Signs of a heartburn
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Signs of Heartburn: Key Symptoms and Insights
Common Symptoms of Heartburn
Heartburn is a prevalent gastrointestinal symptom characterized by a painful or burning sensation in the upper abdomen or chest, which can sometimes radiate to the back. This discomfort is typically caused by stomach acid refluxing into the esophagus, irritating its lining5. Additionally, acid reflux may reach the throat or mouth, leaving a bitter or sour taste5.
Psychological and Stress-Related Factors
Psychosocial stressors have been shown to exacerbate heartburn symptoms. A longitudinal study found that severe, sustained life stress significantly predicted increased heartburn symptoms over a four-month period. This correlation was particularly strong with vital exhaustion, a state of extreme fatigue and stress1. Anxiety and depression were also linked to impaired quality of life and increased heartburn medication use, respectively1.
Heartburn in Specific Conditions
Achalasia
Achalasia, a disorder characterized by a hypertensive lower esophageal sphincter (LOS) that fails to relax, can also present with heartburn. Interestingly, patients with achalasia who experience heartburn tend to have lower basal LOS pressures compared to those without heartburn. In some cases, the onset of dysphagia (difficulty swallowing) can lead to the disappearance of longstanding heartburn, suggesting a complex interplay between these symptoms2.
Nighttime Heartburn
Nighttime heartburn is a significant issue that affects sleep and daytime function. A survey revealed that 79% of individuals with GERD experience heartburn at night, with 75% reporting that it affects their sleep quality. This nocturnal heartburn also impairs next-day function for 40% of sufferers3. Despite the use of over-the-counter and prescription medications, many patients do not find these treatments extremely effective3.
Functional Heartburn
Functional heartburn is a condition where heartburn symptoms persist despite the absence of gastroesophageal reflux disease (GERD) as confirmed by diagnostic tests. This type of heartburn does not respond well to traditional acid suppression therapies. Instead, it is often associated with esophageal hypersensitivity and may require different treatment approaches, including lifestyle modifications, pharmacological interventions, and alternative therapies4 7 8.
Pathogenesis and Mechanisms
The pathogenesis of heartburn, particularly in nonerosive reflux disease (NERD), involves several mechanisms. These include esophageal visceral hypersensitivity, sustained esophageal contractions, and abnormal tissue resistance. These factors contribute to the occurrence of heartburn even in the absence of visible esophageal damage6. In functional heartburn, low-grade microinflammation and neuroimmunologic effects are believed to play a significant role in symptom development7.
Conclusion
Heartburn is a multifaceted symptom with various underlying causes and contributing factors. From stress and psychological factors to specific conditions like achalasia and functional heartburn, understanding the diverse mechanisms and presentations of heartburn is crucial for effective management and treatment. Addressing both physiological and psychological aspects can lead to better outcomes and improved quality of life for those affected by this common yet complex symptom.
Sources and full results
Most relevant research papers on this topic
The Effect of Life Stress on Symptoms of Heartburn
Severe, sustained life stress can significantly increase heartburn symptoms and lead to vital exhaustion, potentially affecting esophageal acid exposure, gastric emptying, or stress-induced hypersensitivity.
Observational Study
Highly CitedHeartburn in patients with achalasia.
Patients with achalasia who experience heartburn have lower basal esophageal sphincter pressures than those without heartburn, suggesting achalasia may develop in the setting of underlying gastrooesophageal reflux disease.
Highly CitedNighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association
Nighttime heartburn is common in most adults with GERD, affecting sleep and affecting daily function, but current therapies often don't effectively treat it.
Observational StudyHighly CitedDiagnosis and Management of Functional Heartburn
Functional heartburn (FH) is diagnosed through endoscopy, reflux and motility testing, and can be managed with lifestyle modifications, pharmacological interventions, and alternative therapies.
Heartburn : gut health
Heartburn is caused by stomach acid returning into the oesophagus, causing a burning sensation and sometimes causing a bitter or sour taste in the mouth.
The pathogenesis of heartburn in nonerosive reflux disease: a unifying hypothesis.
Abnormal tissue resistance is the main cause of heartburn in nonerosive reflux disease, reconciling various proposed mechanisms and reaffirming the definition of reflux-associated "heartburn" as an acid-mediated event requiring antacids.
Highly Cited