Introduction:
More than 40% of all adults experience this uncomfortable, burning sensation at least once a month. For most, it is an occasional occurrence that is easily relieved with an over-the-counter antacid. But for others, heartburn is a daily struggle that has changed the way they live. Their lives, from what they eat to how they sleep, to the type of clothes they can wear.
What Really Is Heartburn?
Heartburn is frequently referred to as acid indigestion. It is generally described as a burning sensation in the chest, usually felt behind the breastbone and sometimes moves upward to the neck and throat. Heartburn may last as long as two to three hours and can occur after eating a large meal or when you bend over or lie flat. Smoking, caffeine and alcohol may increase the level of acid in your stomach, causing even more heartburn. While heartburn is typically not serious, but when accompanied by a sour-tasting fluid in your throat and difficulty swallowing, it can be more serious. Although “heartburn” is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastro-oesophageal reflux disease (This also is known as reflux disease). Other symptoms may also include regurgitation, difficulty swallowing and chronic coughing or wheezing. Occasional heartburn is common but does not necessarily mean one has GORD. Heartburn that occurs more than twice a week may be considered GORD and it can eventually lead to more serious health problems.
So what is gastroesophageal reflux?
Gastro-Oesophageal reflux disease, or GORD, is a chronic disease that occurs when the lower oesophageal sphincter does not close properly and stomach contents leak back, or reflux, into the oesophagus. Anyone, including infants, children, and pregnant women, can have GORD.
Is Your Heartburn Really Gastroesophageal Reflux Disease?
Persons with GORD or reflux disease often complain of having:
- Painful heartburn (indigestion).
- Pain in the middle of the chest.
- Coughing and/or choking while lying flat.
- Increased salivation.
- Regurgitation.
- Difficulty in sleeping after eating.
- Asthma-like symptoms may occur.
What Causes Heartburn?
The burning feeling of heartburn is caused by acid that escapes from your stomach through a weakened one-way valve near the top of your stomach called (lower oesophageal sphincter). The acid can travel or reflux upwards into the oesophagus as far as the throat causing painful heartburn and indigestion. The food is propelled from the mouth into the oesophagus, which is a muscular tube, approximately 10 inches long that leads directly into the stomach. The food automatically travels through the oesophagus as a result of wave-like muscular contractions called peristalsis. 
When you swallow, the lower oesophageal sphincter opens, allowing food to enter the stomach before it quickly closes. But when it fails to close effectively the fluid and juices in the stomach wash back into the oesophagus. This stomach acid irritates the oesophagus and can cause it to become inflamed, scarred or even ulcerated.That is why people with severe GORD may have difficulty swallowing or often have the sensation that food is stuck in their throats. The swelling and inflammation in the oesophagus can lead to pain, pressure and burning in the chest and throat. The scarring which develops in the oesophagus will narrow it and make it harder to swallow. If an ulcer develops in the lining of the oesophagus, it can produce pain and bleeding, as well as difficulty in swallowing. 
If untreated, reflux can lead to respiratory problems or even oesophageal cancer. The increase of the pressure in the stomach and/or relaxation of the muscle tone of the valve can precipitate GORD. Loosening of the muscle tone of the valve with aging, pregnancy, as well as fatty foods, alcohol, coffee, and nicotine (cigarettes). Medications, especially smooth muscle relaxants, such as theophylline, oral bronchodilators, calcium channel blockers and diazepam can cause reflux. Usually foods such as chocolate, peppermint, fried foods, coffee, alcohol and cigarette smoking are involved.
Is Heartburn a Sign Of Heart Disease?
Heartburn pain can also be mistaken for a heart attack or heart disease. But there are major differences. Usually heartburn pain is not associated with any physical activity, while exercise can increase the pain resulting from heart disease or the onset of a heart attack, and rest may temporarily relieve the pain. Chest pain from hiatus hernia and/or oesophageal spasm may be extremely difficult to distinguish from chest pain of cardiac origin. The symptoms of pain spreading from below the sternum (breastbone) to the neck, jaw, and arms can mimic those of coronary artery disease.This situation is complicated by the fact that persons who have both heart disease and reflux may experience acid reflux that increases the workload of the heart and brings on angina. Severe reflux may also cause acid to bubble up from the stomach into the windpipe and lungs, causing respiratory difficulty such as wheezing in an asthma-like attack. If you experience any of these symptoms, it is best to immediately seek medical care to evaluate your problem.
What are the Symptoms of GORD?
The main symptoms are persistent heartburn and acid regurgitation. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GORD can also cause a dry cough, bad breath and damaged teeth.
Is my Reflux Caused By a Hiatus Hernia?
Another cause of GORD or reflux is a hiatus hernia. 
This is an opening in the diaphragm (a flat muscle that separates the thorax from the abdomen). When this occurs, the top of the stomach slips through the enlarged hiatus hernia and bulges into the chest cavity. While some people are born with a hernia, factors such as stress, heavy lifting, or the normal wear and tear of life can cause the opening to enlarge, allowing the stomach to protrude into the chest. This can cause the valve between the stomach and the oesophagus to fail, causing severe heartburn.
What are the Symptoms of Reflux Disease (GORD)?
- Burning sensations in the chest. These may start in the upper abdomen & radiate into the neck
- Regurgitation of sour/bitter-tasting material into the throat & mouth.
- Regurgitation when lying down/ sleeping.
- Heartburn 1-4 hours after eating or immediately after drinking orange juice.
- Excessive Belching.
Some people have GORD without heartburn. Instead, they experience chest pain, hoarseness in the morning, or trouble swallowing, bleeding. Occasional choking sensation (your throat is tight). GORD can also cause a dry cough, bad breath and damaged teeth.
How would you diagnose GORD?
The above history of heartburn, followed by an upper GI endoscopy and possibly a pH manometry (A study to define whether or not and how much a patient refluxes acid). The patient attends an out patient clinic, where a naso-gastric tube is inserted and a small, portable monitor is given to wear around the waist. They then go about their normal activity for a full 24 hours, returning the next day for the equipment to be removed and the data interpreted).
When to See a Doctor?
- If your heartburn persists with bleeding, pain and difficult swallowing.
- If you’re having symptoms you can’t distinguish from heart problems.
- If you’re having “wheezing” symptoms that don’t respond to medication.
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