Doctor, I have heartburn

Sylvia: Since last week, I have been bothered with heartburn. I wonder if I’m not making an ulcer, explains the patient.

Dr Pierrat: You think? Where exactly is it burning?

Sylvia: Well, usually it goes from there, she said, pointing to the hollow at the bottom of her sternum. And it goes back. In fact, it stings more than it burns!

Dr Pierrat: You never have a sensation of stricture (tightening), nor pain on the left side?

Sylvia: No not at all. For what ?

Dr Pierrat: Some heart conditions are manifested by digestive-like pain. Even nausea sometimes.

Sylvia: I sometimes have referrals that go up and sting into the throat.

Dr Pierrat: If not, are you eating normally? Haven’t lost weight lately?

Sylvia: No not at all. I devour as usual! I just have a little shoulder problem, but the anti-inflammatories you gave my husband when he had his knee problem are helping me a lot.

Dr Pierrat:It all sounds like gastroesophageal reflux: a bit of your stomach contents come up intermittently and attack the wall of your esophagus. That’s why you feel that burning under the sternum: the esophagus is right behind it.

Sylvia: But where does this come from?

Dr Pierrat: Either the small valve located between the esophagus and the stomach does not close properly, which is most likely in your case. Either a small part of the stomach goes up through the diaphragm, the muscle located between the thorax and the abdomen, to form a pocket that drains poorly. This is called a hiatal hernia. In both cases, taking anti-inflammatories does not help matters…

Sylvia: And what can I do to be less embarrassed?

Dr Pierrat: For your shoulder, we’re going to look, but you’re going to stop the anti-inflammatories and I’m going to send you to a physio. For heartburn, we will start with lifestyle and dietary measures: no more than two cups of coffee a day, and no alcohol or large meals in the evening. Also try to identify foods that trigger pain more often. They are not necessarily the same for everyone. I also advise you to raise the head of your bed or sleep with a thicker pillow.

Sylvia: You don’t give me medicine?

Dr Pierrat: I’m just prescribing an antacid to take before meals. Your pain is recent, you should be relieved fairly quickly. If this is not the case, we will review the problem next month and perhaps do some additional tests.

What to know about heartburn

When they are not accompanied by other specific signs, heartburn is most often due to gastroesophageal reflux. Over time, the sphincter located between the esophagus and the stomach becomes less toned, which allows stomach acid to rise up into the esophagus and leads to inflammation. Favored by lying down or leaning forward, these reflux can also be accompanied by belching and nocturnal cough, sometimes hiccups or a hoarse voice. Simple measures can often improve the situation. It is advisable to avoid foods that attack the mucous membrane (alcohol, spices, excess of strong coffee, etc.) and not to lean forward after meals.

After 50 years, we must be extra vigilant. The doctor will consider various examinations to assess the importance of the lesions along the esophagus: gastric fibroscopy (examination of the mucosa with an optical fiber), pHmetry (measurement of acidity)… Taking gastric protectors is possible on a case-by-case basis, for a few days, if the discomfort returns.