Heartburn is first and foremost symptom that shows up in many gastroesophageal diseases.
Gastroesophageal reflux disease (GERD) is a major disease caused by acid regurgitation.
Heartburn is a common discomfort experienced occasionally by everyone.
But when the reflux episodes repeat more than two weeks, then it becomes a symptom of many gastroesophageal diseases like esophagitis, esophageal cancer, dyspepsia, Barrett’s esophagus, and heart diseases.
Proper care in diet and medical help to get rid of the discomforts caused by heartburn in our daily life activities
Possible Health Consequences on Health
There can be several health consequences of heartburn.
Some of the most common ways heartburn can impact health are as follows:
Functional Heartburn
Functional heartburn is not related to gastroesophageal reflux.
It is a gastrointestinal disorder, which is an episodic retrosternal burning sensation. It is observed in nonerosive reflux disease.
In endoscopic diagnosis, no esophagitis is noticed. Functional heartburn is classified into several subgroups.
The identification of different subgroups of functional heartburn based on the history of clinical studies not achievable by doctors at present.
Because the pathophysiological reason of functional heartburn is not known till now.
The response to antireflux treatments is very limited in functional heartburn disorder.
The absence of esophagitis in endoscopy clearly reveals that reflux-related symptoms are absent in functional heartburn.
It is identified that the prescription of a standard dose of proton pump inhibitors ( PPI) and an increased dose of PPI in addition to pain modulators don’t cure functional heartburn.
Esophagitis
Prolonged heartburn and acid regurgitation cause esophagitis.
The inner membrane tissues of the esophagus are damaged by prolonged acid regurgitation and this result in irritation in the esophagus.
Any inflammation, swelling or irritations in the esophagus are generally termed as esophagitis.
Eosinophilic esophagitis is an autoimmune disorder which also causes the irritation in esophagus.
Smoking, alcohol consumption, intake of medications (eg: corticosteroids, tetracycline) increase the risk of esophagitis.
The symptoms of esophagitis are a cough, difficulty and painful swallowing, heartburn, hoarseness, sore throat and ulcer.
Esophageal infections caused by yeast, Helicobacter pylori (bacteria which causes peptic ulcer), viruses like herpes can also cause esophagitis.
Eosinophilic esophagitis is caused by severe infiltration of eosinophils (a type of white blood cells) into the esophagus.
It is unresponsive to acid blockage. It mimics gastroesophageal reflux disease. Based on the amount of mucosal eosinophils, eosinophilic esophagitis is differentiated from reflux esophagitis.
The symptoms are heartburn, swallowing difficulty, esophageal strictures, and dysphagia.
The cytokines released by the eosinophils are assumed to cause inflammation in the tissues of the esophagus.
This irritation is the main reason for the condition of eosinophilic esophagitis.
Barrett’s Esophagus
Barrett’s esophagus is condition developed by the replacement of esophageal tissues by goblet cells present in the stomach due to acid regurgitation.
The stomach acid causes inflammation in the lining of the esophagus. Men are more susceptible to Barrett's esophagus than women.
Prolonged heartburn and GERD causes Barrett’s esophagus.
It can develop into adenocarcinoma (cancer).
The treatment of Barrett’s esophagus mainly focuses on the removal of the harmful tissues developed in the esophagus.
The laser device Photodynamic therapy along with drugs and surgical techniques are used for the treatment.
The process of replacement of esophageal tissue cells to cells of the stomach is termed as intestinal metaplasia. 1.6 to 6.8 percent of people have Barrett’s esophagus disease.
It is majorly caused by people who are above 50 years and it is rarely caused to children.
The squamous epithelial cells in the esophagus are replaced by lumnar epithelial cells present in the stomach.
Presence of lumnar epithelium in the gastroesophageal junction reveals the incidence of Barrett’s esophagus.
It is noticed that bacterial infection, especially Helicobacter pylori can decrease the risk of Barrett’s esophagus. H
igh intake of fruits, vegetables, vitamins and frequent use of aspirin and nonsteroidal anti-inflammatory drugs reduce the risk of development of Barrett’s esophagus.
Esophageal Cancer
Esophagus cancer develops in the tissue lining of the esophagus. Cancer is a condition of abnormal cell growth.
Cancer is also termed as malignant tumor. Barrett’s esophagus disease increases the development of esophageal cancer.
It develops in the inner lining of the esophagus and extends towards other tissues.
There are two main types of esophageal cancer-Squamous cell carcinoma and adenocarcinoma.
Squamous cell carcinoma is found in the squamous cells in the lining of the upper esophagus.
Adenocarcinoma develops in the glandular cell lining of the lower esophagus.
Esophageal cancer is uncommon cancer caused to people who are above 60 years.
Men are more susceptible than women. Adenocarcinoma causes the release of mucus and other fluids. The symptoms of esophageal cancer are
- Chest pain
- Difficulty in swallowing food and liquid
- Acid and food regurgitation
- Heartburn
- Vomiting of blood
- Weight loss
- Hoarseness and cough
The major cause of squamous cell esophageal cancer is smoking and a high level of alcohol consumption.
But adenocarcinoma is more common esophageal cancer, which develops from Barrett’s esophagus disease.
The causative factors develop esophagitis and increased cell turnover that initiates the tumor growth.
It has been identified that esophageal cancer is the sixth leading cause of death worldwide in case of all cancer diseases. Esophageal cancer’s pathophysiology is unknown till now.
Several epidemiological studies have shown that obesity and esophageal cancer are parallel.
Increase in obesity shows a threefold increase in the incidence of esophageal cancer.
Experimental studies in animals also reveal that nitrosamines a carcinogen present in tobacco can induce esophageal cancer.
Cessation of smoking and diet control can improve and prevent the incidence of esophageal cancer.
Dyspepsia
Pain and discomfort in the upper abdomen define the condition of dyspepsia. It is also called as indigestion.
The symptoms are bloating, nausea, heartburn and recurrent pain in the upper abdomen.
The discomfort is felt right after a meal and experience fullness in the stomach after a full meal.
The reasons for incidence of dyspepsia are alcohol consumption, intake of spicy and fried food, smoking and high caffeine intake.
The subgroups of dyspepsia are ulcer-like, non-ulcer (functional) dyspepsia, dysmotility-like, reflux-like, and unspecified dyspepsia.
Functional dyspepsia is also observed in children.
In ulcer-like dyspepsia, upper abdomen pain is reduced by food and antacid therapy.
In functional dyspepsia, the symptoms prolong from at least three to six months.
Helicobacter pylori infections can also incidence dyspepsia. Effective treatments for functional dyspepsia are very limited.
Antacids, antispasmodics and prokinetics drugs provide relief for the symptoms of dyspepsia.
Asthma and other Respiratory Disorders
A large number of patients who have GERD also develop asthma.
Sometimes, it is also considered one of the symptoms of GERD since other common symptoms such as frequent heartburns can be totally absent in some patients.
It occurs when acid reflux in the oesophagus stimulates the vagus nerves in the gut which are also connected to the respiratory system.
These nerves in response to the acid constrict that in turn causes asthma.
Another way in which acid reflux can cause asthma is by reaching the upper portion of the food pipe near the throat, it is at this point that it is aspirated in the airways.
This may cause irritation in the cells of the respiratory tract leading to the symptoms of asthma.
There is a limited consensus between scientists on this topic. Some justify that GERD causes this respiratory disorder whereas others state vice versa.
Whatever the case may be, it is a well-established fact that GERD is associated with respiratory disorders which include asthma, bronchitis, cough, pulmonary pneumonia, chronic sinusitis, pulmonary fibrosis (scarring of the lung tissue), hoarseness in voice and even cancer of the larynx.
Laryngeal cancer is a condition similar to that of oesophageal cancer except that in this case cancer develops due to the damage caused by acid in the tissues of the larynx .
Dental Erosion
Sometimes, the acid reflux occurs to a greater extent and the acid reaches the mouth not just giving sour taste all the time but also eroding the teeth.
Prolonged exposure of the teeth to the acid causes the erosion of the tooth enamel which is the protective white covering of the dentures.
If this is not treated on time, it may also lead to permanent tooth damage and may need full dental rehabilitation.
Sleep Apnea
Also called obstructive sleep disorder, sleep apnea is a condition in which breathing stops temporarily but frequently during sleep.
It is not clear if GERD causes obstruction in sleep or vice versa because some researchers state that acid reflux blocks the airways due to which breathing is obstructed whereas the others state that obstructive breathing alters the pressure of the LES causing acid reflux.
Whichever the case may be, sleep apnea is a serious problem and may have grave consequences on physical and psychological health.
Obstructive sleep can be more harmful to health than it seems because it can make the patient feel drowsy and lethargic all day.
People with interrupted sleep are not as active and are more prone to mental and physical disorders such as depression, tonsils, and headaches, loss of interest, hallucinations, and loss of concentration.
More important consequences of sleep apnea include high blood pressure, increased risk of heart attacks, strokes, obesity, diabetes, and arrhythmias.
Oesophageal Strictures - Benign
It is a medical condition in which repeated acid damage in the oesophagus causes the build-up of scar tissue that narrows down the food pipe.
This causes pain (odynophagia) and difficulty (dysphagia) during swallowing.
This disorder is also caused by cancer of the oesophagus in which case it is called oesophageal stricture – malignant.
Major symptoms of strictures are difficulty in swallowing, pain in the food pipe, unintentional weight loss, regurgitation of food and loss of appetite.
The possible complications of strictures include food being stuck in the oesophagus that might need an endoscopy to remove.
It can also cause choking and pneumonia due to frequent regurgitation of the food.
The disorder is treated by procedures that essentially work to widen the oesophagus.
They can be treated using a tiny balloon or any other type of dilator that can dilate the oesophagus.
The process is simply performed at the same time when the endoscopy is done to check any problems in the oesophagus.
Proton pump inhibitors can inhibit the stricture to be formed again after treating one. The treatment rarely requires surgery except when it is in severe or advanced stages .
Summary
Heartburn causes many health consequences.
The causes of these consequences are unhealthy dietary habits, obesity, bacterial infection, smoking, and alcohol consumption.
Heartburn is observed as the first symptom of all these gastroesophageal diseases.
These diseases are diagnosed by esophageal endoscopy, x-ray and pH monitoring in the esophagus.
Treatments like proton pump inhibitors, antibiotics, prokinetics drugs, and surgery provide relief from all these gastroesophageal diseases.
Healthy diet habits prevent the aggressiveness of these diseases.