Heartburn is acid reflux that occurs when stomach acid refluxes back into the esophagus. The esophagus is the tube that connects the mouth to the stomach. It happens as a burning pain right behind your breast bone or as a sour food taste at the back of your mouth. It mostly occurs after a meal, during the evening, when lying or bending over.

Many people experience occasional heartburn that occurs once or twice per week, which should be no cause for panic since it is manageable through lifestyle changes and over the counter medications such as zanzole tablets. In severe cases, if you experience severe heartburn that causes discomfort or interferes with your daily activities, it may be a symptom of a more severe disease known as gastroesophageal reflux disease (GERD).

Symptoms of heartburn

The common symptoms of heartburn include:

• A burning sensation in the chest which mostly increases after a meal or during the night. It may cause you to awaken from sleep during the night.
• A sour/bitter taste at the back of the mouth.
• A burning chest pain that occurs when you bend or lie down.

Other symptoms in severe cases and which will require you to see a doctor include:

• Persistent nausea or vomiting.
• Difficulty in swallowing.
• Heartburn that persists even after using over the counter medications.
• Heartburn occurs more than twice per week despite lifestyle changes.
• Difficulty in eating and poor appetite that leads to weight loss.
• Sharp pain or spasm behind the sternum or breast bone.
• Coughing or voice hoarseness due to acid reflux near the larynx or voice box.

If you don't see a doctor after experiencing severe acid reflux or heartburn symptoms, the condition worsens, and you may experience recurrent irritation and inflammation of the esophagus. That leads to small tissue breakdowns known as stomach ulcers that can cause intestinal bleeding.

Other resulting conditions of severe heartburn include stricture and scarring of the cells lining the esophagus, leading to Barrett's esophagus condition. That increases the risks of developing esophageal cancer.

What causes acid reflux?

As earlier mentioned, acid reflux or heartburn occurs when stomach acid backs up to the esophagus. 

When you swallow food in normal conditions, the esophagus, through a band of muscle known as the lower esophageal sphincter, relaxes, allowing food through to the stomach then tightens up again. When the lower esophageal sphincter weakens or relaxes abnormally, it causes stomach acid to flow back into the esophagus, causing acid reflux leading to heartburn.

The risk factors of heartburn

Heartburn is a common condition whose risk factors are widely known. They include:

• Eating acidic foods such as spicy foods, tomatoes, onion, oranges, peppermint, etc.
• Drinking acidic juices such as grapefruit, pineapple, orange juice, etc.
• Taking carbonated drinks such as sodas.
• Prolonged use of NSAIDS such as ibuprofen, asprin, naproxen, etc.
• Smoking and also second-hand smoke relaxes the lower esophageal sphincter (LES), allowing acid to flow back to the esophagus.
• The use of alcohol.
• The prolonged use of coffee and caffeinated drinks.
• Consumption of highly fatty foods which relax the lower esophageal sphincter.
• A hiatal hernia (a part of the stomach lies within the chest instead of the abdomen). It doesn't cause heartburn symptoms by itself but can affect the way LES works, leading to acid reflux.
• Obesity and pregnancy may increase pressure to the stomach cavity and affect how LES works, hence increasing acid reflux risks.
• Other diseases of the esophagus, such as scleroderma, can present their symptoms as heartburn.

Heartburn/acid reflux diagnosis

One of the reasons you should seek medical intervention in severe heartburn cases is because its symptoms can be similar to the signs of a heart attack, pulmonary embolus, chest wall pains, or pneumonia.

When you see a doctor, he/she will perform diagnosis in the form of:

Medical examination

The first diagnosis will include a physical examination and review of your medical history, depending on the symptoms you experience. In most patients, that will be enough for the doctor to diagnose and initiate a treatment plan. But, if symptoms persist, the doctor will request further tests. 

x-ray/ barium meal

As a patient, during this diagnosis, you will be asked to swallow a type of contrast material (barium) as the radiologist observes the swallowing through an x-ray to determine if the esophagus is appropriately working. This test may also reveal any inflammation of the esophagus.

Endoscopy

Here, the doctor uses a fibreoptic camera too observe the linings of the esophagus and stomach walls to identify any inflammation and ulcers. During this test, small stomach tissues can be obtained to test for cancerous cells.

Ph testing

It is the use of acid measurements and pressure monitors from the esophagus to confirm heartburn diagnosis. It is mostly useful when conventional therapy has failed in confirming the diagnosis.

Heartburn treatment

The first line of treatment against heartburn is lifestyle changes, including but not limited to:

• Eat little portions of food frequently instead of a few heavy meals.
• Avoid eating acidic foods and drinks.
• Quit alcohol use and smoking.
• Avoid the use of NSAIDs.
• Allow yourself time after eating supper or dinner before sleeping. Or generally, avoid lying down immediately after a meal.
• Raise the bed head for your head and chest to be at an elevated position than the feet when sleeping. That keeps the acid in the stomach.
• Wear the belt loosely.

The other treatment for heartburn is medications such as:

H2 or proton pump inhibitors such as zanzole tablets. They are available over the counter, and you do not require prescriptions to access. They act as acid production blockers. However, it is vital to consult with your pharmacist if you are taking other medication to avoid drug interactions.

Antacids you can take after meals, before bedtime, or occasionally coat the esophagus and relieve heartburn.

Histamine H2 antagonists such as cimetidine block a chemical in the brain that triggers stomach acid production.

Surgery to treat heartburn is an option in patients whose:

Heartburn symptoms persist despite the above treatment options.

Patients with barret’s esophagus.

Severe heartburn causes voice hoarseness, pneumonia, and wheezing frequently.

CONCLUSION

Heartburn is a common medical condition that should not be a cause for alarm. With the right medical intervention, it is treatable and manageable. However, if you have heartburn problems, adopt lifestyle changes such as avoiding acidic foods as much as possible to avoid worsening the condition.