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Effects of Uncontrolled Heartburn

Heartburn and acid reflux affect millions of people every year. Because it’s common, you may be inclined to believe that frequent heartburn is no big deal and something you should simply learn to endure. However, frequent heartburn that is left untreated can lead to more serious health complications.

What causes heartburn?

In most cases, the pain of heartburn is caused by stomach acid flowing back up into the esophagus. Frequent heartburn can be a symptom of GERD, or gastroesophageal reflux disease. GERD patients experience persistent heartburn and acid reflux because the valve that’s supposed to keep acid inside the stomach is malfunctioning in some way. While occasional reflux may be nothing more than an uncomfortable annoyance, uncontrolled and recurring heartburn can cause long-term problems.

What are the effects of uncontrolled heartburn?

  • Esophagitis: Repeated exposure to stomach acids can injure the lining of the esophagus and cause painful inflammation known as esophagitis. Esophagitis can also cause ulcers, painful, open sores on the lining of the esophagus, and bleeding.
  • Cancer: In some cases, long-term GERD can lead to a condition called Barrett’s esophagus (BE). This condition is characterized by new, abnormal cells forming to replace those damaged by constant exposure to acid. Over time, Barrett’s esophagus can lead to cancer. People who suffer from nighttime heartburn are especially prone to developing cancer as a result of their acid reflux.
  • Narrowing of the esophagus: If your esophagus is damaged from acid, it may develop a buildup of scar tissue that narrows the opening of the esophagus. This can cause problems with swallowing and the ingestion of food.
  • Respiratory problems: It’s believed that GERD causes respiratory problems because acid backs up into the airway and nasal passages. Frequent heartburn has been linked to an increased risk for asthma, chronic bronchitis, chronic cough, chronic sinusitis, emphysema, and recurrent pneumonia.
  • Dental problems: GERD patients have been shown to have more erosion of tooth enamel than people without GERD. Stomach acids that back up into the mouth can also cause bad breath.

If you have heartburn that occurs two or more times a week, contact your doctor. There are treatment options available to handle heartburn and GERD, and they can prevent you from experiencing any of these long term effects.

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Treating Heartburn and Acid Reflux

If you’re suffering from heartburn, your doctor will probably conduct a few routine tests to diagnose the source of your heartburn discomfort and rule out any underlying cardiac problems. After pinpointing the source of your problems are reflux related, there are several options your doctor may recommend for the diagnosis and treatment of your heartburn.

Diagnostic Tests for Evaluation of Heartburn

If you’re complaining of frequent heartburn you may be suffering from symptoms of another underlying health problem. Your doctor may run a series of diagnostic tests to evaluate if your chest pain and heartburn is caused by GERD, an acid-reflux disease.

The Proton Pump Inhibitor Test

If you have non-cardiac chest pain, your doctor may have you take a proton pump inhibitor, a medication that reduces the production of acid in the stomach. After a trial period, your doctor will assess whether or not PPI treatment alleviated your symptoms. The benefit of this type of diagnostic test is that it is simple, safe, and generally cost-effective. The proton pump inhibitor test is also less invasive than other diagnostic testing methods.

pH Monitoring

If your doctor is concerned about abnormal esophageal acid exposure, or if your symptoms do not respond to PPI treatment, you may undergo 24-hour pH monitoring. This diagnostic test is also commonly used to determine if a patient is a good candidate for antireflux surgery.

To perform esophageal pH monitoring, a thin plastic tube is inserted into one nostril, down the back of the throat, and into the esophagus as you swallow. An acid sensor on the tip of the tube is positioned in the esophagus, just above the lower esophageal sphincter. The sensor records each reflux of acid that occurs over the next 24 hours and reports to a recorder that you carry with you.

This diagnostic test helps create a correlation between acid reflux and the symptoms you’re experiencing.

Esophageal Manometry

During an esophageal manometry, a tube is inserted into your nose and down your throat. You’re then asked to lay on your left side and swallow small amounts of water. A sensor on the tube measures how much pressure your body is exerting on the tube. The test takes 20 to 30 minutes to complete.

An esophageal manometry can help your doctor determine how well your lower esophageal sphincter, the valve that should keep acid from backflowing into your esophagus, is functioning. It can also test whether your esophagus is moving food into your stomach properly. An esophageal manometry may also be done before pH monitoring to determine where the sensor should be placed.

Possible Treatment Options For Serious Heartburn

Lifestyle Changes

If you have mild symptoms of heartburn or acid reflux, your doctor may suggest making simple lifestyle changes before further intervention. Some of these modifications may include elevating the head of your bed to reduce nighttime reflux, staying away from acid-inducing foods, avoiding late-night meals or snacks, and quitting smoking.


Your doctor may prescribe a medication designed to decrease your body’s production of acid. The most common and typically effective medications used in these instances are proton pump inhibitors, or PPIs. Other medications that are less commonly used to treat heartburn include histamine receptor-2 antagonists (HR2As) and smooth muscle relaxants.


Some patients will not respond to PPI therapy, or are responsive but do not wish to be on long-term medication. In these instances, antireflux surgery may be suggested as a treatment option. Currently, the two most commonly performed antireflux surgeries are Nissen fundoplication and Toupet partial fundoplication.
Talk to your doctor about which treatment for heartburn and chest pain is right for you. You’ll want to consider the severity of your symptoms, the underlying cause of your pain, and overall effects on your lifestyle.

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Laryngopharyngeal Reflux

GERD, or gastroesophageal reflux disease, is characterized by stomach acid that flows back into the esophagus. The symptoms of GERD include frequent heartburn that occurs more than twice a week. In some cases, stomach contents will actually flow past the esophagus up to the larynx or pharynx, which are located at the back of the throat. This is referred to as laryngopharyngeal reflux or pharingotracheal reflux.

Laryngopharyngeal reflux (LPR) and GERD are two related, yet different, diseases. They each have different risk factors, symptoms, and treatments. People who suffer from one type of reflux disease are not necessarily diagnosed with other types of reflux diseases.

LPR Symptoms vs. GERD Symptoms

The most common symptoms of gastroesphageal reflux disease include:

  • Frequent heartburn
  • Pressure or nausea in the stomach
  • Regurgitation
  • Reflux symptoms when laying down

People who suffer from laryngopharyngeal reflux or pharingotracheal reflux do not usually complain of frequent heartburn. Instead, their symptoms are more likely to include:

  • Hoarseness
  • Globus sensation (feeling a lump in your throat)
  • Throat-clearing
  • Sensation of postnasal drip
  • Difficulty swallowing
  • Chronic cough
  • Laryngospasm (vocal chord spasm that makes it difficult to speak or breathe)
  • Reflux symptoms when sitting up

GERD can cause damage to the esophageal lining. LPR, on the other hand, involves damage to the laryngeal mucosa. Because the laryngeal mucosa is more susceptible to injury from acid reflux, it usually requires a longer treatment time for the symptoms of laryngopharyngeal reflux and pharingotracheal reflux to subside.

Diagnosing Pharingotracheal or Laryngopharyngeal Reflux

Pharingotracheal reflux (or, Laryngopharyngeal reflux) involves stomach acid backflowing past the esophagus to the larynx or pharynx, which lies at the top of the the larynx before the split between the esophagus and trachea. This type of reflux is usually characterized by hoarseness, sore throat, or upper respiratory problems rather than frequent heartburn.

Often times, LPR can be diagnosed by a simple examination in a doctor’s office. A mirror and light is used to view the throat and vocal box. In people suffering from LPR, the tissue in the throat may appear to be red, irritated, or swollen.

Further diagnostic testing may include barium esophagography, radionucleotide scanning, the Bernstein acid perfusion test, esophagoscopy with biopsy, impedance testing, and pH probe to determine the extent of damage caused by pharingotracheal or laryngopharyngeal reflux.

Treating Pharingotracheal or Laryngopharyngeal Reflux

While it often takes as little as two weeks of treatment to reduce symptoms of GERD, it may take several months of treatment for LPR symptoms to resolve. Treatment for LPR may include:

  • Histamine blockers: Medicines such as Pepcid, Tagamet, or Zantac that reduce acid production
  • Proton pump inhibitors: Medicines such as Prilosec, Nexium, or Prevacid that prevent stomach acid from forming
  • Lifestyle changes: Eating smaller meals, avoiding late-night snacks, and quitting smoking
  • Dietary changes: Avoiding alcohol, caffeine, carbonated beverages, citrus fruits and juices, fatty foods, and spicy foods

If antireflux therapy does not reduce the symptoms of LPR, further testing may be needed to rule out another underlying laryngeal disorder.

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Hiatal Hernia

A hiatial hernia is a rare anatomical abnormality that is usually seen in an adults and is thought to have developed over the course of several years.

What is a hiatial hernia?

A hiatial hernia is a condition in which part of the stomach protrudes through the diaphragm and up into the chest. Normally, the esophagus passes through a small hole in the diaphragm and is connected to the upper stomach just below the diaphragm. In people with a hiatial hernia, the opening of the diaphragm is larger than normal and part of the stomach pushes up past it so that the connection between the esophagus and stomach is now located above the diaphragm.

What causes hiatial hernias?

There are three common physical causes that can contribute to a hiatial hernia.

Large esophageal hiatus: The opening in the diaphragm that the esophagus normally passes through is called the esophageal hiatus. If this opening is larger than normal, the stomach can have room to push up past the diaphragm.

Permanent shortening of the esophagus: If the esophagus is shortened, possibly due to damage from acid reflux, it can pull the stomach up farther into the chest than it should be, past the esophageal hiatus.

Loose attachment of the esophagus to the diaphragm: If the connection between the esophagus and the diaphragm isn’t secure, that can also cause the stomach to slip up into the upper chest.

Although most hiatial hernias do not cause noticeable symptoms, in some cases they can lead to GERD, a condition associated with frequent heartburn and acid reflux. In these cases, repairing the hiatial hernia with surgery may help reduce the symptoms of GERD.

Types of Hiatal Hernia

A hiatal hernia is a condition in which part of the stomach protrudes through the diaphragm and up into the chest. There are two different types of hiatal hernias.

Sliding Hiatal Hernias
The most common type of hiatal hernia is referred to as a sliding hiatal hernia. This occurs when the junction of the esophagus and stomach, or gastro-esophageal junction, and part of the stomach protrude into the chest. While the gastro-esophageal junction can permanently rest in the chest, it usually only juts into the chest during a swallow. When you swallow, the esophagus contracts and shortens and pulls the stomach up. A sliding hiatal hernia will fall back down beneath the diaphragm when the swallow is finished.

Para-Esophageal Hiatal Hernias
The less common type of hiatal hernia is called a para-esophageal hiatal hernia. In these cases, the junction between the esophagus and stomach stays below the diaphragm, but part of the stomach itself actually bulges up into the chest around or beside the esophagus. A large para-esophageal hiatal hernia may cause food to stick in the esophagus after it is swallowed or cause ulcers in the herniated part of the stomach.

Most hiatal hernias cause no symptoms; however, in some cases, hiatal hernias can cause frequent heartburn or acid reflux associated with GERD. Hiatal hernias can only be diagnosed by upper gastrointestinal x-ray or endoscopy and are usually discovered incidentally while trying to address other health concerns.

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What is Proton Pump Medication for Heart Burn?

Heart burn is a miserable and often chronic condition. When you have chronic heart burn, your stomach acid creeps up from your stomach into your esophagus through a loose or strained valve. It can leave you with a bitter tasting sting in your throat that often feels like your actual chest is burning.

There are many over the counter medications used to fight and treat heart burn. Some of these medications are known as proton pump inhibitors, and they are the latest defense in an age-old battle.
Proton pump inhibitors work by attaching to some of the pumps that rest in the lining of your stomach. Normally, these pumps are responsible for releasing the stomach acid that helps you break down foods and get them ready for absorption and digestion.

With proton pump inhibitors attached, however, the pumps are unable to produce acid. The inhibitors only affect a few pumps within the stomach lining, thereby decreasing the overall amount of acid your pumps are able to produce, but not stopping it all together. This leads to less stomach acid and less heart burn without compromising your body’s ability to digest food and absorb vital nutrients.

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