Heartburn

Heartburn

Heartburn is characterized by a burning sensation or discomfort felt in the upper abdomen (epigastric region), extending upwards behind the breastbone and occasionally reaching the throat. Despite its name, heartburn does not involve the heart but arises from gastrointestinal issues, specifically the reflux of gastric acid into the esophagus.

Factors that trigger heartburn include poor dietary habits (eating quickly, inadequate chewing), fatty and spicy foods, chocolate, smoking, alcohol consumption, tea, coffee, stress, certain medications, tight clothing around the abdomen, heavy lifting, and lying down immediately after meals. Medical conditions such as hiatal hernia, pregnancy, and weakness of the esophageal sphincter can also contribute to heartburn.

Some patients may experience severe pain mistaken for cardiac conditions. Associated symptoms include belching, sour or bitter taste in the mouth, wheezing during sleep due to laryngeal or bronchial narrowing, tooth discoloration, and chronic cough.

Patient Advice

• Improve eating habits by avoiding high-fat foods, spices, chocolate, alcohol, coffee, and tea.
• Maintain healthy body weight.
• Quit smoking, as smoking increases stomach acid and swallowing air while smoking exacerbates reflux symptoms.
• Avoid tight clothing around the abdomen; loosening belts can reduce abdominal pressure.
• Avoid stressful situations or practice relaxation techniques if unavoidable.
• Do not lie down, bend forward, squat, or lift heavy objects immediately after eating.
• Elevate the head during sleep.
• Avoid high-protein and fatty foods for at least 2 hours before exercising.
• Exercise on an empty stomach to prevent increased intra-abdominal pressure, which can provoke heartburn.
• Drink small amounts of water before and during exercise.

When to See a Doctor

• Symptoms persist despite initial antacid treatment for at least 1 week.
• Heartburn is associated with medication use.
• Difficulty swallowing (dysphagia).
• Regurgitation of food.
• Symptoms worsen or become chronic.
• Heartburn accompanied by coughing or wheezing.
• Unexplained weight loss.
• Vomiting blood or material resembling coffee grounds.
• Black, tar-like stools.
• Burning and severe chest pain.

Treatment Options

1.Antacids, Antireflux Agents & Antiulcerants

Since heartburn results from excessive gastric acid secretion, acid-neutralizing medications are effective.

• Antacids
  neutralize hydrochloric acid using alkaline substances such as aluminium salts, magnesium salts, calcium carbonate, and sodium bicarbonate. Aluminium may cause constipation; magnesium may cause diarrhea. Combinations reduce these effects. Complex compounds (e.g., polymigel ) containing both aluminium and magnesium are alternative options.
• Sodium-containing antacids (e.g., sodium bicarbonate)
  should be avoided in patients with hypertension, heart disease, kidney disease, or pregnancy.
• Antacids often include antifoaming agents (e.g., simethicone,dimethicone) to prevent bloating. Alginates (e.g., sodium alginate ) may also be added to protect against acid reflux.
• Local anesthetics (e.g., oxetacaine, sulcain) are often combined to relieve burning sensations.

2. Antiulcer Agents

Used to treat and prevent pain caused by heartburn, categorized into:

Acid Secretion Inhibitors

• H2-blockers (e.g., cimetidine, famotidine, nizatidine, ranitidine) Provide short-term relief by blocking histamine receptors in the stomach, reducing acid secretion.
• Proton Pump Inhibitors (PPIs) (e.g., omeprazole, dexlansoprazole, esomeprazole, lansoprazole, rabeprazole, pantoprazole ) Inhibit acid secretion by blocking the enzyme that transports protons.
• Potassium-Competitive Acid Blockers (PCABs) (e.g., vonoprazan )Inhibit acid secretion by competitively blocking potassium binding at parietal cells.

3. Cytoprotective / Mucosal Protectant Agents

• Sucralfate, teprenone, rebamipide, aluminium and bismuth-containing antacids: Form protective barriers on the stomach lining.
• Misoprostol (synthetic prostaglandin E₁ analogue): Inhibits acid secretion and enhances bicarbonate and mucus secretion. Contraindicated during pregnancy.