Heartburn is due to acidic stomach contents leak out and irritate the lining of the esophagus. You may also experience acid regurgitation into the mouth. Heartburn is usually harmless, although it is unpleasant and annoying.

Heartburn – typical symptoms

* A burning sensation behind the breastbone
* Acid reflux
* Pain in my upper abdomen.

Acid reflux and heartburn may occur for several reasons. Stress, anxiety and depression can increase symptoms. But there is much you can do about it, both with medication and changes in habits.

Choose the right prescription medicine for heartburn. Here you will find prescription drugs for heartburn and acid regurgitation, depending on how hard you have trouble:

If you experience heartburn occasionally:
Medicine and power in 1-2 hours

Heartburn more than once on the day or at night:
Medicine and power in 12 hours

Do you have heartburn several days in succession:
Medicine and efficacy in up to 24 hours

Heartburn is sometimes at the ulcer

A typical symptom of ulcers is that it hurts in the upper abdomen, slightly above the navel, often at night. Sometimes even heartburn, acid regurgitation and nausea. If you have symptoms of gastric ulcers, it is important that you seek medical advice.

The burning or heartburn is a condition that affects many people and is characterized by a burning sensation that starts in the pit of my stomach and then rises up to the throat.

Usually this arises burning an hour after eating and can extend for several more, according to each person. There are cases where the heat is accompanied by regurgitation, ie the return of liquids or food into the throat, especially when bending over or lying down, the table is known as esophageal reflux.

Basically, we can say that heartburn is caused by a malfunction of the lower sphincter of the stomach, which is known under the name of the cardia. This sphincter separating the esophagus and stomach, and its function is to allow the passage of food from the esophagus to the stomach, and not vice versa.

When the cardiac function properly once the food has gone down into the stomach, it closes automatically. And just here fails in cases in which causes heartburn, the cardia is not closed as it should and allows food and stomach juices back into the esophagus.

As the gastric juices are very powerful can irritate or inflame the walls of the esophagus and hence the characteristic feel burning or stinging.

As for the causes of this malaise are varied and can range from very succulent meals or eaten very quickly, certain foods that cause time, situations of pregnancy or obesity, to the use of certain drugs that cause acidity (some painkillers , antidepressants, dopamine, etc.).

So, too, can be included in the list of possible causes of heartburn to certain diseases or oral problems (such as caries, gingivitis), laryngitis, pharyngitis, or who suffer from hiatal hernia, are much more likely to experience reflux esophagitis .

Thus, when the lower esophageal sphincter is at rest is fully closed, the lower esophageal sphincter prevents gastric fluid climb into the esophagus. Then, swallowing opens to let the cud. But that sometimes happens with certain foods (eg fat) or taking certain medications or even a particular way of life (cigarettes, gum to be chewed …), the lower esophageal sphincter tonicity decreases. What makes tracing the gastric juice of the stomach into the esophagus fragile wall reacts to the acidity of the juice. Hence the burning and stomach ailments. You can then have the difficulty of hire, or even to open the wrong time.

When stomach acid reflux becomes chronic, it is called esophagite. It is more serious to the ignition of the lower esophagus. In extreme cases, that could cause changes to pre-cancereuses the esophagus. Although some antacids may be effective against gastroesophageal reflux, you need to change their practices of life and monitor your diet.

Designate part of gastroesophageal reflux (or RGO) step in the esophagus of a part of gastric contents. Usually is a phenomenon that can occur intermittently throughout the world and especially after dinner, ie postprandial period. When the gastroesophageal reflux becomes frequent and a source of complications, it is called gastroesophageal reflux disease.

At present, it is considered that 30-45% of Western populations present RGO symptoms at least once a month and 5-10% daily! Gastroesophageal reflux is well more widespread than we could believe. Indeed, in Canada, for example, it is considered that 29% of the population would be bothered by gastroesophageal reflux, is also 44% of the adult population in the United States and 45% of the French population to have reflux least once a month.

Gastroesophageal reflux is thus a disorder that causes regurgitation of stomach contents into the esophagus. As it was not designed into the esophagus to withstand the acidity of gastric juices, the ignition is done. Then still burns and other symptoms of irritation of the esophagus also clumsy ones as the others. They note that the current language you want the gastroesophageal reflux is so reductive designate its main symptom, the heartburn.

More concretely, the RGO is caused by a dysfunction of the lower esophageal sphincter is a muscular ring located at the junction of the esophagus and stomach. When functioning normally, the lower esophageal sphincter prevents stomach contents go up into the esophagus. Only opens to let food swallowed.

Instead, we speak of reflux when the sphincter opens at inappropriate times. Then allowed to escape the stomach contents into the esophagus, gastric juices containing compound, which leaves room for burns, regurgitation, the irritations, etc …. Spitting is also more widespread in infants in whom the sphincter is immature.

It is necessary to guard the various complications usually resulting from the RGO. If the esophagus is too often exposed to acidity, that can generate such a call oesophagite ignition, or even esophageal ulcers.

The administration of drugs such as cimetidine or ranitidine may reduce gastric acidity. Should also be avoided certain foods (like fats and chocolate), tobacco and certain drugs (eg anticholinergics), anything that increases the tendency of the lower esophageal sphincter to let the liquid. The doctor may prescribe a medicine cholinergic (eg, bethanechol, metoclopramide or cisapride) to make the lower sphincter to close more tightly.

Urgent surgery is not necessary unless esophagitis causing a massive hemorrhage. But bleeding can reoccur. The narrowing of the esophagus is treated with drugs and repeated dilations, which can be made using balloons or probes (dilators of progressively larger metal). If dilation is effective, the closer does not limit significantly the food intake. Treatment with omeprazole or lansoprazole or surgery can relieve the intense inflammation, hemorrhage, strictures, ulcers or symptoms that have not responded to other treatments. The omeprazole and lansoprazole are the drugs most effective for the rapid resolution of esophageal inflammation caused by reflux. Barret’s syndrome, a precancerous condition, can disappear, provided that the treatment has alleviated the symptoms, although not always so.

What is gastroesophageal reflux?

The burning, heartburn, retrosternal heartburn is a burning sensation in the center of the chest that often occurs after eating, bending over, exercising, and sometimes, when lying down. It is a common problem, nearly one in every 10 adults have these symptoms at least once a week, and one in three monthly. Some pregnant women have it almost daily. These symptoms indicate a disease called gastroesophageal reflux or GERD.

When you swallow, food passes through your throat and esophagus into the stomach. A muscle called the lower esophageal sphincter controls the opening between the esophagus and stomach and remains closed except when swallowing. When this muscle fails to close, the contents of the stomach acid can rise into the esophagus. This is called reflux. When stomach acid enters the lower esophagus, can cause the symptoms described above.

The advice to improve gastroesophageal reflux

* Maintain a healthy weight. Being overweight increases intra-abdominal pressure and it hurts.
* Stop smoking. The snuff relaxes the lower esophageal sphincter.
* Do not use clothes that push the abdomen. Avoid tight belts.
* If possible, avoid heavy lifting and avoid prolonged trunk flexion.
* Make small, frequent meals and avoid abundant.
* Limit consumption of fatty foods, chocolate, peppermint, coffee, tea, soft drinks (especially colas) and alcohol. All cause lower esophageal sphincter relaxation.
* Limit consumption of tomatoes, citrus (fruit juices). They provide acid that can irritate the esophagus.
* Eat foods rich in fiber, especially if it has a tendency to constipation.
* Dine two or three hours before bedtime, and avoid lying down after meals.
* Raise the head of your bed about 15-20 cm by placing wooden blocks under the legs of the header, to allow gravity to keep stomach contents inside. The use of pillows does not usually work well.

Many people improve following the above recommendations. Antacids are sold in pharmacies without a prescription can be useful for occasional symptoms.

Antibiotic treatment for H. pylori is in development. Simple agents should not be used because no single antibiotic can cure in a predictable way most infections H. pylori. At first it was recommended triple therapy based on bismuth. This approach has been tested with simple patterns of two drugs, which include the use of drugs blocking acid secretion. Whatever treatment is used, antibiotic resistance, the advice of the physician and patient compliance determines its success.

H2 blockers are important in the treatment of peptic ulcer disease, but are no longer the primary treatment when used alone, are often used as antisecretory drugs in a regimen anti-H. pylori. With power and different half-lives, all these drugs (cimetidine, ranitidine, famotidine and nizatidine) are competitive inhibitors of histamine H2 receptor. Histamine has an important role in acid secretion stimulated by vagal and gastrin, thus making H2 blockers effective in suppressing basal acid output and gastric acid production stimulated by food, the vagus nerve and gastrin. The volume of gastric juice is reduced proportionally. It also decreases the secretion of pepsin mediated by histamine.

H2 blockers are well absorbed from the GI tract with a bioavailability of 37 to 90%. The onset of action is 30 to 60 min after ingestion, and effects are maximum after 1-2 h. The administration i.v. produce an onset of action faster. The duration of the action is proportional to the dose and ranges from 6-20 h. There are several liver metabolites, inactive or less active than the parent compound, but most of the drug is eliminated via the kidneys, requiring dose adjustment to renal function. Haemodialysis removes H2 blockers, and is essential to examine the dose after dialysis. Doses should be reduced in the elderly often.

Cimetidine has weak adrenergic effects that are expressed in the form of a reversible gynecomastia and, less commonly, impotence in some patients treated with high doses for prolonged periods (eg., The hypersecretory). After administration i.v. quick all H2 blockers have been reported altered mental status, diarrhea, rash, drug fever, myalgia, thrombocytopenia, and sinus bradycardia with hypotension, usually in <1% of treated patients, but more often in the elderly

Symptoms depend on the location of the ulcer and the patient’s age, many patients, especially seniors, have few symptoms or none. Pain is the most common symptom, usually located in the epigastrium and is relieved by food or antacids. The pain is described as burning, burning or hunger. The course is usually chronic or recurrent. Only about half of the patients presented the characteristic pattern of symptoms.

The symptoms of gastric ulcers do not usually follow a uniform pattern (eg., Eating often exacerbates the pain instead of alleviating it.) This is especially true in ulcers of the pyloric canal, which are often associated with obstructive symptoms (eg., Fullness, nausea, vomiting) caused by edema and scarring.

In duodenal ulcer, the pain tends to be more uniform. The pain is absent when the patient awake, but appears at mid-morning, is relieved by food but recurs 2-3 h after the meal. The pain wakes the patient at night is common and highly suggestive of duodenal ulcer.

Diagnosis

The diagnosis of peptic ulcer is suggested mainly by history and confirmed by the studies described below. Stomach cancer may present with similar and must be discarded, especially in older patients who have weight loss or refer particularly severe or refractory symptoms. Endoscopy, cytology and multiple biopsies are reliable means of distinguishing the malignant gastric ulcers benign. The incidence of malignant duodenal ulcer is extremely low, so that biopsies are generally not justified. A malignant tumor secreting gastrin and Zollinger-Ellison syndrome should be considered in a patient with a severe ulcer diathesis, especially when the ulcers are multiple and occur in atypical sites (eg., Retrobulbar).

Fiberoptic endoscopy is a powerful tool for the diagnosis and treatment of peptic ulcer disease. An alternative diagnostic test is the double-contrast radiography with barium. Although endoscopy and radiography have similar sensitivities to detect ulcers, endoscopy is becoming the diagnostic modality of choice. Endoscopy detected more reliably esophagitis and esophageal ulcers and ulcers located in the posterior wall of the stomach and the sites of surgical anastomosis. Conversely, up to 10% of duodenal ulcers and may go unnoticed retrobulbar endoscopically, prompting a follow-up times radiological study with barium if clinical suspicion is high. Endoscopy also enables biopsies or brush cytology of gastric and esophageal lesions to distinguish between a simple ulcer and ulcerated gastric cancer. Endoscopy can also be used for definitive diagnosis of infection by H. pylori.

Ulcers can range in size from several millimeters to several centimeters. The sores are different from erosion by the depth of penetration, the erosions are superficial and do not affect the muscle layer of the mucosa.

Because the knowledge of the central role of H. pylori in the pathogenesis of peptic disease is increasing, diagnosis and treatment of peptic ulcer disease has changed dramatically.
Is an erosion in the lining of the stomach or the first part of the small intestine, an area called the duodenum.
If the ulcer is located in the stomach is called gastric ulcer.

Etiology and Pathogenesis

While traditional theories about the pathogenesis of peptic ulcers are concentrated in the acid hypersecretion, this finding is not universal, and today it is known that hypersecretion is not the primary mechanism by which produce most of the ulcerations. It appears that certain factors, namely H. pylori and NSAIDs, hinder the defense and repair of normal mucosa making the mucosa more susceptible to acid attack.

The mechanisms by which H. pylori causes mucosal injury are not entirely clarified, but several theories have been proposed. Urease produced by the microorganism catalyzes the conversion of urea to ammonia. Ammonia, while allowing the organism to survive in the acidic environment of the stomach, can erode the mucosal barrier and cause epithelial injury. Cytotoxins produced by H. pylori have also been implicated in the host epithelial injury. Mucolytic enzymes (eg., Proteases, lipases bacterial) appear to be involved in the degradation of the mucous layer, making the epithelium more susceptible to acid damage. Finally, the cytokines produced in response to inflammation may play a role in mucosal damage and subsequent ulcerogenesis.

NSAIDs probably cause mucosal inflammation and ulcers through topical and systemic effects. As NSAIDs are weak acids and are not ionized at pH gastric diffuse freely through the mucosal barrier within gastric epithelial cells, where H + ions are released leading to cell injury. Systemic effects appear to be mediated through its ability to inhibit cyclooxygenase activity and thereby the production of prostaglandins. By inhibiting the production of prostaglandins, NSAIDs induce various alterations of gastric microenvironment (eg., Reduced blood flow to the stomach, reducing the secretion of mucus and HCO3, reduced repair and cell replication), leading to deterioration of the mucosal defensive mechanisms.

Doctors refer to “lifestyle change” as the first treatment for reflux. A 2006 study suggested that most of the dietary changes were anecdotal, and only weight loss and elevation of the head of the bed were tested as effective. A randomized study of transition had the advantage of avoiding meals two hours before going to bed.

Positional therapy, sleeping on the left side, has proven to drastically reduce nighttime reflux episodes. The elevation of the head of the bed is also an effective measure. Combining drug therapy, meals just before bedtime, and elevation of the head of the bed, over 95% of patients have complete relief. If not fully improved, additional measures may be considered.

The elevation of the head of the bed can be done using various items: plastic or wooden props to support the legs of the bed, pillows, wedges, lifts, inflatable or a spring mattress. The lift height is very important and should be at least 15 to 20 inches to be minimally effective in preventing the rise in gastric fluids. Some mattresses are not suitable when inclined and tend to cause back pain, and are therefore preferred foam mattresses. Some people tip the bed more than 20 cm, and argue that the efficiency is higher.