Heartburn
A burning chest sensation often linked to acid reflux.
Heartburn is a burning sensation felt behind the breastbone, often rising to the throat and associated with an acidic taste. It is a common symptom linked to acid reflux and gastroesophageal reflux disease (GERD), affecting 25% of the population at least once a month. Heartburn can be triggered by food, lying down, bending, lifting, and certain exercises, and its causes include acid reflux, bile acid, mechanical stimulation, and esophageal hypersensitivity.
- Prevalence
- Affects 25% of the population at least once a month
- Common triggers
- Food, lying down, bending, lifting, certain exercises
- Primary causes
- Acid reflux, GERD, bile acid, mechanical stimulation, esophageal hypersensitivity
- Diagnostic methods
- Endoscopy, esophageal pH monitoring
- Treatments
- Lifestyle changes, antacids, alginates, H2RAs, PPIs
Lore & Background
Heartburn is a symptom characterized by a burning sensation behind the breastbone, which may spread to the neck, throat, or back. It is commonly triggered by food and tends to occur within an hour after eating, especially after a large meal. Lying down, particularly after eating, can worsen symptoms, and some individuals find symptoms more severe when lying on their right side. Nighttime heartburn can disrupt sleep, and activities that increase abdominal pressure, such as bending, lifting, or certain exercises, can also trigger symptoms. Stress and lack of sleep may heighten the perception of heartburn by increasing the body's sensitivity.
Reader's Guide
Heartburn is a significant symptom in clinical practice, as it is a primary indicator of gastroesophageal reflux disease (GERD) and other esophageal disorders. Its evaluation often involves endoscopy and esophageal pH monitoring, though GERD may be diagnosed based on symptoms alone. The differential diagnosis for heartburn is broad, including motility disorders, ulcers, esophagitis, and medication side effects, making careful assessment crucial. Treatment typically begins with lifestyle changes, such as weight loss and avoiding fatty foods, and over-the-counter alginates or antacids for mild cases. For persistent symptoms, antisecretory medications like H2 receptor antagonists and proton-pump inhibitors are used. Understanding heartburn's multifactorial causes—chemical irritation, mechanical stimulation, and esophageal hypersensitivity—guides effective management and helps differentiate it from conditions like functional heartburn, which requires specific diagnostic criteria.
Did You Know?
- A 1989 study found that acidic solutions induced heartburn in all participants, but basic solutions still caused heartburn in over 40%.
- When taking PPIs, 17–37% of heartburn cases are linked to non-acidic, usually weakly acidic, reflux.
- Functional heartburn is diagnosed when symptoms persist despite effective acid-suppressing treatment and no signs of GERD or esophageal motility disorders are found.
More in Symptoms and signs: Digestive system and abdomen 1-24
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