a burning sensation in the
esophagus, or below the sternum in the region of the heart, one of the common symptoms of
indigestion. Called also
pyrosis.
Heartburn often occurs when there is distention of a part of the esophagus, particularly the lower part. This may happen with
gastroesophageal reflux (regurgitation by the stomach of part of its contents upward into the esophagus). Since this matter is acidic, it acts as an irritant, producing discomfort or pain.
Excessive acidity (
hyperacidity) is thought to be a cause of heartburn, occurring when the stomach secretes an excessive amount of
hydrochloric acid. Recent evidence, however, indicates that hyperacidity in itself may not be the actual cause, and that heartburn results from excessive gastric secretions only when there is improper eating so that
reflux takes place.
The functions of the stomach, both those of motion and secretion, are controlled by the
vagus nerve, one of the cranial nerves. Emotional stress can stimulate this nerve, which in turn starts the churning of the stomach and the flow of the various gastric juices; it can also cause contraction and spasm of the pylorus. If some of the stomach contents are displaced into the esophagus during this nervous activity, heartburn may result. Other causes include gastroesophageal reflux accompanying hiatal hernia, stooping or bending after a large meal, and the ingestion of certain foods and drugs, such as alcohol and aspirin.
Treatment of heartburn is aimed at determining its underlying cause. Antacids may be used to relieve the symptoms but they will not cure heartburn and should not be used indiscriminately. Antacid therapy is the key maneuver along with instituting small meal size and elevation of the head of the bed to prevent reflux.