heartburn

from Wikipedia, the free encyclopedia
Classification according to ICD-10
K20 Esophagitis
K21.0 Gastroesophageal reflux disease with esophagitis
K21.9 Gastroesophageal reflux disease without esophagitis
R12 heartburn
ICD-10 online (WHO version 2019)

Heartburn (from Greek and medically obsolete pyrosis ; in Switzerland also stomach ache ) describes a burning and painful sensation rising from the upper abdomen behind the breastbone , which under certain circumstances radiates to the throat and throat, often together with sour or bitter belching. Heartburn is the leading symptom of gastroesophageal reflux disease .

Etymologically , the rarely used word Sod means “boiling, the boiling” and is derived from the Old High German sōd, gisōd and Middle High German sōt “the billowing, boiling, boiling liquid, broth, well”.

Causes and course

The pain is usually triggered by the backflow of the strongly acidic stomach acid into the esophagus ( esophagus ). The chemo- pain receptors stored in the epithelium of the esophagus are irritated by H + ions because of the loosening of the cell connections of the mucous membrane epithelium caused by the acid and thus increased permeability in the intercellular area. Bitter, bilious belching can also indicate reflux from the duodenum . It can occur as a concomitant symptom, especially with increased activity of the intestine ( motility disorder ) and not acid-related with a weakening of the smooth gastric sphincter muscles. Heartburn can result from non-acidic gastric reflux, for example from food and drinks, various mechanisms such as reflux induction, local irritation or lowering of the stimulus threshold are possible.

Heartburn does not actually develop with every reflux event. The generation of symptoms depends on the extent and duration of the drop in pH , the extent of the mucosal surface attacked by acid and a sensitization of the receptors from previous heartburn. Frequency and intensity can be significantly influenced by individually different acid sensitivity as well as by psychosocial factors such as stress or physical concomitant illnesses. Furthermore, interactions between the chemical and mechanical sensitivity of the esophagus appear to play a role in its development, for example due to stretching. Furthermore, inflammatory mediators can lead to hypersensitivity of the chemo pain cells, which can be intensified and spatially expanded via central mechanisms.

Prevention and treatment

Acid reflux can occur especially after fatty, acidic, or spicy food or drink, such as peppermint food, coffee, alcohol, or nicotine consumption. It can increase while lying down. Therefore, it is recommended to avoid these triggering factors before going to bed.

Drug treatment should be accompanied by changes in drinking and eating habits. The order and type of food intake plays a role. The day should start with a glass of warm water followed by solid food and only then should orange juice, coffee or alcohol be drunk. For acid binding and fight bad breath caused by gases can Heilerde be used. Light food: no strongly acidic or sweet, hot fried and spicy foods and drinks that cause flatulence. To protect the stomach walls can flaxseed - or gruel be taken before meals. Depending on the cause, this may be sufficient.

Drug treatment options to reduce symptoms in acid gastroesophageal reflux are antacids , which act as a buffer to neutralize gastric acid immediately . Antacids containing aluminum "should only be prescribed by a doctor if there are clear indications and only for a therapeutically meaningful period of time", since high doses of aluminum can have neurotoxic effects. A connection with other neurodegenerative diseases such as Alzheimer's is also controversially discussed; a causal connection has never been proven. A short-term, if necessary, intake is not a problem as far as we know.

The most important group of drugs are proton pump inhibitors , which suppress the formation of gastric acid by inhibiting the H + / K + -ATPase in the parietal cells of the stomach. This does not prevent the reflux, but the esophagus is no longer irritated by the acidic gastric juice. Long-term use should be monitored by a doctor, taking into account the potential for side effects.

Another treatment option is to take alginate , which forms a thick foam over the contents of the stomach and thus protects the esophagus.

Another treatment option is a combination of hyaluronic acid , chondroitin sulfate and Poloxamer 407. At body temperature, this changes from a liquid to a semi-solid hydrogel that adheres to the esophageal lining and protects it from damage by stomach acid and pepsin . Hyaluronic acid and chondroitin sulfate provide rapid relief from reflux symptoms and also contribute to the regeneration and wound healing of the damaged mucous membrane.

pregnancy

Heartburn affects between 40% and 80% of all pregnant women, usually in the last trimester of pregnancy . The main cause of heartburn during pregnancy is the disturbed locking mechanism between the esophagus and stomach. The pregnancy-related increase in the hormones progesterone and estrogen means that the lower esophageal sphincter is less tense than before or after pregnancy. In addition, due to the growing uterus, there is increased pressure in the abdominal cavity, which further reduces the ability of the lower esophageal sphincter to close. The interplay of these factors means that more stomach acid can flow into the esophagus. Sleeping with an elevated upper body, frequent small meals instead of less rich ones and generally avoiding fatty foods and sweets can provide relief. Medicines should only be used in more serious cases and after consultation with a doctor.

literature

Web links

Wiktionary: Heartburn  - Explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ heartburn. In: Digital dictionary of the German language .  (In the Etymology section).
  2. ↑ a b c d Christian Pehl, Wolfgang Schepp: How does heartburn develop? Pathomechanisms and Influencing Factors. In: Deutsches Ärzteblatt . 2002 ( aerzteblatt.de ).
  3. ↑ Irmtraut Koop: Gastroenterologie compact: Everything for clinic and further education. Thieme, 2009 ( books.google.de ).
  4. ↑ Why digestive sleep isn't necessarily a good idea. In: Wissenschaft.de. December 29, 2005, accessed September 8, 2019 .
  5. ^ A b Austrian Federal Ministry of Health (June 2014): Aluminum toxicology and health aspects. (PDF), ISBN 978-3-902611-79-6 .
  6. ↑ a b Federal Institute for Risk Assessment (Ed.): Antiperspirants containing aluminum contribute to the absorption of aluminum. (PDF; 144 kB) February 26, 2014.
  7. ↑ Hinnerk Feldwisch-Drentrup and Jakob Simmank: Aluminum salts: The aluminum deodorant hysteria . In: The time . December 12, 2019, ISSN  0044-2070 ( zeit.de [accessed January 28, 2020]).
  8. ↑ Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. In: Alimentary Pharmacology and Therapeutics . Volume 14, No. 6, 2000, pp. 669-690, doi: 10.1046 / j.1365-2036.2000.00759.x ( onlinelibrary.wiley.com PDF).
  9. ↑ a b c V. Savarino, F. Pace, C. Scarpignato: Randomized clinical trial: mucosal protection combined with acid suppression in the treatment of non-erosive reflux disease - efficacy of Esoxx, a hyaluronic acid-chondroitin sulphate based bioadhesive formulation . In: Alimentary Pharmacology & Therapeutics . tape 45 , no. 5 , 2017, ISSN  1365-2036 , p. 631-642 , doi : 10.1111 / apt.13914 , PMID 28116754 , PMC 5347926 (free full text).
  10. ↑ Massimo Di Simone, Fabio Baldi, Valentina Vasina, Maria Laura Bacci, Fabrizio Scorrano: Barrier effect of Esoxx® on esophageal mucosal damage: experimental study on ex-vivo swine model . In: Clinical and Experimental Gastroenterology . 2012, ISSN  1178-7023 , p. 103 , doi : 10.2147 / CEG.S31404 , PMID 22767997 , PMC 3387832 (free full text) - ( dovepress.com [accessed September 23, 2019]).
  11. ↑ B. Palmieri, A. Merighi, D. Corbascio, V. Rottigni, G. Fistetto: Fixed combination of hyaluronic acid and chondroitin-sulphate oral formulation in a randomized double blind, placebo controlled study for the treatment of symptoms in patients with non -erosive gastroesophageal reflux . In: European Review for Medical and Pharmacological Sciences . tape 17 , no. December 24 , 2013, ISSN  1128-3602 , p. 3272-3278 , PMID 24379055 (PMID = 24379055 [accessed September 23, 2019]).
  12. ^ Cancer Therapy and Oncology International Journal (CTOIJ). Retrieved September 23, 2019 .
  13. ↑ Patrick du Souich, Antonio G. García, Josep Vergés, Eulàlia Montell: Immunomodulatory and anti-inflammatory effects of chondroitin sulphate . In: Journal of Cellular and Molecular Medicine . tape 13 , 8A, August 2009, ISSN  1582-4934 , p. 1451–1463 , doi : 10.1111 / j.1582-4934.2009.00826.x , PMID 19522843 , PMC 3828858 (free full text) - (PMID = 19522843 [accessed September 23, 2019]).
  14. ↑ M. Schnabelrauch, D. Scharnweber, J. Schiller: Sulfated Glycosaminoglycans As Promising Artificial Extracellular Matrix Components to Improve the Regeneration of Tissues. 2013, accessed on September 23, 2019 .
  15. ↑ Kessiena L. Aya, Robert Stern: Hyaluronan in wound healing: Rediscovering a major player . In: Wound Repair and Regeneration . tape 22 , no. 5 , 2014, ISSN  1524-475X , p. 579-593 , doi : 10.1111 / wrr.12214 .
  16. ↑ E.-G. Loch, O. Leiss: Heartburn during pregnancy - just a symptom? In: Gynecological Practice. Volume 26, 2002, pp. 219-226.