Treatment of heartburn

Heartburn caused by gastroesophageal reflux disease (GERD) ranks third among digestive system disorders, following peptic ulcer disease and gallstone disease. Reflux disease, or reflux esophagitis, involves recurring episodes of acidic stomach contents flowing back into the esophagus, leading to damage in its lower sections.

The main cause of heartburn (gastroesophageal reflux disease) is the excessive effect of hydrochloric acid on the walls of the esophagus. This occurs due to the malfunction of the lower esophageal sphincter, whose function is to regulate the passage of food from the esophagus into the stomach.

Other causes of GERD include:

• altered chemical properties of saliva;

• poor muscle tone of the esophagus;

• impaired gastric motility;

• increased intra-abdominal pressure, etc.

Reflux often develops in people who are overweight, smokers, and those who abuse alcohol. Contributing factors also include stress, consumption of spicy and fatty foods, and the use of certain medications.

The main symptoms of GERD are:

• belching;

• heartburn;

• pain in the back and behind the sternum radiating to the neck and jaw;

• painful swallowing;

• unexplained dry cough.

To identify the process of stomach contents refluxing into the esophagus, gastroenterologists perform various diagnostic procedures. Endoscopic examination makes it possible to confirm the presence of reflux and assess the extent of mucosal damage. 24-hour esophageal pH monitoring is used to determine the frequency, duration, and severity of reflux episodes. In cases where Barrett's esophagus is suspected, a biopsy of the esophagus is performed along with histological examination, as epithelial changes can only be diagnosed using this method.

GERD treatment can be either conservative or surgical.

Medical treatment of heartburn includes the use of the following medications:

• antacids (to reduce the acidity of stomach contents);

• drugs that suppress the stomach’s secretory function;

• prokinetics to normalize gastrointestinal motility.

If duodenal contents reflux is present, ursodeoxycholic acid is prescribed. Patients are strongly advised to quit smoking (if applicable), completely abstain from alcohol, and in cases of obesity — reduce body weight. It is not recommended to bend forward or lie down immediately after meals. Tight clothing that increases intra-abdominal pressure should be avoided, as should overeating and eating before bed. Fatty and spicy foods, strong coffee and black tea, carbonated drinks, chocolate, sweets, and citrus fruits should be entirely excluded from the diet.

Surgical methods of treatment are used in cases of significant narrowing of the esophageal lumen or in the presence of severe bleeding.