Heartburn, or gastro-esophageal reflux disease (GERD), is caused by the reflux of acid from the stomach into the esophagus. This stomach acid can result in a burning pain as well as other symptoms that can be bothersome. In women, this can be difficult to distinguish between other medical problems such as gallstone disease and heart disease. Additionally, pregnancy may worsen heartburn symptoms considerably. While most people have occasional symptoms of heartburn, patients who experience this more than twice a week may ultimately have damage of the lining of the esophagus.
Causes
According to the National Institutes of Health (NIH), heartburn occurs when the lower esophageal sphincter opens spontaneously or does not close properly. Obesity and smoking may cause heartburn symptoms. In women, heartburn symptoms are particularly frequent when the patient is pregnant. Additionally, food such as citrus fruit, chocolate, caffeine, alcohol, spicy food and fatty or fried foods may produce symptoms of heartburn or may make heartburn worse.
Types
Heartburn symptoms in women are similar in nature to the symptoms that occur in men. Common symptoms include a burning pain in the mid-chest area or mid-abdomen. Particularly in women, these symptoms may be mistaken for cardiac disease and an evaluation for heart disease may be needed prior to diagnosis of heartburn. Additionally, patients may experience a dry cough, pain with swallowing or a worsening of asthma.
Identification
The symptoms of heartburn for women are diagnosed by a physician after taking a clinical history. The physician can typically tell that the symptoms are caused by heartburn due to the location of the pain and the fact that certain foods worsen the symptoms. If there is uncertainty regarding the diagnosis, a study called an upper endoscopy may be performed. As discussed by the NIH, this study involves a camera that goes through the mouth and allows direct visualization of the esophagus. This allows the physician to see the lining and whether there is damage from stomach acid.
Treatment
The treatment of heartburn symptoms depends on the cause of these symptoms. If a woman is pregnant, the symptoms often improve dramatically once the baby is delivered. In the meantime, raising the head of the bed, eating smaller meals, avoiding foods that worsen heartburn, quitting smoking and wearing loosely fitting clothes may help the symptoms. In severe cases, medications may be used. Antacids help to relieve heartburn by neutralizing stomach acid and are often used by women in pregnancy. Proton pump inhibitors and H2 blockers are also often used to improve heartburn symptoms by healing the esophageal lining and decreasing stomach acid. Women who are pregnant should discuss any medication with their physician prior to initiating treatment.
Complications
Heartburn symptoms in women are typically easily treated and resolve with therapy. If symptoms do not resolve or are not treated, however, several complications can result. Long-term inflammation of the lining of the esophagus can cause bleeding, scarring or ulcers. Scars can lead to narrowing of the esophagus and make it difficult for food to pass. Additionally, the lining of the esophagus can change and can lead to pre-cancerous or cancerous cells. This is known as Barrett's esophagus, and patients who develop this complication must be closely monitored by a physician to detect potential cancers as early as possible.
