The reality about heartburn

Author: Jose Maria M. Villarama II

Whenever they dine out, friends cannot help but notice how adventurous Rowena is when it comes to food choices. When in a restaurant for the first time, she usually stays away from the safe or typical dishes and always orders the exotic. When choices are limited or when there is nothing out of the ordinary, she would order the hottest or spiciest item on the menu, which no one dares to taste or share with her. Rowena explains that foods that are not spicy are boring. She recounts that at age 3, her parents already exposed her to chili and spices; that is why she has acquired and loved the taste since then. But one experience changed all this for Rowena. As she was downing an extremely spicy Szechuan chicken dish one night, Rowena started feeling warm midway between her stomach and throat, as if something was burning her insides. After drinking a glass of water, she belched and regurgitated what she described to be something “spicy and acidic.” A check-up with a doctor revealed that she was experiencing heartburn and was drawing up stomach acid because of too many spices in the food she ate.

Heartburn: A Misnomer

The use of the term “heartburn” to refer to Rowena’s case is actually misleading. After all, the burning pain that she felt in her chest isn’t a cardiac event, even if it can be felt on the chest, jaw, arms or back and can be mistaken for symptoms of a heart attack. That is why when one experiences these symptoms, it is best to immediately go to the doctor to rule out a heart attack.
Heartburn actually takes place along the digestive tract, the stretch from the stomach climbing up to the throat. It usually takes place 30-60 minutes after starting a meal. What is actually causing the burning sensation is gastric acid that escapes or refluxes from the stomach into the esophagus. This happens when the sphincter or “gate valve” between the stomach and esophagus, which opens and closes during food digestion, fails to close completely. The refluxed stomach acid can irritate the thin or sensitive esophageal lining, causing what is loosely described as “heartburn.” The more accurate term is gastric or acid reflux. It is also sometimes referred to as acid indigestion.

Reasons for Reflux

In general, the loosening of the valve, known as the cardiac sphincter, by virtue of its proximity to the heart, is the main reason for acid reflux. Many factors can aggravate the passage of gastric acid into the esophagus. They are the following:
  1. Overeating – downing too much food at an accelerated rate may not give the stomach enough time to digest the food and move it down to the intestines, causing the stomach to bloat or overflow and push the food (and acid) up and against the cardiac sphincter. Following this same train of thought, overweight or obese individuals are likely or are more prone to suffer from acid reflux, because of their overstretched stomach muscles and possibly the compromised integrity of their cardiac or esophageal sphincters.
  2. Lying down immediately after eating – although stomach muscles contract and function to move digested food down the alimentary tract, it seems logical that the mere act of lying down, especially with a weakened valve, won’t help as this obviously defies the law of gravity. Similarly, anything that causes pressure on the esophageal sphincter can push stomach acid upward. These include lifting, straining, coughing, wearing tight clothing and even pregnancy.
  3. Certain Food and Beverages – some food items either loosen the cardiac sphincter or increase the production of gastric acid that may flow back into an already loose sphincter. These include caffeine-rich beverages like coffee and tea, carbonated beverages, citrus juices, vinegar, and alcohol. Tomato-based sauces, chocolates, mints, fatty or spicy food like curry, chili, garlic & onions, among other things, are also culprits.
  4. Certain drugs – blood thinners like aspirin, pain killers like ibuprofen, as well as sedatives and medication for hypertension and asthma irritate the esophageal lining or loosen the sphincter and thus aggravate heartburn. Cigarette smoking does this as well.
  5. Stress – any condition that causes strain to the mind and body, such as taking examinations, performing on stage, competing, having arguments or relationship problems, and the like, can increase the production of acid in the stomach and contribute to the worsening of acid reflux. Notice how the stomach contents seem to boil under these circumstances.

Relieving Reflux

Immediate remedies to acid reflux that usually have an instantaneous or quick effect include standing upright, swallowing water or saliva or taking antacids (preferably liquid variants) whose active ingredient is calcium carbonate. Other remedies that may take time but may alleviate any pain and discomfort in the long term are:
  1. Lifestyle changes – if the problem stems from being overweight or obese, or if one is eating or drinking too much of the known heartburn triggers, reducing intake, modifying one’s diet and losing weight are the only remedies to the problem. These include eating smaller meals, avoiding suspect food and beverages, and refraining from stressful activities after eating. Avoid lying down within 3 hours after a meal. If one suffers from night time reflux, elevating the head by propping up more pillows is advisable. Avoiding alcohol and tobacco will also help. Aside from eliminating the incidence of heartburn, losing weight and modifying the diet & lifestyle will also cut the risk of developing other diseases.
  2. Acid Blockers – luckily, medications are now available in the market that can be prescribed to keep acid secretion at bay. Acid blockers provide more long-term relief than antacids. A class of acid blockers called histamine-2 or H2 blockers decrease the amount of acid the stomach produces. They provide relief of symptoms within 30 minutes and are usually taken twice a day. Some examples of these drugs include cimetidine, ranitidine and famotidine. Another class of acid blockers are the proton pump inhibitors. Proton pump inhibitors, such as omeprazole, lansoprazole, esomeprazole, and pantoprazole meanwhile prevent the stomach from secreting acid. Taken once a day, usually before breakfast, they are prescribed as the last option if other drugs do not work.
  3. Other drugs – if acid blockers do not work, another class of drugs can be used to alleviate heartburn symptoms. For example, metoclopramide hastens the movement of food and acid out of the stomach (into the intestines) so that less acid can flow back to the esophagus. It also tightens the cardiac sphincter.
  4. Surgery – If all else fail, surgery might be the only hope. A procedure called fundoplication is performed to tighten the sphincter muscle. The stomach is tied to prevent acid from flowing backward into the esophagus. At least 80 percent of patients who have undergone this procedure report a 100% success rate.

Intervention

As advised many times before in most of the articles written in Health.Care, prevention is still the best remedy for any disease. Simple modifications to lifestyle, diet and physical activities do more wonders than all the medicine and surgery that science and technology can provide. Knowing when to stop eating or what to change in one’s habits can be determined, not by any doctor or specialist, but by the one who owns the body. In short, know your body, love your body, and get to live longer.

 

 

This material is copyrighted. Printed with permission from Medicomm Pacific, Inc., publisher of Health.Care magazine and www.TheFilipinoDoctor.com

Did you know?

  • 73% of people will suffer from both heartburn and indigestion interchangeably.
  • 1 in 5 people suffering from heartburn may experience symptoms every week.