“There’s this peppery feeling that I have in my chest sometimes…”
This is one of the most common complaints that some clients have when they come to visit the Doctor. “Sometimes I have a dull ache in my chest and it seems to reach up to my throat. It’s worse when I bend forward to pick up stuff from the floor.”
Chest pain is one of the most complained-about symptoms the world over.
There are very many causes of chest pain, but we will consider just one today: It’s called Heartburn.
People have had frustrating experiences with this symptom since ancient times, and their doctors and philosophers called it “heart pain”-a logical name, since the pain was in the chest, and the heart was known to be in the chest as well! It was illegal to dissect human bodies to study Anatomy those days, but now we know better. Heartburn was not exactly a perfect name for the condition, but it has stuck with us since!
What is Heartburn?
Heartburn is a burning sensation in the centre of the chest or upper central part of the abdomen. The pain often spreads from the chest and may radiate to the neck, throat, or angle of the jaw.
How Does Heartburn Happen?
Normally, during a meal, food is swallowed from the mouth to the throat (the oesophagus or esophagus) and from there, the food passes into the stomach. The stomach contains some fluids and acids for digestion of food. At the junction between the oesophagus and stomach, there is a gate or valve called the Lower Esophageal Sphincter, or LES for short.
The LES closes securely after food is passed into the stomach, and ensures that what happens in the stomach stays in the stomach…
But sometimes, and for some reasons, the LES gets weak and stomach acid can reflux backwards through it, into the oesophagus. This is very much like when the drains reflux back into the kitchen sink!
The acid irritates the oesophagus and causes the characteristic pain of heartburn.
The Bigger Picture…
Heartburn is not the bad guy in itself! It’s just a sign of a specific disease.
The condition in which there is a reflux of acid from the stomach to the oesophagus is called Gastroesophageal Reflux Disease, or GERD, or GORD, or just Gastric reflux.
GERD is the most common cause of heartburn. A few other times, the heartburn has no traceable cause, hence it is called a Functional heartburn.
What Are The Symptoms of Gastric Reflux?
Peppery chest pain and occasional regurgitation (when stomach contents come back up to the mouth!) are some typical symptoms noticed.
Less common, more bizarre symptoms are:
Cough; wheezing; and breathing difficulty. All these are usually worse at night, while lying down.
Bad breath (halitosis); corroded teeth and episodes of recurrent chest infections are even more disturbing symptoms and these usually occur when acid has travelled up the oesophagus to the mouth and into the lungs, destroying anything in its path!
What Causes LES Weakness and Gastric Reflux?
Lifestyle. Risk factors include being overweight; eating large meals; wearing tight clothing; smoking.
Certain foods like chocolate; coffee; peppermint; fizzy drinks; tomato-based products…and indeed, alcohol.
Some drugs can weaken the LES too and cause Gastric Reflux: Sleeping pills like diazepam (Valium®); the asthma drug salbutamol or albuterol (Ventolin®); Hyoscine or Scopolamine (Buscopan®) and the likes…
Pregnancy, heart failure and liver failure are among conditions that can cause a big tummy and hence lead to Gastric reflux.
Things Aren’t What They Seem…
Chest pain can be a masquerade, hiding things from us that could put us in grave danger.
A few serious conditions that may look like an “innocent” heart burn include:
Peptic Ulcer Disease,
What to Do About Heartburns
Work on weight loss if necessary, have a talk with your doctor;
Avoid frequent large meals;
Avoid late night meals. No meals at least three hours before bed time;
Cut down on oily or fried food;
Watch out for tight clothing, especially belts and shirts;
Check with your pharmacist or medical staff before using medications;
Identify your “trigger meals”. Some people have their heartburn caused by certain foods unique to them;
Elevate the head of the bed to at least 18 degrees: This helps to reduce overnight reflux risk and bring about sound sleep.
Most people have had at least an episode of heartburn before.
But do you have recurrent episodes of heartburn? Any other kind of chest pain?
Go pour out your heart to your doctor as soon as you can.
…and have yourself a heart-ache-free week indeed!
p.s: Thanks to Dr. V. John Bagnato of www.georgiarefluxsurgery.com; and www.webmd.com