Heartburn or pyrosis is a painful burning sensation in the esophagus, just below the breastbone. The pain often rises in the chest and may radiate to the neck or throat. Heartburn is also identified as one of the causes of asthma and chronic cough.

Pathophysiology
The sensation of heartburn is caused by exposure of the lower esophagus to the acidic contents of the stomach. Normally, the lower esophageal sphincter (LES) separating the stomach from the esophagus is supposed to contract to prevent this situation. If the sphincter relaxes for any reason (as normally occurs during swallowing), stomach contents, mixed with gastric acid, can return into the esophagus. This return is also known as reflux, and may progress to gastroesophageal reflux disease (GERD) if it occurs frequently. Peristalsis, the rhythmic wave of muscular contraction in the esophagus, normally moves food down and past the LES and is responsible for ultimately clearing refluxed stomach contents. In addition, gastric acid can be neutralized by buffers present in saliva.

Causes
Foods that may cause Heartburn:

Alcohol
Coffee, tea, cola, and other caffeinated and carbonated beverages
Chocolate
Citrus fruits and juices
Tomatoes and tomato sauces (such as pizza and pasta sauce)
Spicy foods and fatty foods (including full-fat dairy products)
Peppermint and spearmint

Diagnosis
Doctor initially makes a diagnosis of gastroesophageal reflux disease (GERD) based on the symptoms. In some cases, other tests will be done to confirm the diagnosis or exclude other disorders. Some of these are:

pH Monitoring

A probe is placed in the esophagus to keep track of the level of acidity in the lower esophagus. This is done over a 24-hour period.

Upper Gastrointestinal (GI) Series

A series of x-rays of the upper digestive system are taken after drinking a barium solution.

Manometry

This test measures muscle pressures in the lower esophagus.

Endoscopy

A thin, lighted tube with a tiny camera attached is passed down the throat to examine the esophagus and stomach.

Biopsy

A small sample of tissue from the esophagus is removed. It is then studied to check for inflammation, cancer, or other problems.

Treatment
Immediate Relief
If heartburn occurs when lying down, raising the head with pillows or sitting up frequently provides relief – although care must be taken to avoid placing continuous strain on the neck. Avoidance of certain foods shortly before bedtime is frequently advised to avoid future attacks.

Medications
Antacids, H2-receptor antagonists and proton pump inhibitors are used (in that order) to treat heartburn.


Antacids
Daily treatment with Antacids is effective for 25-30% of people with GERD. Acid-blocking medications are the most effective for mild forms of the condition.

H2-receptor antagonists
With the advent of proton-pump inhibitors, H2-receptor antagonists are not widely used.

Proton-pump Inhibitors
Proton pump inhibitor is a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors directly block acid production in the stomach cells and provide more effective relief than less powerful medications.

Restricting Diet
Restricting diet is very important, since 90-95% of sufferers of heartburn or esophageal disorder can link their symptoms to specific foods. Therefore, it is important that heartburn suffers manage their diets as a way to treat their heartburn. Sufferers should take kind of food and drinks which have little risk of causing acid reflux, while some kind of foods or drinks should be avoided as they are major heartburn triggers.

The source of this article is Wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL
 

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