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Home is where the heartburn is.

Heartburn, judging from the tonnage of antacids sold annually in this country, seems to be one of our most common maladies--little wonder, given our propensity for fast foods and faster living.

The backflow (reflux) of stomach acid into the lower end of the esophagus causes chronic heartburn (more correctly termed reflux esophagitis) and produces inflammation and irritation of the esophageal lining. Food moves to the stomach by the one-way muscular action of the esophagus. Reflex is normally prevented by a ring of muscle fibers (called a sphincter) at the lower end of the esophagus, where it joins the stomach. Weakness or relaxation of this sphincter permits the reflux of stomach acid into the esophagus.

After ruling out other. potential causes of pain in the mid-lower chest, the physician can diagnose reflux esophagitis either through endoscopy (in which a tube is inserted into the esophagus for direct viewing of the affected area), or the socalled upper GI series. In the latter procedure, the patient swallows flavored liquid barium while the radiologist views its action under the x-ray screen. As the barium flows into the stomach, any reflux can be seen and photographed as it occurs.

Chronic heartburn is usually treatable. Changes in lifestyle -- overeating, eating the wrong foods, smoking, and alcohol consumption -- Can bring relief. (Fatty foods, chocolate, smoking, and alcohol tend to relax the esophageal sphincter.) It helps to eat multiple small meals before bedtime, as does elevating the head of the bed.

If antacids don't work, drugs are available to reduce stomach acid formation. Don't, however, mistake the symptoms of more serious disease -- especially coronary heart disease -- for heartburn. Chest pain or sensation of fullness in the mid-lower chest region because of coronary insufficiency can mimic the symptoms of heartburn. In any case, let your doctor decide which it is.
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Publication:Medical Update
Date:Dec 1, 1993
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