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  • Heartburn - Causes, symptoms and treatment. MF.

    Heartburn is an unpleasant burning sensation in the area behind the sternum and in the upper abdomen. So determine her patients. Anatomically, this region corresponds to the esophagus. Heartburn occurs when unnatural stuffing of stomach contents into the esophagus and into the mouth and causes severe burning of the esophagus and mouth cavity, which, unlike the stomach, do not have protection from gastric juice.

    Digestive tract

    Causes of heartburn

    If you dig a little deeper into the anatomy, we will see that our digestive tract is nothing but a tube. On its length this tube narrows and expands. In order for food to move along it in the right direction, there is a system of targeted muscular movements( peristalsis) and a system of "valves"( sphincters).Sphincters are bundles of muscle fibers located circularly and bounded from both sides of the chamber of the Gastrointestinal tract, united by one function. So in the lower part of the esophagus, in the place of its passage through the diaphragm and the transition to the stomach, there is a sphincter separating the stomach cavity and esophagus, called cardia. In turn, the transition of the stomach into the duodenum also has a border in the form of circular muscles of the terminal section of the stomach-pylorus. Function of the gastrointestinal tract - in the delivery of nutrients to the body in the form in which it can use them. For this, food that comes from outside is crushed physically and chemically. And a big part in this is the stomach. Its walls are so arranged that the substances they produce easily disintegrate various products without harming themselves. The walls of the esophagus do not have such protection. Therefore, if the contents of the stomach hit the esophagus walls, the enzymes of the stomach have a damaging effect on them. At this moment a person feels a burning pain.

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    Defining the main causes of heartburn, let's say a word and about the sensitivity of the esophagus to various irritants. It is individual for each person and depends on the characteristics of his psyche and nervous system. Sensitivity is aggravated in most of us against the background of acute and chronic stressful situations.

    Most of the adults experienced heartburn at least once in their life. And, of course, they consider themselves to be healthy people. And there is. Everyone can face heartburn if they are prone to overeating, eating too much hot, fatty, fried smoked food. The same provoking factor can be alcohol and some vegetables( tomato, radish, radish) and fruits( apples, lemons, plums, rhubarb, sorrel).The casting of gastric contents into the esophagus is facilitated by all situations in which intra-abdominal pressure increases, such as weight lifting, constipation and flatulence.

    Heartburn during pregnancy

    Separately it is necessary to talk about heartburn in pregnant women. It quite often worries expectant mothers, especially in later terms. The fact is that there is a sum of several predisposing factors: increased intra-abdominal pressure due to the increased uterus, an increase in the hormone level of pregnancy-progesterone, which has a relaxing effect on all smooth muscles, and they are the basis of sphincters.

    So, if any of you suddenly felt unpleasant feelings similar to heartburn and it happened: a) once, b) after the error in the diet c) stopped quickly enough d) did not have other accompanying symptoms - that means you just need more regularand rationally eat.

    Diseases that cause heartburn

    But, it would seem, such an innocuous thing as heartburn can become a sign of another, more serious disease.

    In what diseases arises heartburn:

    - Peptic ulcer of the stomach and duodenum
    - Gastritis
    - Chronic pancreotitis
    - Chronic cholecystitis
    - Disceases of biliary tract
    - Gallstone disease
    - Insufficiency of esophageal sphincter
    - Reflux gastroesophageal disease
    - Cancerstomach
    - Pancreatic cancer
    - Poisoning

    Most often these are diseases such as gastroesophageal reflux disease( GERD), hiatal hernia aperture( GAPD), gStreet( often with increased secretion), peptic ulcer and \ or duodenal ulcer, chronic cholecystitis. I think we should talk about each separately.

    GERD - a disease that occurs due to the casting of aggressive stomach contents into the esophagus. It is not difficult to guess that the main symptom of it is just heartburn. At the site of contact on the wall of the esophagus appears the area of ​​inflammation, and then ulceration. This is reflux esophagitis. The reason is the insufficient closeness of the lower esophageal sphincter( cardia).It is worth saying that the intensity of heartburn is not always comparable with the depth of the esophageal wall. That is, if the patient indicates an almost intolerable burning sensation, then the lesion of the wall in him may be scarcely begun. But even minor pain can indicate a deep defeat.

    Hernia of the esophageal opening of the diaphragm is also manifested by heartburn due to insufficient closure of the cardia. With this disease, the opening in the diaphragm intended for passage of the esophagus widens. It can increase so much that it can pass through itself and some other organs from the abdominal cavity. Most often such an organ becomes the stomach. The cause of hiatus is the weakening of the muscle of the diaphragm in total with a regular increase in intra-abdominal pressure. Heartburn with a hernia of the esophageal opening of the diaphragm appears suddenly, more often with inclinations, in a horizontal position. Pain can be irradiated to the back or region of the heart. It is also characteristic that the pain passes by itself when the patient takes an upright position.

    Diaphragmatic hernia

    Hyperacid gastritis( with increased secretion).Heartburn for this disease occurs due to increased formation of hydrochloric acid. Most often this happens as a compensatory reaction to an excess of food or the regular use of indigestible food. The organism adapts itself to new conditions, increases the production of digestive enzymes. But in the event that the amount of food decreases or goes there irregularly, and the production of enzymes remains at the same high level, their excess can enter the esophagus, causing heartburn. Similarly, an increased amount of gastric juice does not pass without a trace for the stomach itself, causing inflammation and the formation of erosion in its wall. Heartburn in this case is combined with pain in epigastrium( upper third of the abdomen) immediately after eating.

    A peptic ulcer like the stomach and duodenum also has heartburn as a symptom. There are also complaints about nausea, vomiting, pain in the upper third of the abdomen( both on the right and on the left, depending on the location of the ulcer).It can be absolutely asymptomatic. In such patients, in most cases there is an increased acidity of the gastric juice. Under these conditions, short small episodes of casting it through the cardiac sphincter, which are the norm, cause a significant damaging effect on the mucosa of the esophagus. Also, with peptic ulcer there is a defect of the mucous membrane( ulcer) of the stomach or duodenum. This leads to a violation of the contractions of the stomach, which contribute to the normal withdrawal of a partially digested digestive lump from the stomach into the intestine. The delay in food in the stomach leads to overstretching of the stomach and increasing the pressure in it. This aggravates reflux. An increase in reflux for the same reason may occur when the outlet of the stomach is narrowed. Stenosis of the gatekeeper is a complication of peptic ulcer and is caused by the formation on the site of a ulcerative defect of the pyloric wall( outlet stomach) of the scar, narrowing the lumen of the sphincter.

    Disease of the operated stomach develops as a result of removal of a part of the stomach and duodenum during surgical treatment of peptic ulcer or gastric cancer. In this case, the juice containing the enzymes of the pancreas and liver is thrown into the esophagus. They also have a damaging effect on the mucous membrane.

    With chronic cholecystitis, heartburn is combined with pain under the right rib in the region of the liver, sometimes feeding into the right scapula. They appear after eating fatty foods or jolting the ride.

    It should also be said about diseases in which other organs are primarily affected, and the esophagus is affected indirectly. These are the so-called systemic diseases of connective tissue. With these diseases, chronic inflammation of the muscles of various organs, including the esophagus, and the replacement of their connective tissue occurs. In this case, the lower esophageal sphincter can not fully contract and cover the entrance to the stomach. In addition, these diseases are characterized by dry mucous membranes, which reduces the protection from damaging agents from the outside. The vessels are also damaged, the blood flow to the damaged areas is reduced, and the process of repair of the damaged mucosa of the esophagus is slowed.

    Examination for heartburn

    So, if you have heartburn, which periodically but regularly worries a person, you naturally need to see a doctor. These diseases are in the competence of a physician, general practitioner and gastroenterologist. After additional examination at the doctor's discretion, additional consultations of a rheumatologist, dentist and psychotherapist are possible.

    What are the methods of examination in the arsenal of a modern doctor? First of all, it is FibroEzofagoGastroDuodeno copy. This is a visual examination in which the organs of the upper gastrointestinal tract can be examined by means of an optical fiber in the order indicated in the name of the procedure. That is, the esophagus, stomach, duodenum is examined. After the examination, the doctor will know if there are any changes on the walls of the esophagus, and what diseases could cause anxiety. Also, it is possible to determine acidity in the stomach( pH-measure), to take suspicious particles from the surface of the mucous membrane and to test for the detection of Helicobacter pylori( a bacterium that promotes the appearance of a peptic ulcer).If there is no possibility to conduct FEGDS, then such information can be obtained by radiography with contrasting suspension. In this case, the patient drinks the drug, and after getting into the stomach, make a series of X-rays from different points. But, firstly, the method is less informative, Secondly, it is associated with additional exposure of the patient, thirdly, it is impossible to obtain tissue samples for additional research. This significantly narrows the range of indications for the appointment of this method of examination.

    When reflux at night, when the patient is in a horizontal position, the casting of acidic contents can pass to the oral cavity, destroying the enamel of the teeth. Therefore, consultation and treatment in the dental office may be required.

    Treating Heartburn

    Did you feel heartburn? Make an appointment with a specialist and see what's in your medicine cabinet can help you.

    Good use of any alkaline( hydrocarbonate) mineral water, decoction( infusion) of flaxseed. Everyone knows about the good effect of a solution of soda, which is, by the way, very close to alkaline mineral water, only of greater concentration. But we do not recommend using soda as a regular help, because when it gets into the stomach, a lot of carbon dioxide is formed and the pressure inside the stomach sharply increases, which causes a second heartburn.

    Antacid groups are distinguished from medicines. These drugs are widely known and common. Everyone knows the names: Almagel, Fosfalugel, Maalox, Rennie. The mechanism of their action is based on the binding of salts of magnesium and aluminum hydrochloric acid in the stomach. A more modern group of drugs is alginates. These drugs do not simply bind hydrochloric acid, but also form a gel film on the surface of the mucous membrane, which protects the mucosa from further damaging agents. For long-term treatment, Proton Pump Inhibitors( PPI) are used. They block the production of hydrochloric acid in the walls of the stomach for a longer period of time.

    If the effect of the treatment prescribed and controlled by the doctor is insufficient, counseling of the therapist may be necessary to reduce the level of stressful alertness of the body as a whole.

    Heartburn Complications

    The danger of this symptom is in the case of a long absence of diagnosis and treatment of the diseases that caused it. At the site of inflammation of the mucous membrane with the continuation of the action of the damaging factor ulcer is formed. It can penetrate the entire thickness of the wall and cause a violation of its integrity. The scar formed on the site of the healed ulcer can narrow the lumen of the esophagus and make it difficult to pass food through it. This is treated only through surgery. Therefore, heartburn can not be underestimated. Address to the doctor and are treated on time.

    To which doctors to contact if Heartburn occurs:

    - Therapist
    - Gastroenterologist