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Heartburn is a burning sensation in the chest that can extend to the neck, throat, and face. It usually occurs after eating and is worsened by bending, lifting, or lying down.
Heartburn, sometimes called acid indigestion or gastroesophageal reflux, is very common. More than one third of the population suffers from occasional heartburn, as do about one half of pregnant women. Some 50 million adult Americans complain of frequent heartburn. The occurrence of heartburn generally increases with age; however, it is common—and often overlooked—in infants and children.
Heartburn occurs when digestive juices from the stomach move back up into the esophagus, the tube connecting the throat to the stomach. The upper third of the esophagus consists of skeletal muscle that propels the food downward. The lower two-thirds of the esophagus is smooth muscle. The lower esophageal sphincter (LES) is a thick band of muscle that encircles the esophagus just above the uppermost part of the stomach. This sphincter is usually tightly closed—opening only when food passes from the esophagus into the stomach—and prevents the contents of the stomach from moving back into the delicate esophageal tissue. The stomach has a thick mucous coating that protects it from the strong hydrochloric acid it secretes to digest food. However the much-thinner esophageal mucous coating does not protect against stomach acid. Thus, if the LES opens inappropriately or fails to close completely, stomach acids can back up and burn the esophagus, causing heartburn.
Occasional heartburn is usually harmless. However, frequent or chronic heartburn (recurring more than twice per week) is called gastroesophageal reflux disease (GERD) and requires early management. Repeated episodes of GERD can lead to esophageal inflammation (esophagitis). If the esophagus is repeatedly subjected to
stomach acid and digestive enzymes, ulcerations, scarring, and thickening of the esophageal walls can result. This causes a narrowing of the interior of the esophagus that can affect swallowing and the peristaltic movements that send food downward. Repeated esophageal irritation also can result in Barrett's syndrome—changes in the types of cells lining the esophagus. Barrett's esophagus can develop into esophageal cancer.
Gastroesophageal reflux may occur in children under age one, particularly pre-term babies or those with cerebral palsy. It also may be a cause of some migraine headaches. In addition, chronic heartburn can be a symptom of a gastric ulcer or coronary artery disease.
Author Info: Margaret Alic PhD, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Alternative Medicine, 2005
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