DIGESTIVE DISORDERS – Heartburn
Everyone would have sometime or other time felt a burning volcano in the
chest, referred to usually as ‘heartburn’ in case of indigestion. It can also
be seen in all oesophageal diseases, Hiatus hernia and gastritis. Heartburn is
actually a misnomer, since this burning pain is no way related to the heart.
Heartburn is mostly related to inflammation/irritation of the food tube –
oesophagus and stomach. This is the most common complaint where the patients
use to suffer with burning acid eructations (i.e. back flow of food with
digestive juices/acids from stomach to throat) with indigestion or abdominal
complaints. Usually, secretions of stomach and intestines (acid gastric
juice/bile) have irritable nature with bitter/sour taste. When these secretions
get regurgitated into the oesophagus with or without food, it irritates the
oesophageal mucosa and causes a type of burning pain behind the breast bone (retro
sternum pain) commonly called as heartburn. One should take caution in the
treatment/care of heartburn since angina pain also mimics symptoms of the
heartburn.
Incidence – Heartburn is more common in adults and rare in
children. People who lead hurried, tense life and depend mostly on fast food,
carbonated drinks and tinned food suffer more from heartburn irrespective of
sex. Habits of smoking and alcohol lead to higher incidence. Also it is most
commonly seen in people who are bedridden and take lots of medicines.
Pathophysiology – Stomach acid secretion (Hydrochloric acid –
HCL) is very helpful not only for digestion of food particles but it also helps
in the absorption of the nutrients and killing the bacteria or parasites i.e.,
worms, trophozites (amoeba), etc., in the food. Normally, stomach and
intestines have mucosal coating as a barrier to have protection against these
acid secretions. Even though oesophagus secretes enormous mucous for
lubricating the food to pass, it doesn’t have enzymes to digest the food
particles and cannot tolerate the irritation or inflammation caused by reflux
or regurgitation of food with acids. So it gets ulcerated during reflux or
regurgitation with indigestion. Also, indigestion aggravates the heartburn by
gas formation, bloated abdomen and sour belching which drives more and more
acids into the oesophagus.
Architecture which naturally prevents back flow of food
·
Lower oesophageal sphincter, i.e., the valve in the
junction of the oesophagus and stomach, acts like a one-way valve avoiding back
flow of food.
·
This one-way valve lies below the diaphragm – in the
abdomen. So, the high intra abdominal pressure will also influence this valve
for tight closure to avoid back flow.
Oesophagus enters (ends in) the stomach in an oblique manner. This oblique
joining / junction enhances the tight closure of the valve while the stomach
gets distended or filled up
Causes
·
Food habits
·
Spicy and hot foods or sauces can cause irritation and
reflux.
·
Overeating and gulping of food (skipping the initial
process of digestion, i.e., chewing, masticating and mixing the food with
saliva)
·
Untimely, irregular meals.
·
Toxicity – Chemicals in the food or food poisoning can
cause erosions or ulcers in the oesophagus and stomach to cause heartburn.
·
Increased acid secretion – can load the stomach with
acids to suffer with GERD or gastric ulcers.
·
Hiatus hernia – occurs and causes pain when a part of the
stomach slides through the diaphragm into the chest. Hiatus hernia occurs
commonly in pregnant women, obese persons and in persons who constantly suffer
with peptic ulcer or cholecystitis or chronic pancreatitis. Here complaints
often start with raised abdominal pressure which occurs during weightlifting
and change in posture like bending down and lying down.
·
Habits – of smoking, drinking alcohol and carbonated
drinks hinders digestion and often produces heartburn
·
Neurological – Non-coordination of nerves can lead to
return of foods into the oesophagus due to impaired/relaxed lower oesophageal
sphincter.
·
Mind – Stress and strain can also cause acid peptic
diseases/GERD which may lead to heartburn. It is most commonly seen in
depressed, emotional, anxious and tense people who worry a lot. During all
these conditions, acid secretion will be more and continuous in stomach.
Drugs – Continuous use of non-steroidal, anti-inflammatory
drugs/painkillers.
Symptoms
occur mostly 1- 2 hours after eating or on an empty stomach. Usual symptoms
of heartburn are:
·
Burning pain in chest and throat with warm and sour
eructations
·
Burning pain in stomach with warm waves rising to the
throat
·
Belching often with chest discomfort
·
Difficulty in swallowing and even a small handful of meal
fills the abdomen
·
Abdomen feels bloated after eating
·
Burping and rumbling abdomen with much flatulence
·
Indigestion, nausea and vomiting
·
Diarrhea or constipation
·
Bad breath
Weight loss when left untreated for a prolonged time
Diagnosis
Heartburn is very commonly noted by
everyone, at one time or the other with unusual, heavy food. However, frequent
and severe heartburn may need detailed evaluation and treatment. Most of the
time, people won’t give any importance to heartburn and just get along with
their hurried life. Since the same set of symptoms are present in a heart
attack, and differentiating between the two is not an easy one, one should take
care check the BP and have an ECG done. The following tests will give a clear
idea about heartburn:
·
Endoscopy readily identifies the complaints of
oesophagus, hiatus hernia and gastritis, if any
·
pH of oesophagus – to have idea about acid load
·
Biopsy of the ulcers (if any) – to rule out cancer or
presence of H. pylori
·
Plain and series of Barium meal X-rays – to rule out any
obstruction or strictures
·
Ultrasound abdomen scan – to rule out cholecystitis,
pancreatitis, appendicitis
·
CT scans or MRI – in difficult cases for diagnosis
Management
·
Stand or sit erect while having heartburn
·
Sleep in 45 degree elevated bed or keep high pillows
·
Swallow saliva or sip water often to neutralize the
regurgitating acids
Preventive measures – An ounce of prevention is better than pounds of cure.
So,
DO
·
Masticate food well and then swallow it
·
Have food in a relaxed manner, without any hurry or
tension
·
Exercises like walking, jogging, swimming, etc.
TAKE
·
Easily digestible & oil-free diet to reduce the
workload of the stomach
·
Food for not more than 3/4th of the stomach
·
Small meal often to utilise/neutralize the acid load in
the stomach
·
Water before and after meal
Nutritious diet at regular interval
AVOID
·
Tension and a hurried life
·
Habits of smoking, drinking alcohol and chewing tobacco
·
Food containing high spices, chillies, pepper, sausages
·
Overeating/full meal, oily diet, pickles and fatty snacks
before bedtime
·
Aerated drinks, coffee and tea
·
Drugs like NSAIDs/pain killers
General treatment
Usually patients treat heartburn by themselves by leaving the stomach empty
giving it rest or by taking only fruits/fruit juices or by taking soda or with
antacids or H2 blockers which are readily available in counters without any
prescription. Using lemon juice or buttermilk in the situation of heartburn
will temporarily wash away reflux stomach acids/bile from the lower end of the
oesophagus and thus hide the irritation or symptoms for the time being. The
recurrent or persistent reflux of the acidic foods cause oesophagitis and can
cause or lead to a series of serious problems. So, it should be treated early
to avoid complications like oesophageal bleeding, vomiting of blood, formation
of strictures and stenosis in the lower end of oesophagus, severe chest pain,
anxiety, tension, etc. Nowadays, depending upon the intensity of symptoms and
severity of the diseases, drugs are prescribed to control acid production in
the stomach. This will also work temporarily.
Surgery – In resistant cases, surgery is advised to remove
the ulcerated or damaged part of the stomach/oesophagus or to correct hiatus
hernia to improve the condition. Advanced laparoscopic surgery provides it in
an easier way.
Homeopathic approach to acidity
Covering the fire without putting it off is like adding fuel to it for a
dangerous event. Likewise, most patients manage this acidity problem
temporarily with antacids. They are not reducing the acid secretion in the
stomach but only temporarily neutralizing it. This type of approach usually
makes the stomach secrete more and more acid. They should also keep in mind
about the study which shows that more antacids can produce more sodium in blood
which in turn shows a greater risk for heart attack.
Treating acidity is tough since it often gets exposed toirritants/chemicals
in foods. Acidity can be treated successfully in Homeopathy without any side-
effects. Homeopathy gives importance to the patient’s symptoms than to the
disease symptoms to expel the disease. In Homeopathy, for selecting right drug,
it gives importance to the character of symptoms, its onset, type and
periodicity of pain, aggravating factors, relieving factors and characteristics
symptoms of patients i.e. aversions, desires, cravings, taste, thirst,
appetite, stool habit, sleep, sweat, etc. It also gives importance to symptoms
like gurgling and rolling of wind, relief from belching/flatus or not,
difficulty in bringing up wind, type of stool, etc.
Homeopathic medicines commonly used in cases of acidity/heartburn are Acid
nit, AmbraG, Antim crud, Arg Nit, Asafoetida, Belladonna, Bismuth, Borax,
Bryonia, Capsicum, Carbo veg, Causticum, China, Cocculus, Condurango,
Graphites, Hydrastis, Iris vers, Kali bich, Kali Brom, Lycopodium, Nat mur, Nat
phos, Nux Vom, Phosphorus, Psorinum, Pulsatilla, Rhus tox, Robinia, Silicea,
Sulphur, Symphytum, etc.. These Medicines should be taken under the advice and
diagnosis of a qualified Homeopath.
for
new hope
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001
India
Tel: +91-984-319-1011 (Mob /
Whatsapp)
Clinic : +91-452-233-8833 |
E-mail: drcheena@gmail.com
(Disclaimer: The contents of this column are for informational
purpose only. The content is not intended to be a substitute for professional
healthcare advice, diagnosis, or treatment. Always seek the advice of
healthcare professional for any health problem or medical condition.)