Heartburn is a kind of chest pain that is caused by the irritative effects of gastric juice going backward into the esophagus. The most common cause of this condition is gastroesophageal reflux. Though painful, heartburn is rarely a serious problem and can be treated with antacids. Frequent heartburn may be due to gastroesophageal reflux disease, or GERD, and should prompt a visit to a doctor. Anyone of any age can have GERD.
Causes of Reflux
The esophagus is a hollow organ that transmits food from the mouth to the stomach. The lower end of the esophagus is normally kept closed at all times except during swallowing. This prevents substances in the stomach from going backward. When the lower end of the esophagus cannot close effectively, gastric acid can travel upward and irritate the organ's inner lining. This leads to the typical burning sensation of heartburn.
Reflux in Teenagers
Heartburn is a common cause of chest pain in teenagers, with males being affected more often than females. Though the specific causes are unknown, GERD is associated with factors such as such weight gain, smoking, oral contraceptive use and asthma, all of which may begin in the teenage years. Obesity is particularly linked to acid reflux and may be due to a weakness of the lower esophagus because of excess fat accumulation.
Symptoms
Heartburn typically causes a burning sensation in the chest, directly behind the breastbone. The pain may get worse on bending forward, straining or lying down. Some teens may find that their symptoms worsen if they eat fatty foods, spices, coffee or chocolate. Some may experience a sour taste in the mouth; this unpleasant sensation is called waterbrash and is due to excess salivation following reflux. In severe cases, patients may have painful or difficult swallowing.
Diagnosis
The pain of heartburn is usually very characteristic and requires no specific testing. Pain occurring more than once a week should prompt a diagnosis of gastroesophageal reflux disease. Patients with severe or atypical pain may require an electrocardiogram to rule out heart conditions. If the diagnosis is not clear, measurement of lower esophageal weakness can be done by a procedure called manometry.
Treatment
Acid reflux is usually a mild disease, and treatment can relieve symptoms. For simple cases of heartburn, an over-the-counter antacid may be used. Gastroesophageal reflux disease can be treated with acid-suppressing agents such as ranitidine or omeprazole. Patients should also try lifestyle changes such as losing weight, avoiding aggravating foods and quitting smoking.
Complications
Untreated esophagitis can lead to complications including anemia and the formation of constrictions in the esophagus. A rare but serious complication of GERD, Barrett's esophagus, is due to changes that can occur in the esophagus over years and can increase the risk of cancer. Patients with longstanding reflux may be advised to undergo endoscopy to look for any such changes.
References
- MedlinePlus: GERD
- National Jewish Health: Gastroesophageal Reflux Disease (GERD); December 2010
- "Davidson's Principles and Practice of Medicine"; Nicholas Boon et al.; 2006
