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Minor complication
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Depending on the severity of heartburn — a bodily malfunction — the doctor may prescribe medication or perform `key hole' surgery, says Dr. UMA KRISHNASWAMY.
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AFP
Large, hot and spicy meals could trigger heartburn.
HEARTBURN or reflux is a burning sensation in the chest and neck triggered by the contents of the stomach rising up into the gullet.
The lining of the gullet is not made to withstand the acidic contents of the stomach and hence the burning sensation. It is often a sporadic phenomenon occurring in many individuals, but in some is a persistent problem. The reason for heartburn is a malfunction in the valve-like mechanism found at the junction of the gullet and the stomach.
In normal individuals, this valve allows contents to pass only one way. But in heartburn victims, the faulty valvular mechanism, allows a two-way passage of stomach contents.
Heartburn is not identical to a Hiatus hernia wherein the stomach slides up into the chest. But a concomittant Hiatus hernia may well aggravate reflux. The symptoms are usually triggered by a large, hot, greasy or spicy meal.
Alcohol, tobacco, obesity, lying down soon after a meal, stooping after a meal, pregnancy, etc. are some of the other triggers. In most individuals, the problem remains a nuisance. But in others, the lining of the gullet sustains repeated damage from the refluxing acid and becomes inflamed and ulcerated. This is referred to as Oesophagitis. Scarring in the inflamed area may lead to a narrowing of the gullet referred to as a Stricture.
The latter leads to difficulty in swallowing with the patient complaining that the food is "sticking" in the chest.
Rarely do more serious complications in the lining of the gullet arise wherein there is an increased risk of a cancer of the gullet. In milder instances, heartburn is treated by attention to lifestyle: losing weight, eating smaller meals, not lying down for at least two hours after a meal, lying propped up on several pillows, etc.
Alcohol and tobacco use is stopped and simple antacids available as over the counter medication used to annul the symptoms. If there is no response, the problem is investigated by endoscopy (viewing the gullet and stomach directly by a flexible telescope) or a barium study.
Special tests to monitor the acidity of the gullet or the pressure gradient within the gullet may be needed. According to the severity of the problem, the doctor may prescribe medication either to suppress stomach acid or tighten the valve mechanism or both. If there is no response, surgery may be used to create a valve-like mechanism. Today, this is often done as a "key hole" procedure.
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