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Heartburn

What do doctors call this condition?

Gastroesophageal reflux

What is this condition?

Heartburn - a burning sensation in the throat or chest - is caused by a backflow of stomach or upper intestinal contents, or both, into the esophagus. Even without belching or vomiting, stomach acid can reflux into the esophagus. Mild cases, which produce few or no lasting symptoms or effects, can be remedied with an antacid or a change in diet. However, persistent heartburn can lead to esophagitis (inflammation of the throat lining).

What causes it?

Normally, constrictive pressure in the lower esophageal sphincter prevents stomach acid from flowing into the esophagus. If this pressure is weak, stomach acid can flow back into the esophagus. Unfortunately, a person with heartburn can't swallow often enough to clear stomach acid from the lower esophagus and acid can remain in the esophagus for prolonged periods.

The following conditions increase your likelihood of experiencing heartburn:

.  surgery on the pylorus (the valve at the bottom of the stomach)

. a hospital stay of 4 or 5 days with tubes running through the nose to the stomach

.  diet and drugs that decrease lower esophageal sphincter pressure

.  hiatal hernia (especially in children)

.  any condition or position that increases abdominal pressure.

What are its symptoms?

Heartburn may worsen with vigorous exercise, bending, or lying down, and may be relieved by antacids or sitting upright. Sometimes heartburn is accompanied by painful swallowing followed by a dull chest ache. Occasionally, throat pain and spasms develop. If they become chronic, they may mimic symptoms of angina in the neck, jaws, and arms.

If inhaled, the stomach acid can cause respiratory problems such as chronic pulmonary disease, nighttime wheezing, bronchitis, asthma, morning hoarseness, or chronic cough. In children, severe symptoms can include slow development, forceful vomiting, or aspiration pneumonia.

How is it diagnosed?

After asking about symptoms, the doctor will visually inspect the throat lining for problems, often using a special scope. If further information is needed, a barium swallow X-ray may be ordered. In children, X-rays can detect the backup.

How is it treated?

The doctor will suggest positions, especially for sleeping, that help keep stomach acid out of the esophagus and may prescribe drugs to strengthen the lower esophageal sphincter, neutralize stomach acid and reduce abdominal pressure. Often, simply staying upright and taking antacids is enough to resolve mild cases of heartburn.

Surgery may be necessary to address serious, recurrent conditions such as inhaling stomach acid, bleeding, obstruction, severe pain, perforation, incompetent esophageal sphincter, or hiatal hernia caused by the backup.

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