry, some people tend to swallow big mouthfuls of food without chewing it properly. In this case, the stomach has to do extra work to deal with the unchewed lumps. This may cause reverse peristalsis from the stomach, i.e. some regurgitation of the food from stomach to the food pipe, thus resulting in heart burn. In some people, it occurs due to wearing very tight clothing or even with change of posture like lying down or bending over. Obesity and pregnancy also cause heart burn due to increase in the intra-abdominal contents. Some drugs like painkillers can also induce heart burn in an individual. Tobacco smoking and alcohol are also responsible for this condition. In some individuals it can occur due to anatomical defects like incompetence of the lower esophageal or upper gastric sphincter. Hiatus hernia is yet another condition that can cause persistent burning pain in the chest. In this there is herniation of part of the stomach from a hole in the diaphragm. Diagnosis of heart burn is established by endoscopy and barium meal examinations which help to show whether it is due to some physical problem or is simply functional. Treatment of physical problems causing heart burn is feasible through surgery. But prevention and treatment of heart burn due to other conditions is simple. A heavy meal provokes heart burn due to the load imposed on the stomach. If one misses a meal and for few hours nothing is eaten, then the acid present in the stomach is not neutralised. This tends to cause heart burn. Therefore, it is useful to take small, frequent meals. Taking sips of cold milk intermittently is very useful for people suffering from heart burn as milk also neutralises the acid present in the stomach. Alcohol, soda beverages and smoking should be avoided as they tend to cause heart burn. Obese people should try to lose weight to get rid of this condition. Pregnant women feel better, after delivery, because then the pressure of abdominal contents is reduced and heart burn is cured. One should try to avoid wearing very tight clothes. A person should be able to identify foods and drinks that induce heart burn and then avoid them. Mostly, it is the foods with a lot of oil, high carbohydrate level and sugar and or spices. Those suffering from chronic heart burn due to hiatus hernia or functional causes should sleep with the head at foot of the bed slightly elevated. This position helps to prevent reflux of acid, hence heart burn. Regarding treatment, antacids (drugs neutralising the acid of the stomach) provide some relief in the symptom. But they should not be used for a long time. Because, if used for a long time, they suppress the symptoms and mask any underlying disease causing this problem. Besides this, antacid tablets or syrups tend to cause constipation or diarrhoea as adverse effect. Other drugs used for treating patients with heart burn are those which reduce the production of acid in the stomach by different mechanisms. With corrections in lifestyle, one can easily prevent heart burn. Dr Rachna Pande is a specialist in internal medicine. rachna212002@yahoo.co.uk
