CLINICAL PRESENTATION OF HEARTBURN

Question 1

What are some common GI disorders that can cause heartburn

Answer 1

,Heartburn may occur alone or as a symptom of other GI disorders, such as GERD (gastroesophageal reflux disease) or PUD (peptic ulcer disease).

Question 2

When is heartburn most frequently noted

Answer 2

,Heartburn is noted most frequently within 1 hour after eating, especially after a large meal, or with ingestion of offending foods or beverages.

Question 3

What can exacerbate heartburn

Answer 3

,Lying down or bending over may exacerbate heartburn.

Question 4

What is regurgitation?

Answer 4

, Regurgitation is characterized by a bitter acidic fluid in the back of the throat; this phenomenon occurs more commonly after meals, at night, or upon bending over. It differs from vomiting in that nausea, retching, or abdominal contractions do not occur.

Question 5

What is water brash

Answer 5

Water brash is the sudden filling of the mouth with clear, slightly salty fluid secreted from the salivary glands.

Question 6

What are some less common signs and symptoms that may occur with heartburn

Answer 6

,Burping, hiccups, nausea, and vomiting are less common signs and symptoms that may occur with heartburn.

Question 7

How are heartburn symptoms classified in terms of severity

Answer 7

,Severity with any of these problems is subjective, and no standard definitions exist for classifying symptoms as “mild,” “moderate,” or “severe.”

Question 8

What is the suggested frequency of heartburn symptoms for a diagnosis of GERD

Answer 8

,Heartburn symptoms that occur two or more times per week are suggestive of GERD (gastroesophageal reflux disease).

Question 9

What are some complications of GERD

Answer 9

,GERD can be complicated by erosive esophagitis, hemorrhage, esophageal ulcers, strictures, Barrett’s esophagus, and esophageal adenocarcinoma.

Question 10

Is heartburn severity strongly correlated with esophageal damage?

Answer 10

Heartburn severity is poorly correlated with esophageal damage, especially in older patients who may have no or mild symptoms despite severe erosive esophagitis or other complications.
(Mức độ chướng bụng không tương quan tốt với tổn thương thực quản, đặc biệt là ở những bệnh nhân lớn tuổi có thể không có triệu chứng hoặc triệu chứng nhẹ mặc dù có viêm loét thực quản nặng hoặc các biến chứng khác.)

Question 11

What is the standard diagnostic procedure for determining the presence and extent of esophageal damage

Answer 11

Upper endoscopy is the standard for determining the presence and extent of esophageal damage.

Question 12

What are some “alarm symptoms” associated with heartburn and GERD

Answer 12

,Alarm symptoms include dysphagia (difficulty swallowing), odynophagia (painful swallowing), vomiting, GI bleeding, and unexplained weight loss. These severe signs and symptoms can indicate more serious disease and/or complications.

Question 13

What is the most common cause of dysphagia (difficulty swallowing) associated with long-standing heartburn

Answer 13

,The most common cause of dysphagia associated with long-standing heartburn is peptic stricture or Schatzki’s ring. However, severe esophagitis, peristaltic dysfunction, and esophageal cancer are other potential etiologic conditions.

Question 14

What does odynophagia (painful swallowing) indicate

Answer 14

,Odynophagia (painful swallowing) may indicate severe ulcerative esophagitis, pill-induced injury (e.g., from tetracycline, potassium chloride, vitamin C, NSAIDs including aspirin, or bisphosphonates), or infection.

Question 15

What are some signs of GI bleeding

Answer 15

,Signs of GI bleeding include hematemesis (vomiting of blood), melena (black, tarry stools), occult bleeding (hidden blood in the stool), and anemia (low red blood cell count).

Question 16

What are some atypical or extraesophageal signs and symptoms related to gastroesophageal reflux

Answer 16

,Atypical or extraesophageal signs and symptoms related to gastroesophageal reflux include noncardiac chest pain, asthma, laryngitis, hoarseness, globus sensation (subjective sensation of a lump in the throat), chronic cough, recurrent pneumonitis, disordered sleep, and dental erosion.

Question 17

When should patients with alarm symptoms or atypical symptoms seek medical evaluation

Answer 17

,Patients with alarm symptoms or atypical symptoms should seek evaluation by a primary care provider, with likely referral to a gastroenterologist for further assessment and management.

Question 18

What can dysphagia (difficulty swallowing) associated with long-standing heartburn indicate

Answer 18

,Dysphagia associated with long-standing heartburn can indicate peptic stricture or Schatzki’s ring. Other potential etiologic conditions include severe esophagitis, peristaltic dysfunction, and esophageal cancer.

Question 19

What are some medications that commonly cause dyspepsia (indigestion)

Answer 19

,Certain medications such as iron, antibiotics, narcotics, digoxin, estrogens and oral contraceptives, theophylline, levodopa, and nonsteroidal anti-inflammatory drugs (NSAIDs) commonly cause dyspepsia through direct gastric mucosal injury, changes in GI function, exacerbation of reflux, or other mechanisms.

Question 20

What is the pathophysiology of functional dyspepsia

Answer 20

,The pathophysiology of functional dyspepsia is unclear but may include delayed gastric emptying, impaired gastric accommodation to food intake, hypersensitivity to gastric distention, altered duodenal sensitivity, abnormal intestinal motility, or central nervous system dysfunction.

Question 21

What are some “alarm symptoms” associated with dyspepsia

Answer 21

,Alarm symptoms associated with dyspepsia include unexplained weight loss, dysphagia (difficulty swallowing), persistent vomiting, evidence of GI bleeding (e.g., hematemesis, melena), and early satiety.

Question 22

What are some potential contributing factors to heartburn symptoms

Answer 22

,Possible contributing factors to heartburn symptoms include mucosal disruption, decreased acid clearance, inflammation, reduced salivary bicarbonate concentration, volume of refluxate, frequency of heartburn, and interaction of pepsin with acid. Esophagus hypersensitivity from repeated acid exposure is also a theory explaining why some reflux episodes produce symptoms while most do not.

Question 23

What are some atypical or extraesophageal signs and symptoms related to GERD

Answer 23

,Atypical or extraesophageal signs and symptoms related to GERD include noncardiac chest pain, asthma, laryngitis, hoarseness, globus sensation (subjective sensation of a lump in the throat), chronic cough, recurrent pneumonitis, disordered sleep, and dental erosion.

Question 24

What are some factors that can lead to increased esophageal acid exposure

Answer 24

,Factors that can lead to increased esophageal acid exposure include lying or sleeping position, decreased salivation, peristaltic dysfunction, delayed gastric emptying, overeating, and hiatal hernia.

Question 25

What are some potential causes of dysphagia (difficulty swallowing) associated with long-standing heartburn

Answer 25

,Some potential causes of dysphagia associated with long-standing heartburn include peptic stricture or Schatzki’s ring, severe esophagitis, peristaltic dysfunction, and esophageal cancer.

Question 26

What are some common risk factors for heartburn

Answer 26

,Common risk factors for heartburn include certain foods (e.g., fat, chocolate, peppermint), medications (e.g., theophylline, morphine, calcium channel blockers, diazepam), tobacco smoke, anxiety, fear, bending over or straining, lifting heavy objects, isometric exercises, and obesity.

Question 27

When should patients with alarm symptoms seek medical evaluation

Answer 27

,Patients with alarm symptoms such as dysphagia, odynophagia, vomiting, GI bleeding, and unexplained weight loss should seek medical evaluation promptly, as these severe signs and symptoms can indicate more serious disease and/or complications.