Written by Wong Yee Ling, AA Pharmacist

Everything About Heartburn

Heartburn is characterized by burning pain sensation behind the sternum or breastbone, a result of excess gastric acid reflux into the esophagus¹. Heartburn usually tags along with the following symptoms¹:

  • Burning pain in the upper chest
  • Sour and foul taste of the throat
  • Persistent dry cough
  • Sore throat
  • Hoarseness
  • Feeling of food stuck at the back of throat
  • Difficulty in swallowing.

If the burning pain radiates to arm, neck or back and is associated with shortness of breath, one should seek medical attention immediately.

Persistent heartburn for more than twice a week will develop gastroesophageal reflux disease (GERD), in which untreated GERD could possibly lead to esophagitis, esophageal ulcer and esophageal cancer.

Risk factors:

  • Pregnancy  The lower esophageal sphincter weakened during pregnancy, causing regurgitation of gastric acid into esophagus.
  • Food and drinks that trigger heartburn:
    – Alcohol relaxes lower esophageal sphincter
    – Fatty food, spicy food, fried food, caffeinated drinks and acidic juices or
    food (grapefruits, oranges, tomatoes)
  • Medications that precipitate heartburn:
    – Non steroidal anti-inflammatory drugs, NSAIDs (naproxen, mefenamic acid etc), antibiotics like tetracycline, tricyclic antidepressants, sedatives, progesterone, iron supplements.
  • Obesity can cause elevated pressure in the abdomen.

Diagnosis:

  • Endoscopy. Flexible scope with a fibre optic camera is used to examine the esophagus lining and biopsy can be done to identify cancerous and non-cancerous cells.
  • Ambulatory pH testing. It measures the acidity of esophagus via a small tube that goes through the nose into the stomach.
  • X-ray. Fluoroscopy machine is used to monitor the contrast material (swallow barium) by travelling down the esophagus to identify the inflammation within the esophageal and intestinal wall.

Pharmacological interventions:

  • Antacids (aluminium hydroxide, magnesium hydroxide, calcium carbonate and sodium bicarbonate) neutralise gastric acid pH and provide fast relief within 5 minutes but shorter duration of effect of 30-60 minutes.
  • Alginates (sodium alginate, magnesium alginate) react with gastric acid to form a float which prevent reflux.
  • H2 blockers (ranitidine, cimetidine, famotidine) prevents the gastric acid production by inhibiting histamine stimulation acid producing cells. It has a slower onset of action but longer duration of action 4-10 hours.
  • Proton pump inhibitors (PPIs) (omeprazole, dexlansoprazole, esomeprazole) inhibit the production of acid by blocking the enzyme responsible for active transport of proton into gastrointestinal lumen and healing the damaged esophageal lining.

 

Lifestyle changes:

  • Eat at regular timing and avoid large meal each time, preferably eat smaller portion of meal with more frequency.
  • Avoid tight clothing to prevent accumulation of high pressure on abdomen.
  • Avoid trigger factors like spicy and greasy food, caffeinated drinks, alcohol, citrus-based fruits.
  • Quit smoking
  • Avoid eating heavy meal 3 hours before bedtime.
  • Maintain a healthy body weight.

Reference:

  1. R. J. (2018, January 2). Heartburn (Acid Reflux) Symptoms, Relief Medicine, and Cures. Retrieved from https://www.medicinenet.com/heartburn_pictures_slideshow/article.html
  2. W. B. (2016, April 26). Heartburn. Retrieved from https://www.rxlist.com/heartburn/drugs-condition.htm#heartburn_diagnosis
  3. F. M. (2018, January 31). Can certain medications increase GERD severity? Retrieved from https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535
  4. N. N. (2017). MIMS Malaysia Patient Counselling Guide Heartburn (10th ed.). Malaysian Pharmaceutical Society.
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