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Heartburn

Heartburn is a burning sensation in the chest that can extend to the neck, throat, and face; it is worsened by bending or lying down. It is the primary symptom of gastroesophageal reflux, also known as acid reflux, which is the movement of stomach acid into the oesophagus. On rare occasions, it is due to gastritis (stomach lining inflammation).

Infrequent heartburn is usually without serious consequences, but chronic or frequent heartburn (recurring more than twice per week) can have severe consequences. Accordingly, early management is important.

Understanding heartburn depends on understanding the structure and action of the oesophagus. The oesophagus is a tube connecting the throat to the stomach. It is about 10 in (25 cm) long in adults, lined with squamous (plate-like) epithelial cells, coated with mucus, and surrounded by muscles that push food to the stomach by sequential waves of contraction (peristalsis). The lower oesophageal sphincter (LES) is a thick band of muscles that encircles the oesophagus just above the uppermost part of the stomach. This sphincter is usually tightly closed and normally opens only when food passes from the oesophagus into the stomach. Thus, the contents of the stomach are normally kept from moving back into the oesophagus.
The stomach has a thick mucous coating that protects it from the strong acid it secretes into its interior when food is present, but the much thinner oesophageal coating doesn't provide protection against acid. Thus, if the LES opens inappropriately or fails to close completely, and stomach contents leak into the oesophagus, the oesophagus can be burned by acid. The resulting burning sensation is called heartburn.

Occasional heartburn has no serious long-lasting effects, but repeated episodes of gastroesophageal reflux can ultimately lead to oesophageal inflammation (oesophagitis) and other damage. If episodes occur more frequently than twice a week, and the oesophagus is repeatedly subjected to acid and digestive enzymes from the stomach, ulcerations, scarring, and thickening of the oesophagus walls can result. This thickening of the oesophagus wall causes a narrowing of the interior of the oesophagus. Such narrowing affects swallowing and peristaltic movements. Repeated irritation can also result in changes in the types of cells that line the oesophagus. The condition associated with these changes is termed Barrett's syndrome and can lead to oesophageal cancer.

Heartburn may be improved by making lifestyle changes that affect acid reflux, such as eating smaller meals and stopping smoking.

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