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Heartburn

life science Maturity 7-9 Next article →

Heartburn is a painful, burning sensation felt behind the sternum, which is the medical term for the breastbone.

Sternum front
Sternum front

This sensation often travels upward toward the throat. It can also be accompanied by an acidic or bitter taste in the mouth. Many people refer to this feeling as indigestion, sour stomach, or acid regurgitation. It is a very common occurrence in human health. Studies show that 25% of the population experiences heartburn at least once every month. It frequently occurs within one hour after eating, particularly following a large meal.

While many people associate heartburn solely with acid reflux, the underlying mechanisms are complex. Acid reflux occurs when stomach contents move upward into the esophagus. In cases of gastroesophageal reflux disease (GERD), the esophageal lining can suffer physical damage. One early sign is the development of dilated intercellular spaces.

Esophagus - moderate GERD, intermed. mag
Esophagus - moderate GERD, intermed. mag

These are tiny gaps in the lining that weaken the protective barrier. When this barrier fails, acid seeps in and irritates pain-sensitive nerves. These nerves then send signals to the brain to create the sensation of burning.

There are several different types of reflux that can trigger these symptoms. Reflux can be classified by its pH level, which measures how acidic a substance is. Acidic reflux has a pH of less than 4. Weakly acidic reflux falls between a pH of 4 and 7. Non-acidic reflux has a pH greater than 7. Interestingly, about 15% of heartburn cases involve weakly acidic reflux. Even when patients take proton-pump inhibitors (PPIs), 17% to 37% of cases may still be linked to non-acidic reflux. Other substances, such as bile acid, can also cause irritation by damaging cell membranes.

Beyond chemical irritation, mechanical factors can play a significant role. Mechanical stimulation involves physical pressure acting on the esophagus. For example, esophageal balloon distension can trigger heartburn symptoms. The upper esophagus may be more sensitive because it contains more pressure-sensitive receptors. Some people also experience esophageal hypersensitivity. In these individuals, the brain may process signals differently, a process called central sensitization. This means the person feels pain even when acid levels are normal. Stress and anxiety can also heighten this perception through brain mechanisms.

Doctors use several diagnostic tools to determine the exact cause of the pain. One common method is endoscopy, where a doctor uses a camera to look inside the esophagus and stomach.

Stomach endoscopy 3
Stomach endoscopy 3

This helps identify issues like erosive esophagitis or peptic ulcers.

Peptic ulcer
Peptic ulcer

Another tool is esophageal pH monitoring, which measures acid levels over time. To check for motility disorders, doctors use high-resolution esophageal manometry (HREM). This test examines how the muscles in the esophagus move. If a person has burning sensations but no signs of reflux or muscle issues, they may be diagnosed with functional heartburn.

Many different medical conditions can mimic the symptoms of heartburn. This process of distinguishing between similar disorders is called differential diagnosis. Doctors must rule out peptic ulcers, gastritis, or inflammation of the pancreas. They also look for more serious conditions like esophageal cancer or stomach cancer. Some people experience heartburn due to hiatal hernias or gallstones. Even certain medications, such as nonsteroidal anti-inflammatory drugs or corticosteroids, can cause these symptoms. Lifestyle factors like bending, lifting heavy objects, or lying on the right side can also trigger episodes.

Managing heartburn often begins with simple lifestyle adjustments. Avoiding fatty, heavy, or spicy foods can reduce the frequency of symptoms. Losing weight is also a helpful strategy. For mild or occasional cases, people often use over-the-counter antacids.

Antacid-L478
Antacid-L478

These compounds, such as calcium carbonate, work by neutralizing the acid already present. Alginates, which are extracted from seaweed, can be even more effective. For more persistent symptoms, doctors prescribe antisecretory medications. These include H2 receptor antagonists (H2RAs), which block histamine, and proton-pump inhibitors (PPIs), which block the enzyme that produces acid.

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🖼️ Images & Media (6)
File:Sternum front.png
Sternum front.png
File:Peptic ulcer.jpg
Peptic ulcer.jpg
File:Esophagus - moderate GERD, intermed. mag.jpg
Esophagus - moderate GERD, intermed. mag.jpg
File:Stomach endoscopy 3.jpg
Stomach endoscopy 3.jpg
File:Antacid-L478.jpg
Antacid-L478.jpg
File:Sedum acre single - Niitvälja.jpg
Sedum acre single - Niitvälja.jpg
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