Heartburn Flashcards
Definition of heartburn:
burning sensation in the stomach or lower chest that rises up toward neck and occasionally to the back
Heartburn is described as…
- indigestion
- sour stomach
- bitter belching
Heartburn is a common symptom of…
gastroesophageal reflux disease (GERD)
Dyspepsia is…
- feeling full after eating a small amount of food
- epigastric pain
- epigastric burning
Pathophysiology of heartburn and dyspepsia:
esophageal defense mechanisms to help protect mucosa from damage
Lower esophageal sphincter (LES) provide a…
physical barrier against gastric contents being refluxed into the esophagus
LES will relax when…
one is swallowing to allow things to go into the stomach
Risk factors for heartburn:
- food
- lifestyle
- medications
- medical conditions
Why are chocolate, peppermint, and fatty food a risk factor for heartburn?
they decrease LES pressure, which leads to increased reflux
Why are citrus, tomato-based, and spicy foods a risk factor for heartburn?
they can irritate inflamed esophageal mucosa
How does smoking contribute to heartburn?
it relaxes LES pressure and decreasing salivation
How does obesity contribute to heartburn?
it increases intra-abdominal pressure
What are some lifestyle risk factors, excluding smoking and obesity?
- tight fitting clothes
- lying on your back
- stress
- pregnancy
Which medications decrease LES pressure and increase reflux?
- theophylline
- morphine
- Ca2+ channel blockers
- diazepam
Which medications can cause dyspepsia through direct gastric mucosal injury, or changes to GI function?
- iron
- antibiotics
- narcotics
- digoxin
- estrogens
- theophylline
- NSAIDs
What medical conditions contribute to heartburn?
- motility disorders
- PUD
- Zollinger-Ellison syndrome
Heartburn is more frequently noted within…
one hour after eating
- especially after a large meal or indigestion
Why does lying down or bending over make heartburn worse?
it can cause regurgitation, which allows acidic fluid in back of throat
- no abdominal contractions
If you have heartburn that occurs two or more times, then it is suggestive of…
GERD
Exclusions to self treatment:
- dysphagia: difficulty swallowing
- odynophagia: painful swallowing
- upper GI bleeding
- unexplained weight loss
- continuous nausea, vomiting, or diarrhea
- severe stomach pain
- chest pain or shoulder, arm, or neck pain (sign of heart attack)
- heartburn or dyspepsia for > 3 months
Types of pharmacologic treatments:
- antacids
- histamine type 2 receptor antagonists (H2RAs)
- combo of antacid and H2RA
- proton pump inhibitors (PPI)
Antacids and H2RAs are recommended for individuals with…
mild, infrequent heartburn and dyspepsia
Antacids provide…
rapid relief of symptoms w/in 5 minutes
Antacids lasts for…
20-30 minutes
H2RAs are preferred to an antacid when individuals with mild-moderate heartburn need…
more prolonged relief of symptoms