Dr. Kenneth Falchukgtgtgt Heartburn is a common symptom. The greatest concern that we as physicians have, not just gastroenterologists, any physician who deals with a patient who complains of heartburn is, is this symptom an indication of reflux disease, what we call gastroesophageal reflux disease GERD, or could it be something else Could it be heart pain that the patient presents to the physician as I think I have heartburn reflux but yet the patient is unsure and obviously it is the role of the physician to attempt to define this, investigate it.
Further. For the most part, heartburn is a burning sensation. Some people call it bitter sensation in the chest that could go all the way up to your throat. It can occur lying down after eating a large meal, after eating something delicious, rich such as a fatty meal, and delicious pastry with a lot of goodies build into it, eating spicy food, garlic, drinking a lot of liquor, two pieces of chocolate, so there are different food products or deli things that we do in society to enjoy ourselves that can trigger heartburn.
Now heartburn is not usually triggered by exercise, it can, sometimes if you bend forward, if you do pushups but if you are walking on a treadmill or going up a set of stairs or flight of stairs, you should not have heartburn. So, therefore, that is what a cardiologist or physician would call it a red flag. Be careful about that symptom, they may not be something as simple as gastroesophageal reflux but indicative of something more serious that can be originating not in the esophagus but rather in the heart.
Heartburn and Reflux Differences
To evaluate the symptom further, one has to ask the patient about other symptoms. When does it occur What did they do when this happened Were they on any types of drugs that sometimes can also trigger heartburn or uncover something that is associated with heartburn, such as increased acid production Was it related to exertion Was it associated with some nausea or difficulty swallowing Did it happen after meals If it is associated with a meal or as nausea, then more likely or not one is dealing with a condition that.
Originates in the stomach and esophagus were acid is regurgitating, refluxing into the esophagus. So, depending on the age of the patient, they are ways to approach these dietary changes. If someone is young there is no exercise component to it and it goes away quickly. You can treat it with antacids, overthecounter agents such as H2 blockers. There are also something called PPIs, which you could buy over the counter and I could list the names but I am not a proponent of any commercial names but just for example Zantac, Prilosec, Pepcid.
And so on. There are so many out there overthecounter. If the symptoms do not improve or they are persistent and they go more than a few weeks or associated with these red flags as I said before such as difficulty swallowing, persistent vomiting, severe chest pain, the physician must evaluate the patient further or if the patient does not have a physician he or she must see their doctor. Now, who do we evaluate heartburn We do your history in some areas or centers or doctors’ offices, you can do an xray to see if there is evidence of reflux or a barrier back into.
The esophagus. If someone is over 50, that is a warning sign because as we get older and if we have had some so called subclinical reflux for a while their conditions, it could be premalignant that should be evaluated, something called Barrett’s, which is a tissue in the lining of the esophagus, it can be premalignant. So that patient needs to be evaluate further with an endoscopy, that means a camera to look at the lining of the esophagus, take samples and see if there is anything else other than just some mild acid going back.
Into the esophagus or mouth. Now to be definitive, one has to measure acid production. How much acid is going back into the esophagus, refluxing Now a test that accomplish that is something called capsule bravo technique in which you can place a little capsule in the esophagus, send the patient home with a recorder for two days or so and determine how much acid goes back from the esophagus. There are other ways to do it with something called impedance, which is somewhat invasive as a capsule but these are more definitive testing whereby the physician can quantify.
How much acid, how many hours a day, what else occurs of that type and therefore give the physician a more specific evaluation. When an endoscopy is done, samples are taken to look at the tissue under microscope. If the tissue has been injured by reflux, there will be changes there to support that. Now it is important therefore to differentiate heartburn due to reflux from heartburn associated with chest pain of cardiac origin, so it is nonGI chest pain. The cardiologist usually likes to say noncardiac chest pain but in someone who is their 50s or so with risk factors.