Job Osazuwa
Mr. Ekene Ifesinachi is always afraid to eat. Most times when he eats, he begins to feel a burning sensation, which is followed by discomfort that usually lasts up to an hour or more.
He has been taking different drugs he purchased from a chemist, but the pain only subsides immediately after taking the self-prescribed drugs, to resurface after sometime, even more hurting. He continued on the routine for some months until he was diagnosed of heartburn at a government-owned hospital.
Experts have said that when you have a burning feeling in your chest just behind your breastbone that starts after you might have finished eating, it might be heartburn. They explained that the symptoms could last from a few minutes to several hours.
Heartburn, also referred to acid indigestion, begins when stomach acid splashes up into your oesophagus – a tube that connects the back of your throat and stomach. Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own with lifestyle changes and over-the-counter medications, but the remedy is proper medical attention.
On what heartburn feels like, a family physician, who practises at a private hospital in Lagos, Funmilayo Fapohunda, said: “If you have got a burning feeling in your chest just behind your breastbone, that starts after you have eaten, that is likely to be heartburn. However, it might not be all burning feelings that should be concluded to be heartburn. The disease symptoms could last from a few minutes to several hours.
“Heartburn begins when stomach acid splashes up into your oesophagus. Oesophagus is a tube that connects the back of your throat and stomach. Besides the burning feeling in your chest, you may also get chest pain, especially after you bend over, lie down, or eat; burning at the back of your throat and fluid at the back of your throat that tastes hot, sour, acidic, or salty. Another thing that might suggest that one is suffering from the ailment is long-term cough, sore throat, or hoarseness.”
In order to avoid misdiagnosis, the physician advised Nigerians to consult a doctor and run appropriate tests on any of the symptoms.
She said in the course of the special tests, it will be discovered how severe the problem is or for the patient to keep an eye on his or her treatment.
Explaining the difference between heartburn and heart attack, she said, often, the pain from a heart attack and a severe heartburn episode could be so hard to tell apart, and insisted that doctors need sophisticated tests to figure out what exactly the problem is.
“Over the years, it has been discovered that chest pain is one of the most common reasons to go to the emergency room. While many of these people are having a heart attack, some folks may have severe heartburn. It becomes a bit tricky or somehow complicated because heartburn and heart attacks have many of the same symptoms and happen in similar types of people, such as those who are older or overweight,” Fapohunda said.
The medical doctor said the ailment was treatable and could hardly pose any threat to life, except in some instances.
When in doubt of what you might be passing through, especially if one has pain in the chest that has refused to go away and one is not sure whether it is heartburn or a heart attack, she said there is the need to seek the help of an expert.
Fapohunda said if anyone was experiencing any pain that lasts for more than a few minutes or any warning signs of a heart attack, he or she should get medical help right away.
Signs of heartburn
According to a highly rated health journal, Healthwise Unlimited, apart from you having a sharp, burning feeling below your breastbone or ribs, the chest pain can be accompanied by an acidic taste in your mouth, regurgitation of food, or a burning in your throat.
The pain generally does not spread to the patient’s shoulders, neck or arms, but it can, in a few individuals. Pain usually comes after meals, particularly after foods or drinks that trigger reflux in you. The ache also appears when you lie down or exercise on a full stomach. Symptoms usually get better quickly after taking an antacid.
The journal also revealed that one rarely gets a cold sweat or shortness of breath along with the patient’s other symptoms. There could be difficulty swallowing, persistent nausea or vomiting and weight loss because of poor appetite or difficulty eating
The health journal stated: “But don’t forget, the symptoms of heart attack and heartburn can sometimes go away after a while. So always call your doctor if you have pain in your chest and you are not sure why – even if it stops.
“Also, seek the help of an expert if you have symptoms that are more typical of a heart attack or angina (severe chest pain from heart problems), such as: feeling of fullness, tightness or dull pressure or pain generally in the centre of your chest. Others are feeling like a belt is being tightened around your chest, pain that comes on with exercise, and is relieved by rest; sudden chest pain or pressure that gets worse and dizziness or light-headedness.
“There could also be pain that spreads to your shoulders, neck, jaw, or arms; pain that gets better quickly after taking nitroglycerin; shortness of breath and cold sweat along with other symptoms.”
Causes
Heartburn occurs when stomach acid backs up into the tube that carries food from your mouth to your stomach (oesophagus). Normally, when you swallow, a band of muscle around the bottom of your oesophagus (lower oesophageal sphincter) relaxes to allow food and liquid to flow down into your stomach. Then the muscle tightens again.
If the lower oesophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your oesophagus (acid reflux) and cause heartburn. The acid backup may be worse when the affected person bends over or lying down.
Risk factors
Certain foods and drinks can trigger heartburn in some people. They include: spicy foods, onions, citrus products, tomato products, such as ketchup, fatty or fried foods, peppermint and chocolate.
Alcohol, carbonated beverages, coffee or other caffeinated beverages, large or fatty meals and being overweight or pregnant also can increase your risk of experiencing heartburn.
Complications
Heartburn that occurs frequently and interferes with your routine is considered gastro-oesophageal reflux disease (GERD). Its treatment may require prescription medications and, occasionally, surgery or other procedures.
GERD can seriously damage your oesophagus or lead to precancerous changes in the oesophagus called Barrett’s oesophagus.
Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD. Doctors believe that some people suffer from this type of ailment due to a condition called hiatal hernia. In most cases, GERD can be relieved through diet and lifestyle changes; however, some people may require medication or surgery.
For more understanding, gastro-oesophageal refers to the stomach and oesophagus, while reflux means to flow back or return. Therefore, gastro-oesophageal reflux is the return of the stomach’s contents back up into the oesophagus.
In normal digestion, the lower oesophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the oesophagus. Gastro-oesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach’s contents to flow up into the oesophagus.
Researches have revealed that the severity of GERD depends on LES dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralising effect of saliva.
Some doctors believe a hiatal hernia may weaken the LES and increase the risk for gastro-oesophageal reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the abdomen from the chest.
Recent studies show that the opening in the diaphragm helps support the lower end of the oesophagus. Many people with a hiatal hernia will not have problems with heartburn or reflux. But having a hiatal hernia may allow stomach contents to reflux more easily into the oesophagus.
It has been discovered that coughing, vomiting, straining or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.
Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply) or is complicated by severe GERD or oesophagitis (inflammation of the oesophagus). The doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.
Treatment for GERD
Doctors recommend lifestyle and dietary changes for most people needing treatment for GERD. Treatment is aimed at decreasing the amount of reflux or reducing damage to the lining of the oesophagus from refluxed materials.
Avoiding foods and beverages that can weaken the LES is often recommended. These foods include chocolate, peppermint, fatty foods, coffee, cigarettes and alcoholic beverages. Foods and beverages that can irritate a damaged oesophageal lining, such as citrus fruits and juices, tomato products, and pepper, should also be avoided if they cause symptoms.
Decreasing the size of portions at mealtime may also help control symptoms. Eating meals at least two to three hours before bedtime may lessen reflux by allowing the acid in the stomach to decrease and the stomach to empty partially. In addition, being overweight often worsens symptoms. Many overweight people find relief when they lose weight.
Elevating the head of the bed on six-inch blocks or sleeping on a specially designed wedge reduces heartburn by allowing gravity to minimise reflux of stomach contents into the oesophagus. Do not use pillows to prop yourself up; that only increases pressure on the stomach.
Along with lifestyle and diet changes, your doctor may recommend over-the-counter or prescription treatments. Antacids can help neutralise acid in the oesophagus and stomach and stop heartburn. Many people find that non-prescription antacids provide temporary or partial relief. An antacid combined with a foaming agent helps some people. These compounds are believed to form a foam barrier on top of the stomach that prevents acid reflux from occurring.
Meanwhile, there is a warning that long-term use of antacids can result in side effects, including diarrhoea, altered calcium metabolism (a change in the way the body breaks down and uses calcium) and build-up of magnesium in the body. Too much magnesium can be serious for patients with kidney disease.
If antacids are needed for more than two weeks, a doctor should be consulted.
For chronic reflux and heartburn, the doctor may recommend medications to reduce acid in the stomach. These medicines include H2 blockers, which inhibit acid secretion in the stomach.