Usually at night, we may feel a sour liquid in our throat coming from beneath or burning sensation in our upper tummy. The pain goes up through our chest to the throat. Sometimes we fear it as a heart attack. This is called heartburn or gastroesophageal reflux disease (GERD) in medical terms.
How Does It Happen?
The food we eat starts getting digested right from the mouth up to the large bowel. Food passes through the mouth to the throat and then food pipe, stomach, small and large bowels, rectum and at last excreted as feces. Every part of the digestive system plays its role in digesting food. Stomach is unique from other parts as it has acid in it. Yes, stomach produces hydrochloric acid (HCl). This helps in digestion and also kills germs that may be present in unhygienic food.
The hydrochloric acid is present only in the stomach. A functional valve at the lower end of the food pipe called the lower esophageal sphincter preventes the reflux of acid back into the food pipe. It remains closed most of the time and opens for a short time while we swallow food or liquid and then closes again. Sometimes, it opens for short times even without food, to eliminate the air that is swallowed or gas that is produced by some chemical reactions in the stomach. These transient openings are for very short periods. In some individuals, the openings of this valve are recurrent or for longer duration. In that case acid may come back into the lower part of the food pipe and cause burning of walls of the pipe. This causes pain or burning sensation and it is due to acid reflux.
Risk Factors of Acid reflux:
Some common risk factors of acid reflux are as follows:
Heartburn is very common. Most of us experience it three to four times per month. Unless you do not have danger symptoms, this condition is of no concern. Danger symptoms or red flags are weight loss, persistent vomiting, blood vomiting, black colored feces and difficulty in swallowing. If you experience these danger symptoms, then go straight to your doctor without delay.
Usually no investigations are required, but sometimes when the diagnosis cannot be made, few investigations are done to check acid reflux.
1. Esophageal Manometry:
In this, a probe is inserted into food pipe’s lower end, which measures its pressure. If it is decreased, then it causes acid to reflux back.
2. Monitoring Ph:
In this also, a pH probe is inserted into the food pipe through mouth to measure pH of the food pipe continuously for 24 to 48 hours. If it is less than 4, then it gives clue to acid reflux. Normal pH is around 6. This test is also called Bravo test.
In this test a flexible probe is passed through the mouth to the stomach, which has a camera to view inside the food pipe and stomach. It is also used to remove a small piece of tissue from there to test, which is known as biopsy.
4. Acid Suppressing Medicines:
Sometimes a medicine that suppresses acid production is given and if there is symptomatic improvement, then the treatment will be continued.
Complications of Heartburn:
If you suffer from recurrent heartburn, then the following steps may be taken to decrease or prevent further episodes.
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