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October 25, 2006
Despite the mis-spell (Dispepsia? Dyspepsia?) www.dispepsia.com proves a useful plain English health resource for World Wide Web surfers seeking information on dyspepsia, heartburn, indigestion, stress and stress management.
October 21, 2006
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Heartburn is the painful, often very painful consequence of the acid in the stomach coming into contact with the lower esophagus. This acid burning, sometimes described as acid indigestion, can often be stopped or controlled by lifestyle changes and the avoidance of acidic and fatty foods and drinks.
Heartburn or pyrosis is a painful or burning sensation in the esophagus, just below the breastbone caused by regurgitation of gastric acid. The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn is also identified as one of the causes of asthma and chronic cough.
Heartburn actually has nothing to do with the heart; it is so called because of a burning sensation of the breastbone, although some heart problems have a similar sensation to heartburn.
Contents:
1 Pathophysiology
2 Causes
3 Diagnosis
4 Treatment
4.1 Prevention
4.2 Medications
4.2.1 Antacids
4.2.2 Water
4.2.3 H2-receptor antagonists
4.2.4 Proton-pump Inhibitors
4.3 Restricting Diet
The sensation of heartburn is caused by exposure of the lower esophagus to the acidic contents of the stomach. Normally, the lower esophageal sphincter (LES) separating the stomach from the esophagus is supposed to contract to prevent this situation. If the sphincter relaxes for any reason (as normally occurs during swallowing), stomach contents, mixed with gastric acid, can return into the esophagus. This return is also known as reflux, and may progress to gastroesophageal reflux disease (GERD) if it occurs frequently. Peristalsis, the rhythmic wave of muscular contraction in the esophagus, normally moves food down and past the LES and is responsible for ultimately clearing refluxed stomach contents. In addition, gastric acid can be neutralized by buffers present in saliva.
Foods that may cause heartburn:
Alcohol
Coffee, tea, cola, and other caffeinated and carbonated beverages
Chocolate
Citrus fruits and juices
Tomatoes and tomato sauces (such as pizza and pasta sauce)
Spicy foods and fatty foods (including full-fat dairy products)
Peppermint and spearmint
Dry foods such as peanuts
Fatty foods such as ice cream
Heartburn can also be psychosomatic, primarily in relation to stress.
Physicians typically diagnose gastroesophageal reflux disease (GERD) based on symptoms alone. When the clinical presentation is unclear, other tests can be performed to confirm the diagnosis or exclude other disorders. Confirmatory tests include:
A probe can be placed via the nose into the esophagus to record the level of acidity in the lower esophagus. Because some degree of variation in acidity is normal, and small reflux events are relatively common, such monitors must be left in place for at least a 24-hour period to confirm the diagnosis of GERD. The test is particularly useful when the patient's symptoms can be correlated to episodes of increased esophageal acidity.
A series of x-rays of the upper digestive system are taken after drinking a barium solution. These can demonstrate reflux of barium into the esophagus, which suggests the possibility of gastroesophageal reflux disease. More accurately, fluoroscopy can be used to document reflux in real-time.
In this test, a pressure sensor (manometer) is passed through the mouth into the esophagus and measures the pressure of the lower esophageal sphincter directly.
The esophageal mucosa can be visualized directly by passing a thin, lighted tube with a tiny camera attached (an endoscope) through the mouth to examine the esophagus and stomach. In this way, evidence of esophageal inflammation can be detected, and biopsies taken if necessary:
A small sample of tissue from the esophagus is removed. It is then studied to check for inflammation, cancer, or other problems.
If heartburn occurs when lying down, raising the head with pillows or sitting up frequently provides relief – although care must be taken to avoid placing continuous strain on the neck. Avoidance of certain foods shortly before bedtime is frequently advised to avoid future heartburn attacks.
Antacids, H2-receptor antagonists and proton pump inhibitors are used (in that order) to treat heartburn.
Daily treatment with Antacids is effective for 25-30% of people with GERD. Acid-blocking medications are the most effective for mild forms of the condition.
Some have suggested that drinking a large glass of water dilutes the high pH levels in the stomach (since pure water has a neutral pH of 7) and allows the heartburn pain to temporarily subside. However, because pH is measured on a logarithmic scale (a shift of 1 on the pH scale corresponds to a change by a factor of 10), to substantially dilute the pH of stomach acid would mean drinking at least 10 times as much pure water as the volume of acid.
With the advent of proton-pump inhibitors, H2-receptor antagonists are not widely used.
Proton pump inhibitors are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors directly block acid production in the stomach cells and provide more effective relief than less powerful medications. In order to prevent heartburn the medication disfigures and disables the proteins (proton pumps) that control the pH of the stomach, allowing the body to digest them.
Restricting diet is very important, since 90-95% of sufferers of heartburn or esophageal disorder can link their symptoms to specific foods. Therefore, it is important that heartburn sufferers manage their diets as a way to treat their heartburn. Sufferers should choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers.
This article is licensed under the GNU Free Documentation License.
Dyspepsia (from the Greek (Dys-), meaning hard or difficult, and (Pepsi), meaning digestion) refers to disorders of the stomach involving symptoms such as heartburn, nausea, pain, or general discomfort.
Many cases of dyspepsia are caused by stomach ulcers which may be diagnosed with a barium meal test or a gastroscopy. In some situations, for example, stomach ulcers, high levels of gastric acid may irritate the stomach lining and cause dyspeptic symptoms. Dyspepsia may also be occur as a side effect from drugs treating other diseases.
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