Does Heartburn Have Anything to Do With the Heart?

The short answer to that question is no.

The term heartburn originates from the burning sensation which can be felt in the middle of the chest close to the heart.  It is pain caused by the damage to the esophagus that the reflux of acid from the stomach causes and it has nothing to do with the heart at all. However, having said that heartburn has nothing to do with the heart, the symptoms of heartburn can be very similar to the signs of heart disease. If you experience heartburn with any of the symptoms listed below you should consult your doctor immediately as it may possibly mean that you’re having a heart attack.

  • Pain radiating into your back, neck, jaw, shoulders or arms — especially your left arm
  • Sudden pressure, tightening, squeezing or crushing pain in the center of the chest that doesn’t disappear after a few minutes
  • Feeling light-headed or dizzy
  • Being short of breath or having difficulty breathing
  • Becoming clammy or sweaty
  • Vomiting with blood
  • Bloody or black stools

You should also contact your doctor immediately if your heartburn feels different or more severe than normal and it occurs during or immediately following physical activity or, if you experience any new chest pain or discomfort and you smoke, are overweight or have heart disease diabetes, high cholesterol or previously had a heart attack.  Remember that correct diagnosis and prompt medical treatment can save lives.  Although the occasional occurrence of heartburn is extremely common and should be of little concern, if you are regularly experiencing heartburn you need to speak with your doctor as this could mean you have an ulcer or other underlying health condition. Heartburn caused by acid reflux usually increases after eating but if your heartburn is worse before eating, it can be a sign that you have an ulcer.

Why Does Heartburn Return When I Stop Taking Medication?

One possible reason for your heartburn returning is that your medication may be masking the problem. Traditional heartburn medication works by suppressing the acid levels in your stomach but you have to remember that your stomach is meant to be a highly acidic place. The acid in your stomach is there to breakdown food and protect you by killing off bacteria and parasites. By reducing the acid levels in your stomach the medication reduces the damage to the esophaghus when the acid reflux occurs but it doesn’t tackle the underlying reason for the reflux. This means that when you stop taking the medication your acid levels return to their previous levels and the heartburn returns.

Apart from physical causes of heartburn such as pregnancy or obesity placing pressure on the stomach, the most widespread theory for the cause of heartburn puts the blame squarely with the production of excess stomach acid. There is however another school of thought which believes that heartburn is caused by insufficient acid in the stomach. This theory believes that where there is insufficient hydrochloric acid the stomach is no longer able to deal with bacteria and parasites, or foods that are not easily tolerated, such as wheat or dairy products, and the lining of the stomach becomes inflamed. It is this inflammation which is made worse by contact with stomach acid causing the symptoms of heartburn.

The acid levels in the stomach work to both close the lower esophageal sphincter (LES) to protect the delicate tissues of the esophaghus and to trigger opening of the pyloric valve, between the stomach and the small intestine. If the pyloric valve is not opened to release the stomach contents the undigested food will become rancid and start to ferment causing gas and bloating . This gas and bloating places more pressure on the LES, increasing the probability that acid reflux will produce symptoms of heartburn.

Heartburn: Is My Stomach Acidity too High or too Low

If you are suffering from heartburn due to insufficient or excessive stomach acid you either have hypochlorhydria (too little) or hyperchlorhydria (too much).  There are some unfortunate individuals who have no stomach acid and the medical term for this condition is called achlorhydria.

There are at least two medical tests which can be undertaken to measure stomach acidity.  One test is to examine the stools for undigested protein, but the most well known method to measure stomach acidity is called the Heidelberg test; this test was developed at the famous German University of Heidelberg.

To carry out the test you swallow a small radio transmitter about the size of a large vitamin capsule.  This is a very safe procedure with well over a million tests having taken place worldwide and the transmitter is not radio-active. Before you swallow the capsule it is activated and calibrated.  You wear a transceiver on a strap around your neck and after swallowing the capsule the transceiver receives the signal from the capsule which measures the acidity that it finds. You are given doses of acid-neutralizing sodium bicarbonate (baking soda) and if your acid level doesn’t return to normal after a few minutes, hypochlorhydria is a likely diagnosis.

Here are three preliminary self tests which you can undertake at home before visiting your doctor:

  1. Take a small amount of baking soda in water first thing in the morning and if you have not belched within a few minutes, you may not be producing enough stomach acid, since hydrochloric acid reacts with baking soda to produce carbon dioxide gas.
  2. Take a dose of a Betain hydrochloride supplement before the start of a meal and if you experience any warmth, burning or indigestion associated with excess acid, it is unlikely that you are suffering from insufficient stomach acid.  If this happens you should be able to obtain relief by taking a teaspoon of sodium bicarbonate in water.
  3. When you are suffering with heartburn, take one tablespoon of fresh lemon juice. If the lemon juice remedies your heartburn then this probably means you need more stomach acid but if your heartburn becomes worse, your stomach probably has too much hydrochloric acid.


Heartburn Treatment: What is Confocal Laser Endomicroscopy?

Confocal laser endomicroscopy (CLE) is a medical procedure which uses a specially adapted endoscope that allows doctors to look at images that are magnified by a 1,000 times. These extreme close up images enable doctors to make “optical biopsies” and provide a better diagnosis of all gastrointestinal disorders like heartburn, GERD or Barrett’s Esophagus.

This procedure uses a tiny microscope at the end of an endoscope to provide the magnification, whilst a very low power laser light provides the illumination. The laser is focused at a specific depth so only reflected light from this depth is able to provide images and this produces better quality imaging with more spacial resolution.

The images are immediately displayed on a computer screen often allowing the doctor to make an accurate diagnosis then and there and start any treatment straight away. If biopsies are needed the high quality images makes these much more targeted thereby reducing the number needed. Before this procedure was introduced a few years ago, it took anything up to a week to make an accurate diagnosis because the doctor would have to take photos and then do a mucosal biopsy.

For a condition such as Barrett’s Esophagus the procedure is able to identify changes at a cellular level and this can help provide an earlier diagnosis and commencement of treatment. It also allows a more accurate identification of areas needing removal and can also be used after removal to confirm that sufficient tissue has been removed.

How Do Proton Pump Inhibitors Work

Proton Pump Inhibitors or PPIs as they are commonly called, is the name given to a group of pharmaceutical drugs that have been developed to provide a long lasting and very noticeable reduction in the amount of gastric acid that the body produces.  They have all but replaced another group of drugs called H2- receptor antagonists which were designed to have the same effect on gastric acid production, but which achieved their results by different means and were less effective.   PPIs are big business for the Pharmaceutical Industry as they are one of the most widely sold drugs in the world.

How do they work

The drugs work by blocking the body’s proton pump in the stomach, the hydrogen/potassium  adenosine triphosphatase enzyme system as it is this enzyme which is responsible for producing the high levels of acidity in the stomach.  PPIs are highly effective and can cut the production of gastric acid secretion by up to 99%.

Why are they used

The reduction of gastric acid is very useful in allowing time for ulcers to heal and in reducing the pain of indigestion and heartburn.  They are often prescribed to treat GERD (Gastroesophageal reflux disease, Laryngopharyngeal reflux, Dyspepsia, Peptic Ulcer Disease, Barrett’s Esophagus, Gastrinomas, Zollinger-Ellison syndrome and to prevent stress induced gastritis.

What are the Commonly Prescribed PPIs

  • Dexlansoprazole – Brand name Dexilant (formerly Kapidex)
  • Esomeprazole – Brand names include Esotrex and Nexium
  • Lansoprazole – Brand names include Inhibitol, Levant, Lupizole and Prevacid
  • Omeprazole – Brand names include Losec, Omepral, Omez, Prilosec and Zegerid
  • Pantoprazole – Brand names include API, Controloc, Pantoloc and Pantozol
  • Rabeprazole – Brand names include AcipHex, Pariet and Rabeloc

In recent years many of the PPIs have become available in “Over the Counter” OTC formulas that can be brought without prescription.