Heartburn

Introduction Heartburn is a burning pain in the upper abdomen or lower chest, accompanied by symptoms of acid reflux. Heartburn is one of the most common symptoms of the digestive system. For most people, the most common cause is because eating too fast or too much, but some people often have heartburn even if they pay attention to diet, and some people are eating. After certain foods, such as: wine, pepper, etc., these foods can make your lower esophageal sphincter relax or increase gastric acid secretion, both of which can cause heartburn.

Cause

Because of eating too fast or too much, some people eat some specific foods such as wine, pepper, etc., which can cause the lower esophageal sphincter to relax or increase gastric acid secretion, and the relationship between the two is the stomach. The determinant of the ability to close the esophageal junction. A patient with both a low LES pressure and a large esophageal hiatus hernia had a chance to develop gastroesophageal reflux more than a patient with a low LES pressure and no esophageal hiatus. Studies have also shown that both the size of the hiatus hernia and the lowering of the LES pressure can cause heartburn.

an examination

Related inspection

Gastroscopy fiber gastroscopy

Pathological examination Ismail-Beigi et al (1970) studied four groups of people by suction biopsy. They established a histopathological diagnostic criteria for GERD: 1 squamous epithelial basal cell layer thickness increased, normal accounting for 10% of epithelial thickness (from 5% to 14%), such as more than 15%, indicating the presence of reflux inflammation; 2 inherent membrane nipple extension, under normal circumstances, the nipple is less than 66% of the thickness of the epithelium, beyond this limit is abnormal. Later, Kobayashi (1974) also set a similar diagnostic criteria for esophagitis, that is, the thickness of the basal cell layer should exceed 50% of the epithelium, and the length of the intrinsic membrane nipple exceeds 50% of the epithelial thickness. Post-sternal burning or burning pain can be measured by esophageal pH, esophageal pressure measurement, and gastric-esophageal scintigraphy to determine the presence or absence of GER. Apply the esophageal acid test to determine if the symptoms are caused by GER. Esophagoscopy and biopsy can be performed as necessary to confirm the diagnosis.

Differential diagnosis

Differential diagnosis of heartburn:

1. spleen (heartache): mainly chest tightness or paroxysmal chest pain, often after exertion, no sternum: post-burning sensation and difficulty swallowing. The ECG shows ST-T as an ischemic change. The esophageal acid test was negative.

2. Esophageal cancer, esophageal fistula: with sputum as the main disease, esophagoscopy and X-ray swallowing examination can be used for identification.

3. Stomach ulcers: The pain is mostly located in the gastric cavity, often chronic, rhythmic, seasonal and periodic attacks. X-ray barium meal and fiber endoscopy can detect ulcer lesions in the stomach or duodenal bulb.

4. Angina pectoris: Muscle pain and angina pectoris of esophagitis can exist alone, sometimes at the same time, and can be alleviated by nitroglycerin, which is difficult to identify. Cardiac pain often radiates laterally to the chest, while esophageal pain radiates vertically. Both types of pain can be caused by sudden movements, but when the posture is forced, reflux can occur, and continuous exercise without force can cause angina.

5. Hemorrhoids: It means that the patient complained of foreign body sensation in the throat. He could not start swallowing, had a feeling of blockage, and had no organic lesions in clinical examination. It is believed that the high reflux of the stomach causes the upper part of the esophagus to be stimulated. Sometimes it is misdiagnosed for the only symptoms of a small number of patients.

Post-sternal burning or burning pain can be measured by esophageal pH, esophageal pressure measurement, and gastric-esophageal scintigraphy to determine the presence or absence of GER. Apply the esophageal acid test to determine if the symptoms are caused by GER. Esophagoscopy and biopsy can be performed as necessary to confirm the diagnosis.

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