Heartburn



Image Overview


Heartburn and dyspepsia are common symptoms that originate in the upper gastrointestinal (GI) tract. Heartburn is a burning sensation that usually arises from the substernal area (lower chest) and moves up toward the neck or throat. Most patients experience episodic heartburn, which is typically mild, infrequent, and associated with diet or lifestyle. Some patients have frequent heartburn, which is heartburn that occurs ≥2 days per week.


Dyspepsia—literally “bad digestion”—is a consistent or recurrent discomfort located primarily in the upper abdomen (epigastrium). The discomfort is subjective and usually characterized by epigastric pain, burning, postprandial fullness, early satiety, or some combination of those symptoms.


Image Etiology


Image Heartburn



  • Heartburn arises from the sensory nerve endings in the esophageal epithelium and is most likely stimulated by certain foods or beverages or by the reflux of acidic gastric contents into the esophagus. The noxious quality of the refluxate is central to the development of symptoms, esophageal tissue damage, and complications.

    • Esophageal tissue damage is caused primarily by gastric acid, pepsin, and bile salts.
    • Most patients with heartburn do not secrete excessive amounts of gastric acid.
    • There is no direct correlation between heartburn severity and underlying esophageal injury.

  • Many patients with heartburn have transient relaxations of the lower esophageal sphincter. This sphincter serves as the primary antireflux barrier by preventing backflow of stomach contents upward into the esophagus.
  • Factors that contribute to heartburn include diet, lifestyle, medications, and certain diseases (see Table 1). However, evidence to support most of the proposed risk factors is limited.

TABLE 1. Factors That May Contribute to Heartburn


Dietary


Image Alcohol (ethanol)


Image Caffeinated beverages


Image Carbonated beverages


Image Chocolate


Image Citrus fruit or juices


Image Fatty foods


Image Garlic or onions


Image Mint (e.g., spearmint, peppermint)


Image Salt and salt substitutes


Image Spicy foods


Image Tomatoes/tomato juice


Lifestyle


Image Exercise


Image Obesity


Image Smoking (tobacco)


Image Stress


Image Supine body position


Image Tight-fitting clothing


Diseases


Image Motility disorders (e.g., gastroparesis)


Image Peptic ulcer disease


Image Scleroderma


Image Zollinger-Ellison syndrome


Medications


Image Alpha-adrenergic antagonists


Image Anticholinergic agents


Image Barbiturates


Image Benzodiazepines


Image Beta2-adrenergic agonists


Image Bisphosphonates


Image Calcium-channel blockers


Image Chemotherapy


Image Clindamycin


Image Dopamine


Image Doxycycline


Image Estrogen


Image Iron


Image Narcotic analgesics


Image Nitrates


Image Potassium


Image Progesterone


Image Prostaglandins


Image Quinidine


Image Tetracycline


Image Theophylline


Image Tricyclic antidepressants


Image Zidovudine


Other


Image Genetic factors


Image Pregnancy


Image Dyspepsia



  • The pathophysiology of dyspepsia remains unclear.

    • Acute, infrequent dyspepsia is associated with certain foods, caffeine, alcohol, tobacco use, and life stress.
    • Chronic dyspepsia may be associated with peptic ulcer disease, gastroesophageal reflux disease (GERD), gastric cancer, Helicobacter pylori infection, or GI dysmotility (e.g., delayed gastric emptying). It also may lack any identifiable cause.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and cyclooxygenase-2 inhibitors, are a very important cause of drug-induced dyspepsia.
  • Bisphosphonates, potassium or iron supplements, digoxin, theophylline, and certain antibiotics (e.g., erythromycin, tetracycline, and ampicillin) may precipitate dyspeptic symptoms.

Image Signs and Symptoms


Image Heartburn


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Feb 11, 2017 | Posted by in PHARMACY | Comments Off on Heartburn

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