Burning of the esophagus (pyrosis): what to do?

Heartburn is most often a symptom of gastroesophageal reflux (GERD) which is manifested by a burning of the esophagus and regurgitation. THE stress is also a risk factor for heartburn. What are the risks of complications ? What treatments for heartburn? Causes, diagnosis and advice to prevent heartburn.

Definition: what is heartburn?

Heartburn is a burn that we feel behind the sternum (retro-sternal), secondary to an ascent of gastric fluid in the esophagus and sometimes into the mouth, we then speak of regurgitation. It is most commonly related to gastroesophageal reflux syndrome (GERD) which is a chronic disease and corresponds to the passage of acidic gastric contents through the gastroesophageal junction and to the ascents along the esophagus, sometimes to the mouth. Everyone has episodes of reflux: it’s a physiological phenomenon – but it becomes pathological when it causes symptoms or lesions of the esophageal mucosa.

What are the symptoms of heartburn?

Many manifestations can evoke gastroesophageal reflux. The most evocative are:

• THE burns retro-sternal ascending – burning sensations in the chest (heartburn) occurring readily after eating or in certain positions such as leaning forward or lying down
• THE regurgitation acids and/or food.

They make it possible to make the diagnosis without further exploration in nine out of ten patients. Other, less specific symptoms may appear:

• a chronic cough unexplained,
• a cough while lying down “or even during an effort or the carrying of heavy loads” adds Dr. Georges Delamare, general practitioner.
• chest pain that may simulate angina,
• of the heartburn
• otolaryngological (ENT) manifestations such as laryngitis/pharyngitis or even burns,
• the sensation of having a foreign body in the throat (globus)

“Night awakenings for no apparent reason can also be caused by GERD” warns Dr. Delamare. These symptoms can occur every day or be intermittent depending on diet and activity.

What are the causes of heartburn?

A gastroesophageal reflux heartburn occurs because of a dysfunction of the lower part of the esophagus, at the level of the muscle of the diaphragm and the lower sphincter of the esophagus: this one does not play its role of “valve” anymore or not enough. The major factor is obesity (Body Mass Index/BMI ≥ 30 kg/m2), the overweight at the abdominal level and the presence of a hiatal hernia by sliding. Besides being overweight, other factors can contribute to heartburn:

• There pregnancy.
• Some medicationssuch as hormones (progesterone), anti-inflammatories, and certain molecules used in cardiovascular diseases (nitro derivatives, calcium channel blockers).
• THE tobacco.
• The alcohol.
• A diet too rich especially in fat.
• Meals taken on the go.
• THE stress.

When to consult in case of pyrosis?

“You should consult your doctor in case of cough, burns, sleep disturbances as well as in case of otitis or recurrent earaches in children or infants” recommends Dr. Delamare. Other serious factors should lead to rapid consultation:

• appearance of swallowing pain,
• hoarse voice making it difficult to speak,
• dry, recurrent cough, causing great fatigue,
• severe stomach pain accompanied by vomiting,
• weight loss,
• anemia,
• coughing up blood
• blood in stool.

​​​​​​What tests to diagnose heartburn?

In young people, due to the mere presence of symptoms very specific to the disease (pyrosis and/or regurgitation), without warning signs, a interview and clinical examination sufficient to establish the diagnosis. In other cases, the following may be practiced:

► One endoscopy (gastroscopy or esophagogastroduodenal endoscopy). This is the reference examination when the symptoms are atypical and/or after the age of 50. It makes it possible to make the diagnosis of gastroesophageal reflux in the presence of lesions, ie Barrett’s esophagus or peptic esophagitis. This is an exploration done under local or general anesthesia which makes it possible to visualize the esophagus thanks to a small camera inserted through the mouth.

► PH-metry is indicated when the results of endoscopy are normal, in the face of atypical symptoms or in patients refractory to treatment. It measures acid reflux using a small probe or a “wireless” capsule attached to the wall of the esophagus for 48-96 hours.

“We usually prescribe proton pump inhibitors (PPI) as well as a locally acting antacid such as Gaviscon®” says Dr. Delamare. Histamine type 2 receptor antagonists (anti-H2) may also be prescribed. These act at the level of the parietal cells of the stomach to reduce its acid secretion.

A number of tips can help prevent heartburn:

• avoid high fat meals and too abundant;
• avoid going to bed immediately after the end of a meal, especially in the evening (leave a delay of at least two hours, if possible) and raise the head of the bed by 45°;
• losing weight ;
• remove foods that have been identified by each individual as being able to generate disorders (white wine, coffee, spices, etc.).

What are the complications of heartburn?

GERD is also the main factor adenocarcinomaa particular type of esophageal cancer. However, this risk is extremely low. It only occurs in the 10% of people with GERD who develop a “Barrett’s esophagus“, and this after many years of aggression of the esophageal mucosa by severe reflux. Through a phenomenon called “metaplasia”, the esophageal mucosa is transformed and takes on the appearance of an intestinal mucosa called “Barrett’s mucosa” or “endobrachyoesophagus”, fertile ground for the development of adenocarcinoma. However, even in the case of Barrett’s mucosa, the risk of cancer, if it exists, is low (0.1 to 0.3% per year) and does not occur. develops only after many years of evolution.

Thanks to Dr. Georges Delamare, general practitioner.