Heartburn in the chest is a burning sensation along the esophagus that occurs when the pain receptors of the organ are irritated. The symptom is combined with acid belching, dysphagia, pain behind the sternum and in the epigastric region. Episodic short heartburn is a physiological reaction, an increase in the frequency and duration of attacks indicates a possible pathology of the esophagus and other parts of the gastrointestinal tract. To detect the causes of the symptom, ultrasound, endoscopy, manometry and pH-metry, laboratory tests are used. To relieve symptoms, antisecretory drugs, antacids, prokinetics are used.
Causes of heartburn in the chest
Retrosternal burning is usually provoked by diseases of the digestive organs, but sometimes has physiological prerequisites. The symptom is often observed after eating food rich in extractive substances - strong broths, salty, spicy dishes, smoked meats. Heartburn worries with irregular meals and dry food, which disrupt the normal rhythm of gastric secretion. Unpleasant sensations in the chest develop with the constant wearing of tight belts that squeeze the stomach after intense physical exertion, especially when bending over.
Gastroesophageal reflux (GERD)
The reflux of aggressive gastric contents, accompanied by excruciating heartburn in the chest, is primarily due to insufficiency of the lower closing sphincter of the esophagus, which leads to regular gaping of the cardia, independent of food. Severe clinical symptoms are provoked by a violation of two main mechanisms for protecting the organ from the effects of high acidity - esophageal clearance and resistance of the mucous membrane to damaging factors. Diaphragmatic hernias or relaxation of the diaphragm often become the organic basis of the disorder.
The main manifestations of GERD include burning, chest pain, sour belching, nausea or vomiting. Perhaps the development of dysphagia - a violation of swallowing solid and liquid food. Symptoms are aggravated after exercise, bending over, in a horizontal position. Heartburn can be combined with increased salivation, heaviness and discomfort in the abdomen, and hoarseness. Sometimes GERD occurs under the guise of heart disease - in this case, the patient is disturbed by severe compressive pain in the cardiac region.
Complications of GERD
The long course of gastroesophageal reflux disease inevitably provokes organic changes in the esophagus, which aggravates the symptoms. Heartburn is aggravated in the presence of superficial or deep mucosal defects, on which the acidic contents of the stomach enter, causing burning and severe pain. Complications of GERD sometimes lead to extensive ulcerative defects or malignant degeneration of esophageal cells, therefore, if suspicious symptoms appear, a gastroenterologist should be consulted. Heartburn in the chest is caused by:
- Esophagitis . About 30-40% of GERD cases occur with severe inflammatory lesions of the organ, which are localized only in the lower sections or spread throughout the mucosa. With the development of esophagitis, patients complain of an increase in episodes of heartburn, its combination with retrosternal pain, aggravated after eating. Disturbed by sour eructation, regurgitation of gastric chyme into the oral cavity.
- Erosion of the esophagus . Pathology becomes the next stage of esophagitis, when, due to prolonged inflammation, multiple superficial mucosal defects are formed. Erosion is characterized by severe pain in the xiphoid process of the sternum, resembling angina pectoris, intense burning in the chest, which develops regardless of food intake. Patients complain of nausea on an empty stomach, periodic vomiting.
- Esophageal ulcer . With a formed ulcerative defect, in addition to common symptoms in the form of retrosternal pain, burning and acid belching due to diffuse edema of the organ, swallowing disorders are expressed. There is a strong and prolonged heartburn, at the height of which there is often vomiting, bringing some relief. The appearance of streaks of scarlet blood in the vomit indicates bleeding from the ulcer.
- Barrett's syndrome . Intestinal metaplasia of the esophageal epithelium occurs with prolonged existence of reflux esophagitis. The most typical complaint is an unbearable sensation of heartburn in the chest, detected in 75% of cases. Severe pains, sour belching are also disturbing, chyme regurgitation into the mouth is possible due to the constant gaping of the lower esophageal sphincter. In the later stages, there is a sharp weight loss, anemia.
Other diseases of the esophagus
The group of esophageal pathologies also includes motor dysfunction, changes in the vascular network, tumor formations. The development of heartburn in the chest is associated with a violation of the coordinated work of the muscle sphincters, which is combined with relaxation of the smooth muscles of the esophageal tube. With various volumetric formations, the situation worsens due to partial obstruction of the lumen of the organ, the inability to eat. Retrosternal burning sensation is most often provoked by:
- Dyskinesia . Functional organ motility disorders are the most common esophageal pathology. The appearance of heartburn is associated with changes in the work of the esophageal sphincters, their involuntary opening during the day. Hypermotor dyskinesia is characterized by intense pain, dysphagia, feeling of a foreign body behind the sternum. The hypomotor variant of the disorder is less common and, as a rule, manifests itself as gastroesophageal reflux.
- Spasm of the esophagus . Paroxysmal contractions of the muscle layer occur when there is a lack of nitric oxide and other active substances, sometimes they develop secondarily against the background of other esophageal diseases. Typical symptoms are severe chest pain, heartburn, inability to swallow both solid and liquid food. Attacks usually last about an hour, disappear on their own or after taking antispasmodics.
- Varicose veins . In most cases, esophageal varices are asymptomatic for a long time and manifest as profuse bleeding with hematemesis. Sometimes the appearance of a formidable complication is preceded by esophagitis, caused by constant trauma to the loose mucous membrane with food particles and manifested by belching, heartburn, discomfort behind the sternum. In chronic course, deficiency anemia is possible.
- Obstruction of the esophagus . Dyspeptic symptoms appear in all cases of impaired passage of the food bolus associated with cicatricial strictures, intraluminal leiomyoma, and malignant neoplasms. The first sign of damage is dysphagia, there is also a strong burning sensation and pain in the chest, increased salivation. In advanced stages, patients can only take liquid food.
Pathology of the intestine and pancreatobiliary zone
In some cases, the appearance of heartburn is due to lesions of the underlying sections of the gastrointestinal tract, which disrupt the reflex regulation of peristaltic contractions and contribute to the accumulation of aggressive bile acids in the intestinal lumen. Burning occurs a second time as a reaction to already existing disorders in the digestive system and is combined with symptoms pathognomonic for each disease. To the appearance of discomfort in the chest predispose such diseases of the gastrointestinal tract, such as:
- Pancreatitis. Various dyspeptic disorders in the form of flatulence, heartburn, belching with air or rotten air are more characteristic of chronic inflammation of the pancreas. Moderate pain syndrome increases after eating fatty foods, significant physical exertion or stressful situations. It is also possible violations of the stool with alternating constipation and diarrhea, with a long course, weight loss is noted.
- Gallstone disease . Retrosternal burning in cholelithiasis is associated with the reflux of bile into the stomach and esophagus, which irritates the receptors of the nerve plexuses. Heartburn occurs against the background of intense pain in the right hypochondrium or epigastric region, which are provoked by errors in the diet. In children, an atypical localization of the pain syndrome is possible - near the navel. There is instability of the stool, asthenovegetative manifestations.
- Chronic constipation . Although heartburn in the chest is not a pathognomonic symptom of constipation, it is usually potentiated by the underlying disorder causing the patient's bowel problems. The main complaints are the slowing down of the usual rhythm of defecation, painful excretion of feces, the need for increased straining. There may be pain in the left iliac region, bloating, a feeling of incomplete emptying.
- intestinal ischemia . Dyspeptic disorders (nausea, heartburn, flatulence) prevail in the clinical picture of chronic occlusion of the superior mesenteric artery. Symptoms include sharp pains in the abdomen, which appear 20-3 minutes after eating and are stopped with antispasmodics, applying a warm heating pad to the stomach. In the stage of decompensation, the pathology proceeds with severe malabsorption, significant weight loss in patients.
Neurasthenia
Exhaustion of the nervous system and higher mental reactions, which is formed during prolonged stress, in a number of patients is manifested by dyspeptic disorders - belching with air, heartburn, flatulence. These symptoms are associated with disorders of the autonomic regulation of the gastrointestinal tract, discoordinated work of the reticular formation, nuclei of cranial nerves in the medulla oblongata and peripheral nerve plexuses. Characteristic of neurasthenia are severe "compressive" headaches and frequent dizziness, lability of pressure and pulse, psycho-emotional disorders.
Survey
The diagnosis is made by a gastroenterologist. When choosing methods, they proceed from the fact that heartburn in the chest is more typical for lesions of the upper digestive tract. The examination includes conducting modern laboratory and instrumental studies to assess the functional and morphological state of the gastrointestinal tract. The most valuable in terms of diagnostics are:
- Endoscopy . Endoscopic imaging of the esophageal and gastric mucosa is an informative method for confirming gastroesophageal reflux, the most common cause of heartburn. During endoscopy, it is possible to establish signs of inflammation, to detect areas of pathologically altered tissue. If necessary, take a biopsy of mucosal areas.
- Radiography . Conducting a series of x-rays after oral contrasting with barium sulfate is used to detect cicatricial deformities, strictures, volumetric neoplasms in the esophagus and stomach. With the help of radiography, the rate of advancement of the contrast along the gastrointestinal tract is controlled, which makes it possible to assess the contractile function of smooth muscles.
- Ultrasound Scan . Abdominal ultrasonography is indicated in all patients with burning in the chest as a rapid and non-invasive screening method that helps to identify non-specific signs of inflammation or morphological changes in organs. According to the indications, targeted sonography of individual organs is performed - the liver, pancreas.
- pH meter . The measurement of total acidity and the amount of free hydrochloric acid is used to detect hypersecretion of the lining cells of the stomach, leading to heartburn. Intraesophageal pH-metry has a high diagnostic value; normally, the acidity level should be above 4 units. Additionally, a blood test is taken for the level of pepsinogen and gastrin.
- Fecal analysis . Diseases of the pancreas and biliary system, which are often accompanied by a burning sensation behind the sternum, are always manifested by changes in the coprogram. Standard macroscopic and microscopic examination of feces is recommended, if necessary, a reaction to occult blood. According to the indications, the level of pancreatic elastase is determined.
It is mandatory to conduct manometry to study the contractility of the lower esophageal sphincter. The examination plan in the presence of retrosternal heartburn includes standard laboratory methods. An extended biochemical blood test with liver tests is necessary to assess the activity of the digestive processes and the functional state of the hepatobiliary system. After excluding organic causes of heartburn from the gastrointestinal tract, a neurological examination is necessary.
Drug therapy for heartburn is selected by a doctor
Symptomatic therapy
If heartburn behind the sternum occurs no more than 2 times a week for less than 6 months, this is considered a variant of the norm and does not require medical treatment. To reduce episodes of burning in the chest, it is recommended to review the diet: give up smoked meats, spicy and fatty foods, and reduce alcohol consumption as much as possible. To prevent leakage of gastric contents into the esophagus at night, it is better to sleep on a high pillow. It is useful to refrain from wearing compression belts, to avoid bending the torso and heavy physical work for an hour after eating.
The appearance of heartburn in the chest more than 2 times a week and the duration of one attack for more than 1 hour indicates the likely presence of an esophageal disorder or other gastrointestinal pathology. In such a situation, it is necessary to contact a gastroenterologist for examination and prescribing a drug therapy regimen. Until the clinical diagnosis is verified, antisecretory drugs, prokinetics, and antacids can be used to relieve discomfort. In some patients, psychotherapeutic treatment methods are effective.