Many have seen the picture before: a person who seems to spit fire, and next to it the headline "Heartburn". This is of course a crooked picture, because heartburn, despite its name, has nothing to do with fire or flames. Rather, there is an irritation of the mucous membranes in the esophagus behind it - a rather unpleasant feeling.
Heartburn - Danger in the chest (reflux disease)
Almost every person experiences this occasionally. As long as the symptoms disappear on their own after hours or at most one or two days, there is nothing to worry about. At about 10 to 15 percent of those affected stops the burning in the throat, however.
In them, the mucosa is so strong irritated that it ignites. The so-called reflux disease, which results from it, must be treated in each case. Even though mild heartburn is almost always harmless: in advanced stages of the disease, without appropriate therapy, serious health problems - including cancer - threaten.
The following answers to the most important questions about heartburn help to avoid the worst.
How does suffering arise?
The root of the evil is the gastric juice. It serves to pre-digest the food and "digest it" by splitting egg whites. He accomplishes this task with the help of enzymes (pepsin) and - that sounds strange at first - a portion of hydrochloric acid.
Hydrochloric acid in our body? Is that not dangerous? Not as long as the gastric juice remains where it belongs - in the stomach. Despite the very acidic pH of 1 to 3 - which is a hundred times more acidic than vinegar - the digestive fluid does no harm there. Due to their special structure, the inner walls of the stomach can easily tolerate this corrosive environment.
Normally, a sphincter keeps the transition between the esophagus and stomach tight so that no acid escapes through the upper opening of the stomach. But the function of this muscle can be disturbed because of different reasons (see next question). As a result, the stomach contents flow into the esophagus and irritate the mucosa. This is noticeable as heartburn.
Why does not the stomach close anymore?
The sphincter, also called "sphincter", which seals the stomach entrance, can falter for various reasons. First, it is a not uncommon aging phenomenon, which is why heartburn starting from the 50. Age occurs significantly more often. This usually happens at night, because the sphincter between the esophagus and stomach sleeps even more during sleep. In addition, the reflux of gastric contents is favored while lying down.
In other cases, a diaphragmatic fracture results in the displacement of the stomach in the abdomen. The esophagus then loses its tension, and the sphincter no longer works properly. In a large diaphragmatic fracture, contents from the stomach sometimes even flow into the pharynx.
What are the typical symptoms?
The classic symptom of heartburn is a painful scratching and burning in the upper abdomen. The pain sometimes radiates to behind the breastbone. Swallowing or drinking does not improve the feeling. But this feeling is not a must. In some cases, the reflux of gastric acid into the throat initially does not trigger any symptoms at all - this is particularly treacherous. If symptoms do appear later, the disease may be in an advanced stage, which makes therapy difficult.
What are atypical symptoms?
Gastric acid in the esophagus sometimes causes symptoms that neither a patient nor a doctor associates with heartburn. Especially young people often complain of diffuse chest pain. If doctors have then ruled out a heart attack, the problem often turns out to be heartburn.
The acid in the throat can also lead to chronic coughing or hoarseness, which physicians often initially interpret as a concomitant of a cold or asthma symptoms. Sometimes sufferers report a foreign body sensation in the larynx.
When do I have to go to the doctor?
Occasional scratching and burning in the throat are no cause for concern. With rare complaints no one has to go to the doctor. Maybe there was too much coffee, or a heavy, high-fat meal was the cause. In such foods, the stomach produces more acid. The unpleasant feeling in the throat usually goes by itself. However, if the symptoms occur more often - several times a week - sufferers should consult a doctor. Someone who has heartburn several times a day for two to three weeks will recommend a reflex to check the condition of the esophagus.
What does a therapy look like?
In the first place, there is a review of the habits. Is the body weight correct? Am I moving sufficiently? Overweight and sluggishness can promote heartburn. Also be careful when drinking white wine, sweets and fat. In case of doubt it is better to do without it. The same applies to coffee, black tea and carbonated drinks. Smoking is harmful because nicotine reduces the salivation that neutralizes stomach acid. Although adjusting habits can help, it is often not enough. For such cases, there are now a number of fast-acting drugs.
For mild ailments, acid-binding medicines are available (active ingredients: hydrotalcite, Algeldrat, magaldrate, sodium aluminum carbonate) as well as calcium and magnesium carbonate. Preparations containing ranitidine or famotidine inhibit the formation of gastric acid. If a disorder of the stomach movement is the cause, herbal remedies with extracts of peppermint, caraway, gentian and bitter candida flower help. In severe cases physicians prescribe drugs from the class of proton pump inhibitors. They suppress the formation of acid most effectively, but do not work immediately.
Medication as a trigger?
Certain agents cause the sphincter muscle to relax at the stomach entrance, facilitating reflux of gastric contents into the esophagus. These include special asthma, heart and blood pressure medicines. Also, some calcium channel blockers and antidepressants can have a negative effect. However, patients should not do without their medicines - that would be life threatening. People who suffer from heartburn should therefore first talk to their doctor.
Is an operation useful?
If a heartburn-stricken person does not want to take any medications, if he does not tolerate them or if they do not have any effect on them, doctors can often help with surgery. Such an operation is called "fundoplication". Surgeons from the tissue at the stomach entrance form a cuff, which they lay around the transition from the esophagus to the stomach. The resulting narrowing causes the leaky sphincter to function properly again. Most patients live uncomplicated after the operation. In addition to the usual complications that can follow any surgery (infection, poor wound healing), the procedure is safe (if performed by an experienced physician).
How big is the risk of cancer?
In about 10 percent of people with reflux disease, there are mucosal changes in the esophagus. These are cancer precursors, physicians speaking of "Barrett's syndrome". Most of these patients are affected, in whom the reflux disease has made very late or previously not noticeable. Even at this stage, doctors can treat well - provided that the patient reports in time with his complaints.
This is not always the case, so sometimes a true cancer develops from the precancer. Usually such a proliferation initially remains locally limited. When discovered early, surgeons often manage to remove the cancer cells using endoscopic procedures. It is important to closely monitor the condition of the esophagus of such patients after an intervention. If successful, severe complications are rare.