Gastroenterology - Heartburn and Hiatus Hernia

What is Heartburn?

Heartburn is a pain behind the breastbone, often described as ‘burning’. Pain can also be felt at the same level in the middle of the back. Most people suffer from heartburn at one time or another in their lives. Heartburn has nothing to do with the heart. It is a digestive problem. Heartburn is generally related to meals and posture and can often be relieved by remedies for indigestion.

Pain from the heart is also felt in the chest and sometimes in the upper abdomen. There are two kinds of heart pain. The first, angina, is a pain in the chest. This is due to a temporary shortage of oxygen being carried in the blood to the heart muscle. Angina should be suspected if the chest pain is brought on by exercise and eases when resting. The second is a heart attack. This pain is more severe and prolonged. A heart attack should be suspected if the pain is felt mainly in the centre of the chest, spreading perhaps to one or both arms (especially the left) and into the lower jaw. It can also been described as a heavy pressure or ‘vice like’

Do not ignore any heart pain believing it to be heartburn. This confusion could lead to a serious situation.

If you think you may be having a heart attack, it is vital you go to the nearest hospital emergency department anywhere in the world, without delay.

What causes heartburn?

Acid is always present in the stomach to digest food. Heartburn occurs when small amounts of this acid rise into the gullet (oesophagus). This is called reflux.

The gullet, unlike the stomach, does not have a protective lining against acid. Therefore, when it’s exposed to the acid, it can become inflamed and painful.

Why doesn’t everyone get heartburn?

There is a muscle at the bottom of the gullet, which acts as a barrier keeping the acid in the stomach. If this muscle doesn’t work properly, reflux occurs. Some known factors which lead to heartburn include:

• Eating large meals, especially near bedtime
• Drinks that contain caffeine, e.g. coffee, tea and coca cola
• Fatty foods and chocolate
• Being overweight
• Bending a lot
• Wearing tight clothing around the waist
• Alcohol
• Smoking
• Pregnancy

In most of these cases, it is the increased pressure around the stomach, which causes heartburn. Coffee and smoking on the other hand, relax the muscle around the gullet, which also causes heartburn.

What is a hiatus hernia?

A sheet of muscle (called the diaphragm) separates the stomach from the chest. If a small part of the stomach rises into the hiatus (opening where the gullet passes through the diaphram), then this is called a hiatus hernia.

Many people who suffer from frequent heartburn have a hiatus hernia. However, not everyone with a hiatus hernia suffers from heartburn.

What complications can occur?

If acid reflux leads to inflammation (osesophagitis), then the gullet can become scarred and narrowed. If this remains untreated for many years it can lead to other serious conditions, for example cancer. You may experience difficulty in swallowing, especially lumpy foods. If you have difficulty in swallowing, you should consult a doctor.

How can I avoid heartburn?

Helping yourself by avoiding the foods you know bring on your heartburn is the best way to avoid it.

Avoid becoming overweight

For many patients, weight reduction is the most important remedy. Therefore, it is worthwhile trying to improve your eating habits.

Diet

You may find particular foods and drinks can make your symptoms worse. These might include acid fruit drinks; hot drinks; spirits e.g. whisky or brandy and any fatty and spicy meals. These should obviously be avoided. It is better to eat little and often, and avoid large meals.

Foods should be eaten slowly and chewed well.

Sleeping

Let your evening meal digest well before you go to bed. Nightime symptoms can also be reduced by raising the head of the bed by 6 to 12 inches. This can be done using pillows. Gravity helps to keep acid in the stomach.

Posture

Avoid bending from the waist or stooping just after meals. Instead, try and bend from the knees, keeping the back straight. Meals are better taken whilst sitting on an upright chair, rather than slumped in front of the television.

Clothing

Avoid tight belts and underclothes as they increase pressure on the stomach.

Stop Smoking

Smoking after a meal when your stomach is full increases the chance of heartburn.

Pregnancy

It is common for pregnant women to suffer from heartburn. This is due to abdominal pressure from the baby. Try to keep your weight increase within the recommended limits.

What medical treatment is available?

Many people who suffer from occasional heartburn take antacids either in tablet or liquid form, which are available from the pharmacist.

Some antacid preparations relive symptoms by forming a layer on top of the stomach contents.

If you have to take these medicines regularly or you don’t get any relief, it is best to visit your GP. They can then decide whether tests are needed to find the cause of the problem.

Your doctor can also prescribe stronger medicine, which will reduce or prevent the production of acid in the stomach. This allows the inflamed gullet to heal.