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Saturday, January 21, 2012

If Symptoms Persist...

Heart Burn
If Symptoms Persist...
By DR. JOSE S. PUJALTE JR.

“He sows hurry and reaps indigestion.” — Robert Louis Stevenson (1850-1894), Scottish novelist, Virginibus Puerisque, “An Apology for Idlers” (1881)

MANILA, Philippines — There are things to be said about eating, just about the remaining Epicurean pleasure around since orgies were outlawed. Eating can be un-pleasurable when done in excess, in haste, and in lieu of better things to do. All these can lead to heartburn.

If you have a stomach for the unsavory part of eating, or should we say overeating, then this is food for thought. Heartburn is the burning sensation behind the breastbone or sternum usually felt after a heavy, fatty meal. In addition, a sour taste may fill the mouth after the regulation burp (gastro-esophageal reflux). In this case, stomach acid or even bile salts back up into the food pipe. This is definitely NOT the taste of that Batangus beef.

How it happens. Eating shouldn’t be a problem if food made its journey in one direction. But for some reason, in heartburn, food and digestive juices regurgitate. The main cause is abnormal relaxation of the constricting muscle at the end of the food pipe (the lower esophageal sphincter or LES). The only time the LES normally relaxes is when food and liquid pass through. What can cause reflux? Large, fat-laden meals, lying down after eating, chocolate, caffeine, onions, spicy food, alcohol, and tranquilizers.

Risk factors. In addition, certain conditions which affect digestion also give heartburn. In obesity, the extra weight pushes on the stomach and puts pressure on the sphincter to open up. In pregnancy, the extra weight factor is compounded by progesterone, a hormone that relaxes muscles, including the LES. Diabetes may cause delayed emptying of stomach contents, increasing the chances of reflux. In peptic ulcer, any wound near the valve (pylorus) between the stomach and small intestine can delay food emptying as well.

Signs & symptoms. The discomfort of heartburn may be associated with:
Dysphagia or difficulty in swallowing.
Coughing.
Regurgitated blood.
Black stool – may mean bleeding in the gastro-intestinal tract.

It must be stressed that heartburn pain can be confused with (and, therefore, taken lightly) angina or the chest pain of heart-related problems. Classic angina is epigastric (at the pit of the stomach) or left-sided chest pain. When in doubt, it will help to consider what’s catastrophic (an impending heart attack).

Diagnosis. Heartburn is as common as cough and colds. It’s no wonder we self-medicate to some extent with over-the-counter antacids. However, unresolving and more frequent episodes of heartburn should be a cause for concern. See a family medicine practitioner or the specialist in the field – the gastroenterologist. Some tests include: 1) barium X-ray in which the silhouette of the food tract will reveal abnormalities, including narrowing of the esophagus or growths; 2) endoscopy – a fiberoptic tube slid down the throat visualizes directly the possible causes of heartburn such as inflammation or ulceration of the food pipe, stomach, or small intestine.

Treatment. The occasional heartburn responds to over-the-counter antacids. These work by neutralizing stomach acid. H2 receptor-blockers,on the other hand, reduce the production of acid. Proton pump inhibitors such as omeprazole and esomeprazole are known to also decrease gastric acid production. Surgical and non-surgical procedures are resorted to for chronic cases. If there is narrowing (stricture) of the esophagus, endoscopic dilation widens it through an inflatable balloon. In fundoplication, part of the stomach is wrapped around the esophagus to help in sphincter control.

Heartburn, in the end, may just be a warning of abuse.


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