Should You Be Worried About Frequent Heartburn?

It is common to experience a little heartburn after eating spicy foods or drinking alcohol. It may feel like chest pain or burning after eating, a sour taste in the back of the throat or hoarseness.  But suffering daily, long-lasting or frequent heartburn symptoms should not be ignored and may indicate a more serious condition.

It is common to experience a little heartburn after eating spicy foods or drinking alcohol. It may feel like chest pain or burning after eating, a sour taste in the back of the throat or hoarseness.  But suffering daily, long-lasting or frequent heartburn symptoms should not be ignored and may indicate a more serious condition.

As many as 15 million Americans suffer from daily heartburn, or gastroesophageal reflux disease (GERD). This chronic but treatable condition refers to irritation and damage to the lining of the esophagus from prolonged exposure to stomach acid. This damage occurs because of a weakening of the valve that separates the esophagus from the stomach which allows acid to leak up into the esophagus.

Typical treatments for GERD may include medication to reduce stomach acid and simple lifestyle changes to help reduce the reflux symptoms – such as avoiding trigger foods, decreasing portion sizes, losing weight, quitting smoking, elevating the head of the bed, and not eating before bedtime.

For certain patients who have had chronic acid reflux, an upper endoscopy may be recommended to assess severity and to uncover any pre-cancerous changes. If GERD is left untreated or unmonitored for a long period of time, it can result in a condition called Barrett’s esophagus which can progress to cancer.

Barrett’s esophagus is a disorder in which the inflamed, acid-damaged cells in the lining of the lower esophagus change to resemble those found in the stomach. As a result of this transformation, Barrett’s patients have an increased risk for esophageal cancer.

At Atlanta Gastroenterology Associates, many of our physicians are specially trained in the treatment of GERD and Barrett’s esophagus. If you’ve noticed that your heartburn symptoms are frequent, severe, longstanding, or getting worse, schedule an appointment with us today.

Heartburn: Causes, Symptoms & Treatment

Overview

What is heartburn?

Heartburn is an uncomfortable burning feeling in your chest that can move up your neck and throat. This can be a symptom of many different conditions, including acid reflux, gastroesophageal reflux disease (GERD) and even pregnancy.

When you are experiencing heartburn, you may also have a bitter or sour taste in the back of your throat. Heartburn can last from a few minutes to several hours. It often feels worse after you eat or when you lay down too quickly after eating.

How common is heartburn?

Occasional heartburn is fairly common. However, if you have regular and severe heartburn, it can actually be an indicator of a chronic acid reflux condition called GERD. You should talk to your healthcare provider if you frequently experience heartburn.

What does heartburn feel like?

Heartburn typically feels like a burning in the center of your chest, behind your breastbone. When you have heartburn, you may also feel symptoms like:

• A burning feeling in your chest that can last anywhere from a few minutes to a couple of hours.
• Pain in your chest when you bend over or lay down.
• A burning feeling in your throat.
• A hot, sour, acidic or salty taste in the back of your throat.
• Difficulty swallowing.

Possible Causes

What causes heartburn?

To know why heartburn happens, it can help to understand how your esophagus and stomach work. When you eat, the food passes down a long tube that connects your mouth and stomach. This tube is called the esophagus. At the bottom of the esophagus is a valve, called the esophageal sphincter. This valve opens to let food through and then closes to keep your stomach contents down. Inside your stomach is a very strong acidic mixture that starts the process of breaking down your food (digestion). Your stomach is designed to hold this mixture. However, your esophagus isn’t able to hold this mixture without getting hurt.

Sometimes, the valve that separates your stomach and esophagus doesn’t close properly, and some of the acidic mixture from your stomach goes back up the esophagus. This is called reflux. When you have reflux, you’ll often feel the burning sensation that’s heartburn. There are a few medical conditions that can cause reflux and make you feel heartburn, including:

• Pregnancy.
• Hiatal hernia (when the stomach bulges up into the chest).
• Gastroesophageal reflux disease (GERD).
• Certain medications, especially anti-inflammatory drugs and aspirin.

Heartburn can also be caused by your eating habits — including the foods you eat, how large your meals are and how close to bedtime you eat — and certain lifestyle habits.

What can trigger heartburn?

Heartburn can be triggered by many different things that are a part of your daily life. For many people, heartburn can be caused by certain eating and lifestyle habits. These habits can involve things like eating large portions of food, eating too close to bedtime or even having high stress levels.

Certain foods and drinks can also trigger heartburn for some people. Some foods and drinks that could trigger your heartburn can include:

• Onions.
• Citrus fruits.
• High-fat foods.
• Tomatoes.
• Tomato-based products.
• Alcohol.
• Citrus juices.
• Caffeinated beverages.
• Carbonated beverages.

Your lifestyle habits can also play a part in why you might experience heartburn. These everyday factors often contribute to medical conditions that cause heartburn, like GERD or hiatal hernia. Some lifestyle habits that can trigger your heartburn include:

• Being overweight.
• Being a smoker.
• Having a high stress level.
• Wearing tight clothes and belts.

Care and Treatment

How is heartburn treated?

In most cases, heartburn can be treated at home with over-the-counter medications and changes to lifestyle habits that cause the feeling. Occasional heartburn is common and is typically not serious. However, if you have frequent and severe heartburn, reach out to your healthcare provider. This could be a sign of a chronic condition like GERD. GERD can lead to other serious conditions like esophagitis, Barrett’s esophagus and even cancer. Sometimes, your doctor may want to do an endoscopy to check for underlying medication conditions. An endoscopy is the examination of your digestive tract with a lighted flexible instrument.

Over-the-counter medications for heartburn typically include antacids and acid blockers.

How do antacids work to treat heartburn?

Antacids reduce the amount of stomach acid, relieving your heartburn. These medications can also be used to soothe stomach upset, indigestion and other pains in your stomach. Some antacids contain simethicone, which reduces gas. Antacids that you can get without a prescription include:

• Tums®.
• Rolaids®.
• Maalox®.
• Gaviscon®.

Make sure you always follow the instructions on the package or talk to your doctor about the right way to use an antacid. If you use tablets, chew them well before swallowing for faster relief.

Are there any side effects of antacids?

Some antacids contain magnesium or sodium bicarbonate, which can act like a laxative. Do not take antacids if you have any symptoms of appendicitis or bowel inflammation. Side effects of antacids may include:

Serious side effects can occur with an overdose or overuse of antacids.

How do acid blockers work to treat heartburn?

Products like Pepcid AC® are called histamine h3 blockers, or acid blockers. Acid blockers reduce the production of stomach acid. They relieve heartburn, acid indigestion and sour stomach. Always follow the directions on the packaging or talk to your healthcare provider about how to take this medication. Acid blockers you can buy without a prescription include:

• Pepcid AC®.
• Tagamet HB®.

Take your acid blocker medicine regularly for as long as directed by your healthcare provider, even if you do not have any pain or if your symptoms get better.

Stronger acid blockers are prescription medications. These can be used to block stomach acid, treat stomach and duodenal ulcers, erosive esophagitis, and GERD. They work by reducing the production of stomach acid. Your healthcare provider will give you a specific prescription for this type of acid blocker.

The United States Food and Drug Administration (FDA) recently reported elevated levels of a possible carcinogen, NDMA, in the drugs ranitidine (Zantac®) and nizatidine (Axid®). You should speak to your healthcare provider if you are taking one these medications.

Are there any side effects of acid blockers?

Side effects of acid blockers include:

• Headache.
• Dizziness.
• Diarrhea.

If you have any of the following possibly serious side effects after taking acid blockers, tell your healthcare provider right away:

• Confusion.
• Chest tightness.
• Bleeding.
• Sore throat.
• Fever.
• Irregular heartbeat.
• Weakness or unusual fatigue.

Should I take antacids and acid blockers together to treat heartburn?

Your healthcare provider may want you to take antacids when you start taking acid blockers. Antacids will control your symptoms until the acid blockers start to work. If your doctor prescribes an antacid, take it an hour before (or an hour after) you take an acid blocker.

What are prescription medications for heartburn?

If over-the-counter antacids and acid blockers do not relieve your heartburn, your healthcare provider may give you a prescription for other medicines, such as:

• Prescription-strength acid blockers: In prescription-strength (usually higher doses), Zantac®, Tagamet®, Pepcid® and Axid® can generally relieve heartburn and treat GERD.
• Proton pump inhibitors: These are drugs that block acid production more effectively. Proton pump inhibitors include Aciphex®, Nexium®, Prevacid®, Prilosec® and Protonix®.

There are some proton pump inhibitors that can be purchased over-the-counter. Talk to your healthcare provider about these medications and what is best for you.

Can I prevent heartburn?

You can often prevent and manage heartburn by making changes to your diet and lifestyle. These changes include:

• Not going to bed with a full stomach. Eat meals at least three to four hours before you lie down. This gives your stomach time to empty and reduces the chance of experiencing heartburn overnight.
• Avoiding overeating. Cutting back on the size of your portions during meals can help lower your risk of heartburn. You can also try eating four or five small meals instead of three larger ones.
• Slowing down. Eating slowly can often help prevent heartburn. Put your fork down between bites and avoid eating too quickly.
• Wearing loose-fitting clothes. Belts and tight clothing can sometimes cause heartburn. By changing your wardrobe to avoid these items, you might be able to prevent having heartburn.
• Avoiding certain foods. For many people, there are certain foods that trigger heartburn. Avoiding these foods can help. Try keeping a log of these foods so that you can watch out for them in the future. Your healthcare provider may also suggest that you avoid alcohol.
• Maintaining a healthy weight. Losing weight can often help relieve heartburn.
• Not smoking. Nicotine can weaken the lower esophageal sphincter (the valve that separates your stomach and esophagus). Not smoking is recommended for your general health, as well as the strength of this valve.
• Sleeping on your left side. This may help digestion and the removal of acid from your stomach and esophagus more quickly.
• Raising the head of your bed so that your head and chest are higher than your feet. Place 6-inch blocks or books under the bed posts at the head of the bed. Do not use piles of pillows. They may cause you to put more pressure on your stomach and make your heartburn worse.
• Planning your exercise to avoid heartburn. Wait at least two hours after a meal before exercising. If you work out any sooner, you may trigger heartburn. You should also drink plenty of water before and during exercise. Water aids digestion and prevents dehydration.

When to Call the Doctor

When should I call my doctor about my heartburn?

Even though heartburn is common, it can sometimes lead to more serious health problems. Severe, chronic heartburn has been linked to inflammation and narrowing of the esophagus, respiratory problems, chronic cough, GERD, and Barrett’s esophagus, which may lead to esophageal cancer.

You should contact your doctor if:

• Your heartburn won’t go away.
• Your heartburn symptoms become more severe or frequent.
• It’s hard or hurts to swallow.
• Your heartburn causes you to vomit.
• You have had substantial, unexpected weight loss.
• You take over-the-counter antacids for more than two weeks (or for a longer time than recommended on the label) and you still have heartburn symptoms.
• You have heartburn symptoms even after taking prescription medicines.
• You have serious hoarseness or wheezing.
• Your discomfort interferes with your lifestyle or daily activities.

Will heartburn go away on its own?

For many people, occasional heartburn is common. By watching what you eat and avoiding certain triggers (diet and lifestyle habits), you may be able to prevent heartburn or manage it. If you find that you frequently experience heartburn and that it keeps getting worse, it could be a sign of a medical condition like GERD. In these cases, your heartburn will not go away without treatment. Talk to your healthcare provider so that you can develop a treatment plan.

Resources

Where can I learn more about heartburn?

Chronic Heartburn | Rush System

It’s just heartburn, right? Take an antacid, hope it works and worry about it tomorrow. While this approach is fine for occasional heartburn, frequent or uncontrollable heartburn may lead to far more serious problems and shouldn’t be ignored.

Heartburn is caused by acid reflux, when acid from the stomach flows up or refluxes into the esophagus, the muscular tube that connects the throat with the stomach. The result of this acid irritating or damaging the lining of the esophagus can be a sensation of tightness, pain or discomfort in the middle of the chest — what we call heartburn.

“When the lower part of the esophagus is exposed to acid from the stomach, the cells begin to adapt,” says Michael D. Brown, MD, a gastroenterologist specializing in digestive disorders at Rush University Medical Center.

In fact, over time, the cells of the esophagus that are repeatedly in contact with acid adjust to become more like cells found in the small intestines. This is referred to as Barrett’s esophagus. While this change in the cells can protect the esophagus from further damage caused by inflammation, people with Barrett’s esophagus may develop dysplasia, a condition that dramatically increases the risk of getting cancer of the esophagus.

Take a proactive approach

That’s why, if you have had heartburn or acid reflux consistently for longer than three years, you should have an endoscopy, says Brown. An endoscopy is a simple procedure where a specially designed scope is used to examine the esophagus and take tissue samples, when necessary.

“The tissue samples or biopsies are examined to look for any abnormal cell growth,” Brown explains. “The hope is that we’ll be able to catch any abnormal cells before they become cancerous.”

Patients who are diagnosed with Barrett’s typically undergo repeat endoscopies one year and three years later. If precancerous cells are seen at that point, treatment may involve surgical removal of the esophagus to prevent eventual progression to cancer.

But a technique available at Rush, the HALO Ablation System, enables doctors to use radiofrequency ablation (high-frequency electrical currents) to remove Barrett’s tissue completely, without invasive surgery and with relatively few complications.

“HALO ablation has shown to be an effective alternative to surgery in select patients,” says Brown. “However, the good news is that most patients with Barrett’s will never progress to the point that they require this level of intervention.”

Keep the lines of communication open

Brown says it’s important to talk to your primary care doctor if you’ve been experiencing recurring acid reflux or are treating yourself for heartburn with over-the-counter medications or a prescription from another doctor. You’ll also want to visit your doctor if you experience any of the following:

• Trouble swallowing
• Unexplained weight loss
• Anemia
• Blood in your stool or vomit, which indicates bleeding in the gastrointestinal tract

“These are important symptoms to watch out for, because you can have Barrett’s esophagus without experiencing heartburn,” says Brown.

If you have chronic heartburn, falling asleep in the wrong position enables acid to sneak into the esophagus. Keeping your head raised slightly keeps that from happening.

5 tips to keep heartburn on the backburner

To prevent occasional bouts of heartburn, try taking the following five steps:

1. Avoid eating within three hours of the time you go to bed.

2. Take any acid suppressant medication, such as a proton pump inhibitor, first thing in the morning. “Because of the way proton pump inhibitor-type medications activate, it’s not helpful to take these medications at night on an empty stomach,” says Brown.

3. Sleep on a slight incline, with your head elevated, and/or sleep on your left side. If you have chronic heartburn, falling asleep in the wrong position enables acid to sneak into the esophagus. Keeping your head raised slightly keeps that from happening. Studies have also found that while sleeping on the right side actually aggravates heartburn, flipping over to your left side is likely to calm it, although the reason why is unknown.

4. Avoid foods that may cause acid reflux, such as peppermint, coffee and chocolate. “Interestingly, spicy foods haven’t been shown to cause heartburn,” says Brown. “And there’s some evidence that spicy foods may actually protect the body from ulcers.” 

5. If you smoke or use other tobacco products, quit. Not only does smoking relax the lower esophageal sphincter, allowing stomach acid to move up into the esophagus where it doesn’t belong, but it also can slow the production of saliva, which protects against acid in the esophagus. 

“The most important thing is to be aware of what causes you personally to have heartburn,” says Brown. “Everyone is different, so be aware of what triggers an attack for you and what food and remedies work best for you. But always work closely with your doctor and let him or her know when you are experiencing prolonged bouts of heartburn.”

Control your acid reflux

If you have frequent acid reflux, that means you have acid reflux disease (also called gastroesophageal reflux disease, or GERD). The vast majority of patients with acid reflux disease respond well to daily acid suppressing medications, such as proton pump inhibitors.

It’s important to note, however, that while these medications effectively manage symptoms, they are not a cure. The heartburn pain will go away, but the backsplash of damaging fluid still occurs.

That’s because proton pump inhibitors can’t fix the underlying mechanical problem — the dysfunction of the valve between the esophagus and stomach. Long-term use of proton pump inhibitors can also cause significant side effects, and you must consider the lifetime cost of taking these medications.

For these reasons, surgery may be necessary to correct the valve mechanism, with the goal of eliminating the need for reflux medication. Advances in technology have improved doctors’ ability to tailor procedures to each individual patient, with greatly improved outcomes.

These techniques are performed through small or even no incisions, and serve to restore the valve mechanism between the esophagus and stomach to prevent acid reflux,” explains Justin Karush, DO, a thoracic surgeon at Rush. Common procedures for GERD include laparoscopic Nissen fundoplication, transoral incisionless fundoplication (also called TIF Esophix) and magnetic sphincter augmentation (also called LINX).

“If you believe you have acid reflux disease and are having difficulties using medications to control it, TIF and other laparoscopic antireflux procedures may be helpful,” Brown adds. “Having a discussion of these procedures with your gastroenterologist is a great starting point.”

Heartburn and acid reflux – NHS

Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). If it keeps happening, it’s called gastro-oesophageal reflux disease (GORD).

Check if you have acid reflux

The main symptoms of acid reflux are:

• heartburn – a burning sensation in the middle of your chest
• an unpleasant sour taste in your mouth, caused by stomach acid

You may also have:

• a cough or hiccups that keep coming back
• a hoarse voice
• bad breath
• bloating and feeling sick

Your symptoms will probably be worse after eating, when lying down and when bending over.

Causes of heartburn and acid reflux

Lots of people get heartburn from time to time. There’s often no obvious reason why.

Sometimes it’s caused or made worse by:

• certain food and drink – such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods
• being overweight
• smoking
• pregnancy
• stress and anxiety
• some medicines, such as anti-inflammatory painkillers (like ibuprofen)
• a hiatus hernia – when part of your stomach moves up into your chest

How you can ease heartburn and acid reflux yourself

Simple lifestyle changes can help stop or reduce heartburn.

Do

• eat smaller, more frequent meals

• raise 1 end of your bed 10 to 20cm by putting something under your bed or mattress – your chest and head should be above the level of your waist, so stomach acid does not travel up towards your throat

• try to lose weight if you’re overweight

• try to find ways to relax

Don’t

• do not have food or drink that triggers your symptoms

• do not eat within 3 or 4 hours before bed

• do not wear clothes that are tight around your waist

• do not smoke

• do not drink too much alcohol

• do not stop taking any prescribed medicine without speaking to a doctor first

A pharmacist can help with heartburn and acid reflux

Speak to a pharmacist for advice if you keep getting heartburn.

They can recommend medicines called antacids that can help ease your symptoms.

It’s best to take these with food or soon after eating, as this is when you’re most likely to get heartburn. They may also work for longer if taken with food.

Non-urgent advice: See a GP if:

• lifestyle changes and pharmacy medicines are not helping
• you have heartburn most days for 3 weeks or more
• you have other symptoms, like food getting stuck in your throat, frequently being sick or losing weight for no reason

A GP can provide stronger treatments and help rule out any more serious causes of your symptoms.

Information:

Coronavirus (COVID-19) update: how to contact a GP

It’s still important to get help from a GP if you need it. To contact your GP surgery:

• visit their website
• use the NHS App
• call them

Find out about using the NHS during COVID-19

Treatment from a GP

A GP may prescribe a medicine called a proton pump inhibitor (PPI) that reduces how much acid your stomach makes. PPIs include:

You’ll usually need to take this type of medicine for 4 or 8 weeks, depending on how serious your acid reflux is.

Important

Go back to the GP if your symptoms return after stopping your medicine. You may need a long-term prescription.

Tests and surgery for heartburn and acid reflux

If medicines do not help or your symptoms are severe, a GP may refer you to a specialist for:

• tests to find out what’s causing your symptoms, such as a gastroscopy (where a thin tube with a camera is passed down your throat)
• an operation on your stomach to stop acid reflux – called a laparoscopic fundoplication

Page last reviewed: 09 September 2020
Next review due: 09 September 2023

Heartburn and regurgitation have different impacts on life quality of patients with gastroesophageal reflux disease

World J Gastroenterol. 2014 Sep 14; 20(34): 12277–12282.

Shou-Wu Lee, Han-Chung Lien, Teng-Yu Lee, Sheng-Shun Yang, Hong-Jeh Yeh, Chi-Sen Chang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40242, Taiwan

Shou-Wu Lee, Teng-Yu Lee, Chi-Sen Chang, Department of Medicine, Chung Shan Medical University, Taichung 40242, Taiwan

Han-Chung Lien, Sheng-Shun Yang, Hong-Jeh Yeh, Department of Medicine, Yang Ming University School of Medicine, Taipei 11217, Taiwan

Author contributions: Lee SW and Chang CS contributed equally to this work; Lee SW, Lien HC and Lee TY designed the research; Yang SS and Yeh HJ performed the research; Lee TY and Chang CS analyzed the data; and Lee SW and Lien HC wrote the paper.

Correspondence to: Shou-Wu Lee, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 160, Sec. 3, Chung-Kang Rd., Taichung 40705, Taiwan. wt.moc.oohay@924tsecire

Telephone: +886-4-23592525 Fax: +886-4-23595046

Received 2014 Jan 23; Revised 2014 Apr 9; Accepted 2014 May 25.

Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.This article has been cited by other articles in PMC.

Abstract

AIM: To investigate the impact of heartburn and regurgitation on the quality of life among patients with gastroesophageal reflux disease (GERD).

METHODS: Data from patients with GERD, who were diagnosed according to the Montreal definition, were collected between January 2009 and July 2010. The enrolled patients were assigned to a heartburn or a regurgitation group, and further assigned to an erosive esophagitis (EE) or a non-erosive reflux disease (NERD) subgroup, depending on the predominant symptoms and endoscopic findings, respectively. The general demographic data, the scores of the modified Chinese version of the GERDQ and the Short-form 36 (SF-36) questionnaire scores of these groups of patients were compared.

RESULTS: About 108 patients were classified in the heartburn group and 124 in the regurgitation group. The basic characteristics of the two groups were similar, except for male predominance in the regurgitation group. Patients in the heartburn group had more sleep interruptions (22.3% daily vs 4.8% daily, P = 0.021), more eating or drinking problems (27.8% daily vs 9.7% daily, P = 0.008), more work interferences (11.2% daily vs none, P = 0.011), and lower SF-36 scores (57.68 vs 64.69, P = 0.042), than patients in the regurgitation group did. Individuals with NERD in the regurgitation group had more impaired daily activities than those with EE did.

CONCLUSION: GERD patients with heartburn or regurgitation predominant had similar demographics, but those with heartburn predominant had more severely impaired daily activities and lower general health scores. The NERD cases had more severely impaired daily activity and lower scores than the EE ones did.

Keywords: Erosive esophagitis, Gastroesophageal reflux disease, Gender, Life quality, Non-erosive reflux disease

Core tip: The study was aimed to investigate the impact of heartburn and regurgitation on the quality of life among patients with gastroesophageal reflux disease (GERD). The results found GERD patients with heartburn predominant had more severely impaired daily activities and lower general health scores than those with regurgitation predominant. Non-erosive reflux disease greatly impaired daily function in regurgitation-predominant patients, but did not have such impact in those with heartburn predominant.

INTRODUCTION

Gastroesophageal reflux disease (GERD) is a common disorder of the upper gastrointestinal tract that is typically characterized by heartburn and acid regurgitation. According to the Montreal definition, GERD is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications[1]. GERD has an impact on the daily lives of affected individuals, interfering with physical activity, impairing social functioning, disturbing sleep and reducing productivity at work[2-5]. According to the Genval guidelines, a negative impact on the quality of life is a criterion for reflux disease in patients with frequent heartburn[6]. GERD patients can be classified as having either erosive esophagitis (EE) or non-erosive reflux disorder (NERD) depending on endoscopic findings[7]. The aim of this study was to investigate the impact of two cardinal GERD symptoms, heartburn and regurgitation, on the quality of life of patients with EE and those with NERD.

MATERIALS AND METHODS

Data from consecutive adult patients with GERD in our hospital, Taichung Veterans General Hospital, who were diagnosed according to the Montreal definition, were prospectively collected from January 2009 to July 2010. Exclusion criteria were as follows: (1) GERD combined with other structural gastrointestinal disorders, such as peptic ulcer disease, esophageal or gastric malignancy; (2) prior gastric surgery; (3) use of chronic anti-acid medication, such as proton pump inhibitors (PPIs) or h3-receptor antagonists (h3RAs), for more than 2 mo prior to enrollment; and (4) pregnancy. This study was conducted with the approval of the Clinical Research Ethics Committee of Taichung Veterans General Hospital.

The general data of enrolled patients, including age, gender, body weight, body mass index (BMI), symptom duration and lifestyle habits, were recorded. All patients underwent an open-access transoral upper gastrointestinal endoscopy, and the findings of esophagocardiac mucosal break, esophagocardiac junction (ECJ) ulcer, hiatal hernia or Helicobacter pylori (H. pylori) infection of each case were collected. All patients were asked to complete the questionnaires, including the modified Chinese version of GERDQ, the modified GERD impact scale, and the Short-form 36 (SF-36) questionnaire (Chinese version).

The modified Chinese version of GERDQ included questions about the severity of the symptoms of heartburn (“a burning feeling behind the breastbone”) and regurgitation (“unpleasant movement of material upwards from the stomach”). Answers were graded on a three-point Likert scale, as follows: mild was defined as symptoms that can be easily ignored; moderate, awareness of symptoms but easily tolerated; and advanced symptoms sufficient to cause an interference with normal activities. The enrolled patients were classified as having heartburn, defined as more severe symptoms of heartburn than regurgitation, and the regurgitation group, defined as more severe symptoms of regurgitation than heartburn.

The modified GERD impact scale measures the frequency of imparied daily activity, including sleep interruption, eating or drinking problems, and work interferences, graded on a three-point Likert scale, as follows: never, sometimes and daily. The SF-36 questionnaire measures generic quality of life, which allows comparisons between different disease states. It also measures health status in eight domains: physical functioning, role limitations-physical, bodily pain, general health, vitality, social functioning, role limitations-emotional, and mental health. Two summary scores were also calculated from subject responses: the physical health (PH) score and the mental health (MH) score. Scores on the SF-36 range from 0 to 100 in each dimension and on the summary scales, with higher scores indicating better quality of life.

Data are expressed as standard derivation of the mean for each of the measured parameters. Gender, hiatal hernia, H. pylori, ECJ ulcer, endoscopic findings and lifestyle habits, are expressed as a percentage of the total patient number. A P value below 0.05 was considered statistically significant. Statistical analyses were made using Pearson’s χ² test to compare the effects of gender, hiatal hernia, lifestyle habits and GERD impact scale scores; ANOVA test was used to analyze age, body weight, BMI, and scores of the SF-36 questionnaires.

RESULTS

A total of 290 consecutive patients were enrolled, and 58 cases had similar severity of symptoms of heartburn and regurgitation. Among the remaining 232 patients, 108 (46.6%) were classified in the heartburn group and 124 (53.4%) were classified in the regurgitation group. The symptom severities were similar in these two groups, as shown in Table .

Table 1

Severity distribution of patients in the heartburn and regurgitation group n (%)

The characteristics of the heartburn group and regurgitation group are presented in Table . The heartburn group had more males than the regurgitation group did (57.4% vs 38.7%, P = 0.044). Other general data, including age, body weight and BMI, were similar between the two groups. There were no significant differences in endoscopic findings, such as NERD/EE ratio, ECJ ulcer, hiatal hernia, H. pylori infection rate, or lifestyle habits, such as tea, alcohol, coffee consumption, and cigarette smoking.

Table 2

Basic characteristic of the of patients in the heartburn and regurgitation group

The results of the modified GERD impact scale and the SF-36 questionnaire scores of the two groups are displayed in Figures and , respectively. The heartburn group had significantly more sleep interruptions (22.3% daily vs 4.8% daily, P = 0.021), more eating or drinking problems (27.8% daily vs 9.7% daily, P = 0.008), and more work interferences (11.2% daily vs none, P = 0.011), than the regurgitation group did. Similarly, according to the results of the SF-36 questionnaire, the heartburn group had lower scores than the regurgitation group did, including total scores (57.68 vs 64.69, P = 0.042), PH scores (58.53 vs 63.52, P = 0.126), and MH scores (53.04 vs 59.31, P = 0.071).

Results of the modified gastroesophageal reflux disease impact scale of patients in the heartburn and regurgitation groups. H: Heartburn group; R: Regurgitation group.

Results of the SF-36 questionnaire of patients in the heartburn and regurgitation groups. SF-36: Short-form 36; PH: Physical health; MH: Mental health.

There were 54 (50%) NERD patients and 54 (50%) EE patients in the heartburn group, and 56 (45.2%) NERD cases and 68 (54.8%) EE cases in the regurgitation group, respectively. The two main groups, the heartburn group and the regurgitation group, were further divided into four subgroups: NERD with heartburn, EE with heartburn, NERD with regurgitation and EE with regurgitation, depending on individual endoscopic findings.

The basic characteristics of the NERD and EE patients in the heartburn group and regurgitation group are shown in Table . Male predominance in the EE with heartburn subgroup (74.1%) and female predominance in the NERD with regurgitation subgroup (71.4%) were noted. More severe obesity, including higher body weight and BMI, were found in EE patients than in NERD cases in both subgroups, particularly in the EE with heartburn subgroup (mean body weight, 68 vs 56.59, P = 0.001; mean BMI, 24.24 vs 21.68, P = 0.014). ECJ ulcers were found in the EE with heartburn subgroup (14.8%) and the EE with regurgitation subgroup (17.6%). In the EE with heartburn subgroup, there were more cases of hiatal hernia than in the NERD with heartburn subgroup (40.7% vs 14.8%, P = 0.033), but the difference was not significant in the NERD with regurgitation subgroup. The ratio of H. pylori infection was similar among all 4 subgroups.

Table 3

Basic characteristic of the of non-erosive reflux disease and erosive esophagitis patients in the heartburn and regurgitation group

The results of the modified GERD impact scale of these four subgroups are shown in Figure . The NERD and EE with heartburn subgroups had a similar presentation of daily activities. However, the NERD with regurgitation subgroup had a significantly higher ratio of impaired daily activity than the EE with regurgitation subgroup did, in particular, eating or drinking problems (11.8% daily vs 7.1% daily, P = 0.002), and work interferences (50% “sometimes” vs 26.5% “sometimes”, P = 0.046).

Results of the modified gastroesophageal reflux disease impact scale of non-erosive reflux disease and erosive esophagitis patients in the heartburn and regurgitation groups. EE: Erosive esophagitis; NERD: Non-erosive reflux disease; GERD: Gastroesophageal reflux disease.

The SF-36 questionnaire scores of these four subgroups are listed in Figure . In general, the NERD patients had lower scores, both in the physical and mental dimensions, than the EE cases did, but the difference was not significant. The EE with regurgitation subgroup had the highest scores (mean total score 65.68, PH score 63.76, MH score 60.62), and the NERD with heartburn subgroup had the worst scores (mean total score 57.52, PH score 58, MH score 52.88).

Results of the short-form 36 questionnaireof non-erosive reflux disease and erosive esophagitis patients in the heartburn and regurgitation groups. EE: Erosive esophagitis; NERD: Non-erosive reflux disease; SF-36: Short-form 36; PH: Physical health; MH: Mental health.

DISCUSSION

GERD is a chronic disease that tends to relapse and cause complications. Typical symptoms associated with GERD include heartburn, acid regurgitation, and chest pain, as well as extraesophageal manifestations such as nausea, chronic cough, asthma, and hoarseness. Previous studies indicated that the risk factors in patients with GERD include age[4], obesity[5,8], hiatal hernia[9], and an unhealthy lifestyle, including alcohol consumption and cigarette smoking. The two typical presentations of GERD are heartburn and regurgitation. Heartburn is usually characterized as a burning substernal or epigastric discomfort which radiates towards the mouth, and regurgitation refers to reflux of food or bitter-tasting gastric contents from the stomach into the mouth. Though these two symptoms are often paired, they are different conditions, and sometimes one can affect a patient without the occurrence of the other.

Patients with GERD may present with a broad range of troublesome symptoms that can affect the quality of their daily lives[2-5]. The negative effects of GERD are dependent on the frequency and severity of symptoms rather than the presence of esophagitis. Studies conducted in Sweden’s general population, which assessed the impact of the severity and frequency of GERD symptoms, showed that even symptoms rated as mild are associated with a clinically meaningful reduction in well-being[10]. One large European multicenter observational study noted more than half of GERD cases had sleep disturbance, and persistent regurgitation was associated with more hours of work missed[11]. Other two previous studies documented increasing symptom frequency of heartburn that led to significant decreases in well-being[12,13].

Our study disclosed that patients with heartburn predominant had more severely impaired daily activity, including sleep interruption, eating or drinking problems and work interferences, than those with regurgitation predominant. Furthermore, the individuals with heartburn predominant also had lower SF-36 health scores. These results implied that there might be a difference in the presentation of symptoms and quality of life of GERD patients.

Furthermore, recent analyses of clinical trial data suggest regurgitation is less responsive to acid suppression than heartburn, and may be a common cause of incomplete treatment response[14,15]. To investigate the physicopathological presentations of heartburn and regurgitation, one study monitored 32 patients with symptoms suggesting GERD using 24-h ambulatory pH and impedance. The results showed that reflux episodes inducing regurgitation had a higher proximal extent of liquid component, but less esophageal pH drop, than episodes inducing heartburn[16].

Although patients with GERD have a broad range of troublesome symptoms that can adversely affect the quality of life, studies have shown that individuals with EE and NERD have similar total quality of life scores[17,18]. In our study, patients with EE and those with NERD had similar general quality of life scores, both in the heartburn subgroup and the regurgitation subgroup. However, the NERD patients with regurgitation predominant had more significantly impaired daily functions, including eating or drinking problems and work interferences, than the EE cases did. The results implied that NERD regurgitation predominance has a more negative impact on life quality than EE regurgitation predominance, but there were no differences in the heartburn-predominant cases.

There are some limitations in our study. Firstly, co-morbid diseases that tend to influence the severity of GERD, such as chronic heart failure or chronic obstructive pulmonary disease, were not considered, and this might have led to inaccurate outcomes. Secondly, the endoscopic findings were recorded by individual endoscopists, and inter-observer conflict and misclassification might have occurred. Thirdly, gender predominant was found in some subgroups, and that might influence the finial results. Fourthly, not all of our cases with NERD have accepted pH-metry monitoring, and it might lead to a misclassification of the individuals with functional heartburn as NERD. Fively, the lifestyle characteristics in our study only reflect the patients’ current status. Lastly, our study was hospital-based designed. Further research using representative samples of the general population are needed to confirm these results.

In conclusion, in the present study, GERD patients with heartburn and regurgitation predominant had similar demographics, but heartburn predominance had a more negative impact on daily activity and general health scores. In general, the NERD cases had more severely impaired daily activity and lower scores than the EE ones did.

COMMENTS

Background

Gastroesophageal reflux disease (GERD) is typically characterized by heartburn and acid regurgitation. GERD has an impact on the daily lives of affected individuals, interfering with physical activity, impairing social functioning and reducing productivity at work.

Research frontiers

The aim of this study was to investigate the impact of two cardinal GERD symptoms, heartburn and regurgitation, on the quality of life of patients with GERD.

Innovations and breakthroughs

Patients in the heartburn group had more sleep interruptions, more eating or drinking problems, more work interferences, and lower SF-36 scores than patients in the regurgitation group did. Non-erosive reflux disease greatly impaired daily function in regurgitation-predominant cases, but did not have such impact in those with heartburn predominant.

Applications

GERD patients with heartburn predominant had a more negative impact on daily activity and general health scores than those with regurgitation predominant.

Terminology

This is an interesting original manuscript assessing the impact of heartburn and regurgitation on quality of life in GERD patients.

Peer review

This is an interesting original manuscript assessing the impact of heartburn and regurgitation on quality of life in GERD patients.

Footnotes

P- Reviewer: Blonski W, Homan M, Lai YC S- Editor: Nan J L- Editor: A E- Editor: Ma S

References

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Heartburn – an overview | ScienceDirect Topics

6.3 Gastric acid-related disorders [heartburn, gastroesophageal reflux (GERD)] and effects of pro- and/or prebiotic treatment

Heartburn, also called acid indigestion, is the most common symptom of gastroesophageal reflux (GERD) and is characterized as a burning chest pain beginning behind the sternum and moving upward to the neck and thorax. Today, more than 60 million American adults experience heartburn at least once a month, and more than 15 million adults suffer daily from heartburn (WebMD, 2016). Many pregnant women experience daily heartburn. Recent studies show that GERD in infants and children is more common than previously recognized and may produce recurrent vomiting, coughing, and other respiratory problems.

Antacids are often used to help neutralize acid in the esophagus and stomach and stop heartburn. Many people find that nonprescription antacids provide temporary or partial relief. An antacid combined with a foaming agent helps some people. These compounds are believed to form a foam barrier on top of the stomach that prevents reflux from occurring. However, long-term use of antacids can result in side effects, including diarrhea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and hypermagnesemia in the body. Elevated magnesium can be serious for patients with kidney disease. For chronic reflux and heartburn, medications that reduce acid in the stomach may be used. These medicines include acid (H₂) blockers, which inhibit acid secretion in the stomach. H₂ blockers include: cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). In addition to these treatments, proton pump inhibitors (PPIs) or acid pump inhibitors are used to irreversibly block the hydrogen/potassium adenosine enzyme system (the H⁺/K⁺ ATPase, or as it is more commonly known, the gastric proton pump of the gastric parietal cells (Alhazzani et al., 2013). Some of the PPIs include esomeprazole (Nexium), Iansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), dexlansoprazole (Dexilant), and omeprazole/sodium bicarbonate (Zegerid). PPIs are among the most widely sold drugs in the world, and the first one, omeprazole, is on the WHO Model List of Essential Medicines (World Health Organization (WHO), 2013). Their use among the elderly is on the rise (Gomm et al., 2016; Hollingworth et al., 2010). However, the use of PPIs can have significant consequences on health. In a 2016 study, research evaluated 74,000 elderly participants, age 75 and older, with no dementia at the onset of study over a 7-year period (Gomm et al., 2016). The researchers found that participants taking a PPI were 44% more likely to develop dementia than individuals not on a PPI, even after statistical adjustment for age, sex, and the use of multiple medications. In a second, large longitudinal study (German Study on Aging, Cognition, and Dementia) more than 3300 elderly (>75 years) that were followed every 18 months for 6 years, those using PPIs had a 38% increased risk of dementia, and a 44% increase in the risk of Alzheimer’s disease, compared with those with no history of PPI use (Haenisch et al., 2015). Recent research has also demonstrated that even short-term PPI use impairs cognition in healthy young volunteers (ages 20–26 years). After only 7 days of exposure to PPIs, all of the drug recipients had a statistically significant impairment of cognitive function, measured against baseline visual memory, attention, executive function, working memory, and planning functions (Akter et al., 2015). In this study, omeprazole (Prilosec®), the most commonly prescribed PPI, reduced cognitive function the greatest, while others including, lansoprazole and pantoprazole, rabeprazole, and esomeprazole, had lower, but significant influences. The mechanism involved in this health issue involves the impairment of acid production in the microglia cells of the brain, which is necessary to break down beta-amyloid plaque to be removed by the microglia cells (Fallahzadeh et al., 2010; Majumdar et al., 2011). PPIs pass the blood–brain barrier and reduce acid levels contained within the lysosomes of the microglia (Fallahzadeh et al., 2010). Studies have shown that acid levels in the lysosomes of the brains of patients with Alzheimer’s are significantly lower than those of healthy individuals (Guha et al., 2014; Wolfe et al., 2013). As pro- and prebiotics have been shown to reduce mechanisms associated with the development of cerebral inflammatory response, and amyloid plaque formation, they may also be useful during PPI use, see Alzheimer’s disease sections under periodontal disease and diseases of the CNS. However, finding effective alternatives to PPIs is likely necessary.

Some alternatives to PPIs have shown significant promise in treating heartburn and GERD. By example, a combination of two nutrients, zinc and carnosine, has shown to be highly effective in individuals with stomach ulcers, especially in those cases associated with Helicobacter pylori infection (Kashimura et al., 1999; Suzuki et al., 1999; Matsukura and Tanaka, 2000). More recently, raft-foaming alginate gels have also shown promise in preventing reflux symptoms such as heartburn (Kapadia and Mane, 2007; Quartarone, 2013; Strugala et al., 2009; Sweis et al., 2013; Tytgat and Simoneau, 2006). Hamilton-Miller (2003) in his review reported several studies using the probiotic lactobacilli in vitro inhibit or kill the H. pylori bacteria by preventing its adhesion to epithelial cells and prevent IL-8 release. In in vivo models, pretreatment with probiotic prevented H. pylori infections or markedly reduced an existing infection. In several human studies, a probiotic was found to clear an infection, or reduce side effects of infection.

A recent double-blind trial involving 105 patients with IBS fulfilling Rome II criteria with minor intensity of symptoms showed that supplementation with 5 g/d scFOS for 6 weeks was significantly more effective than a placebo at relieving symptoms of dyspepsia such as indigestion, heartburn, low stomach acidity, fullness, constipation urgency, and diarrhea. The average symptom severity decreased by 44% with FOS supplementation (Paineau et al., 2008).

In addition to dementia, PPIs also induce hypomagnesemia, a defect in intestinal absorption of magnesium. Recently, patients with PPI-induced hypomagnesemia that received two 14-day cycles of 20 g of inulin/day significantly enhanced serum magnesium levels from 0.60 to 0.68 mmol/L. As a consequence, 24-h urinary magnesium excretion was significantly increased in patients with PPI-induced hypomagnesemia (0.3–2.2 mmol/d). Symptoms of muscle cramps and paraesthesia associated with hypomagnesemia were reduced during inulin intervention.

GERD, Acid Reflux and Heartburn

It’s important to treat GERD quickly to avoid long-term health risks, including ulcers, bleeding, esophagitis or Barrett’s esophagus. Treatment for GERD may include medication or lifestyle changes. Your gastroenterologist will discuss which treatment option is best for you, including:

• Improve your health – If you smoke, your doctor will discuss how quitting can help relieve GERD symptoms. Losing weight can also help improve acid reflux.

• Adjust eating habits – Eating small, frequent meals, avoiding foods and drinks that worsen symptoms, and staying upright (without lying down) for 3 hours after meals can help avoid acid reflux.

• Use a wedge pillow for sleeping – You could try lying on a special wedge pillow that is designed to keep you at an incline while sleeping to relieve GERD symptoms.

• Take medication – Your gastroenterologist will discuss which medication is right for your GERD. Antacids, foaming agency, h3 blockers or a proton pump inhibitor can help address the source of your heartburn and improve your symptoms.

• Consider surgery for severe GERD – Surgery may be needed to address severe GERD that isn’t managed with medication or diet and lifestyle modification. We offer a wide range of surgical options for diagnosing and treating GERD, including fundoplication, endoscopic techniques and LINX, an innovative and minimally invasive surgery that helps prevent reflux.

About the LINX Procedure

The LINX device

The LINX device is a flexible ring that is intended to reduce daily GERD symptoms. When a patient swallows food or water, the device will expand to allow food to enter the stomach. Then almost immediately, it will close again to prevent reflux from the stomach into the esophagus.

The LINX device is implanted surgically. The LINX procedure is done laparoscopically, meaning that the surgeon makes 3 or 4 smaller incisions in the abdomen and uses tools and cameras to implant the device.

It’s a quick procedure and minimally invasive. Patients often go home from the hospital the very same day.

The device is safe and effective in the long-term.

90,000 why does it arise, how to get rid of it, ways of emergency elimination of the symptom

Heartburn is a condition that is accompanied by a burning sensation that spreads from the epigastric region to the larynx and sometimes radiates into the neck, the space between the shoulder blades, the subclavian zone. Burning is not the only, but the most striking and frequent companion of heartburn. Other symptoms include belching, a bitter or sour taste in the mouth, esophageal flatulence, nausea, vomiting, a feeling of a lump in the throat, and profuse drooling.What do these signs indicate, and what to do if they torment you every day?

Why does heartburn constantly appear?

Heartburn occurs due to the release of stomach contents into the esophagus. This phenomenon is called gastroesophageal reflux. The acids contained in the food mass irritate the mucous membrane of the organ and provoke a burning sensation.

Heartburn can occur in a person for a variety of reasons.Among them:

• weak sphincter, pushing food into the stomach;
• physical activity immediately after eating, increasing the pressure in the abdominal cavity;
• consumption of fatty, smoked, salty foods;
• overeating and resulting obesity;
• hypersensitivity of the esophageal mucosa;
• increased acidity of gastric juice;
• gastroesophageal reflux disease;
• pregnancy;
• smoking and alcohol, provoking relaxation of the sphincter;
• acidic foods and carbonated drinks that irritate the esophagus while passing through it;
• stress, neurological disorders;
• taking aspirin and ibuprofen;
• horizontal position of the body after eating;
• Barrett’s esophagus precancerous disease;
• gastritis, gastroduodenitis;
• stomach and duodenal ulcer;
• hernia in the esophagus;
• esophageal strictures;
• peptic ulcer of the esophagus.

It is very important to prevent heartburn and maintain the intestinal microflora. These tasks are handled by the complex of probiotics Elbifid – Essential Probiotics, which maintains the balance of the natural intestinal microflora, which is responsible for the quality of the immune response and the harmonization of the digestive system.

It is also worth drawing your attention to Bifidogenous balm – Siberian Propolis Agate, which also has a fruitful effect on the natural balance of intestinal microflora, stimulating its growth.The improved formula of the balm contains even more lactulose and Siberian medicinal herbs.

What to do?

Since the causes of severe heartburn are very diverse, and many of them are dangerous to health, it is worth starting treatment with a diagnosis. If the condition is provoked by any disease, it is necessary to get rid of it, and not of its symptom.

The doctor may prescribe an endoscopic, X-ray, or ultrasound examination of the gastrointestinal tract.To check the motility of the esophagus and the functioning of the sphincter, manometry is performed. If cysts or tumors are suspected, a biopsy is done.

After the diagnosis is established, treatment of the causative disease begins. At the same time, medications are prescribed to relieve the symptoms of heartburn. Surgery may be required, for example, to correct the sphincter.

Attention! If the diagnosis does not reveal any abnormalities that could provoke heartburn, most likely the problem lies in the wrong lifestyle or diet.

Power correction

First of all, it is worth giving up the use of salty, fatty, smoked and fried foods, soda, flour products, spices and seasonings, coffee, chocolate. Preference should be given to viscous, neutral and sweet products. Sour fruits and vegetables are prohibited.

The following foods and dishes are great for a heartburn diet:

• steamed vegetables, especially carrots, potatoes;
• boiled, stewed or steamed meat;
• legumes – lentils, peas;
• low fat cottage cheese;
• low-fat sour cream, milk;
• fish and seafood;
• lean meats, poultry;

90,019 rice and cereals – buckwheat, oatmeal, millet;

• flour products from wholemeal flour;
• boiled eggs, steam omelets;
• compote from sweet fruits and berries.

Attention! The risk of gastroesophageal reflux attack is reduced by fractional meals: 5-6 times a day in small portions. You cannot eat less than 2 hours before bedtime.

Lifestyle correction

Lifestyle correction consists in giving up alcohol and cigarettes. If there is no way to exclude these bad habits from your everyday life, you should indulge them at least less often.

After eating, you can not take a horizontal position, as it will provoke the release of food from the stomach into the esophagus. Better to take a walk in the fresh air or do your favorite hobby. It is also not worth lifting weights and physically overloading, otherwise the pressure in the abdominal cavity will increase, which will lead to the same result.

Herbal tea from wild herbs No. 5 (Comfortable digestion) from the Baikal Tea Collection will help you to feel comfort and lightness in the stomach thanks to the unique composition of Siberian herbs. Chamomile, Kuril tea, plantain, and bullock normalize the digestive system and restore the intestinal microflora.

As a snack, you can use the Nutritious cocktail Vanilla Delight – Yoo Go, rich in vitamins, amino acids and healthy fats. Each serving is a complete, healthy snack packed with fiber, omega-3 PUFAs, protein, and L-carnitine. The balanced composition provides the body with vital nutrients and helps to keep you feeling full for a long time.

Attention! It is necessary to give up wearing corsets and shaping underwear, tight belts and belts – common causes of heartburn.

Folk remedies for emergency

Traditional methods of treatment usually relieve heartburn for a short time and, if used too often, are unsafe, so they should not be overused. Of the proven home remedies for the emergency elimination of the symptom, infusions of chamomile, plantain and St. John’s wort or mint, or anise, dill and fennel are used. Another popular recipe is ¼ tsp solution. soda and 100 ml of boiling water. They drink it warm, in small sips.

Why “just heartburn” is dangerous and how to avoid it – doctor’s recommendations

Young men and middle-aged people are more likely to suffer from heartburn. Natalia Bilash, a therapist at the Into-Sana clinic, urges you not to endure a condition that worsens your well-being, and contact a specialist in time

• Heartburn is a burning sensation behind the breastbone that rises up from the epigastric region. Heartburn occurs when acidic stomach contents enter the esophagus. The hydrochloric acid in the stomach is quite aggressive.The mucous membrane of the stomach is protected from hydrochloric acid, but the mucous membrane of the esophagus is by no means. If you overeat, the overfilled stomach prevents the lower esophageal sphincter from closing completely. Hydrochloric acid enters the esophagus, because of which the esophageal mucosa begins to suffer, and the person feels an unpleasant burning sensation.

Heartburn also appears as a result of constant nervous tension. The body reacts to stress by the appearance of the following diseases: inflammation of the esophageal mucosa, erosion of the stomach, gastritis, stomach and duodenal ulcers.Heartburn is one common symptom of all of the above conditions.

It should be remembered that the main danger of heartburn at night is the development of malignant tumors in the esophagus and stomach. Cancer cells develop due to the fact that hydrochloric acid irritates the lining of the esophagus for a long time.

The frequent occurrence of heartburn may indicate the presence of various diseases not only of the gastrointestinal tract, but also of the cardiovascular system, including angina pectoris.Sometimes a burning sensation accompanies high blood pressure. Therefore, you should not hesitate with a visit to a specialist, because it is always better to identify any disease in the early stages. Before making a diagnosis, an experienced specialist must examine the organs of the digestive and cardiovascular systems.

Heartburn also occurs in people who do not have diseases of the cardiovascular or digestive systems. Often in such cases, a burning sensation behind the breastbone occurs due to improper nutrition (when a person prefers spicy and fatty foods, abuses alcohol).In addition, it should be remembered that certain foods can cause heartburn: fruits (apples, lemons), kefir or rye bread.

Also, heartburn can occur due to sudden physical exertion, as a result of which the contents of the stomach are thrown into the esophagus.

In case you suffer from heartburn:

• Try to sleep at an angle, on the part of the bed raised by 15-20 cm.
• Immediately after eating, do not bend over, lift heavy objects, do not exercise or assume a horizontal position.
• Don’t eat dinner before bed. After eating, 2-3 hours should pass.
• Do not overuse foods that can cause a burning sensation in the esophagus.
• Discard tight belts and other clothing that tightens the belly area.
• Try to eat healthy and balanced.
• Try to give up bad habits (alcohol, smoking, overeating).

Heartburn can be a sign of cancer

January 26, 2015

Photo by BBC World Service

Doctors urge not to ignore heartburn, because it can be a sign of stomach or esophageal cancer.

According to Public Health England (PHE), people should see a doctor if they have persistent heartburn or difficulty swallowing for three or more weeks.

The organization adds that most people are unaware of the symptoms of the disease.

Cancer of the stomach and esophagus is the fifth most common cancer in England.

PHE figures show that about 12.9 thousand people in England are diagnosed with this cancer every year, and about 10 thousand people die from these diseases every year.

How to spot the symptoms

The earlier cancer is diagnosed, the higher the likelihood of successful treatment.

This is why PHE’s “Be Clear on Cancer” campaign focuses on how to detect signs of esophageal or stomach cancer.

These may include:

• Recurrent stomach upset for three or more weeks
• Feeling stuck in the throat when swallowing
• Weight loss for no apparent reason
• Bloating and frequent belching
• Feeling full very quickly after eating start
• nausea or vomiting
• pain or discomfort in the upper abdomen

Campaign works

obvious symptoms of possible cancer.

Some are afraid of being diagnosed with cancer or are used to pretending to have no health problems at all.

Others do not trust their doctors or simply believe that these are age-related problems.

However, there is some good news for PHE – it looks like their campaign is encouraging people to seek help.

Dr. Katrina Whitaker, study author and senior fellow at University College London, says: “Some people chose to test their symptoms after seeing a cancer awareness campaign, or are encouraged to do so by family or friends.”

Sarah Heom, director of early diagnosis at Cancer Research UK, says the results were helpful in understanding the British psyche.

In her opinion, the study could encourage anyone with anxiety symptoms to seek help as early as possible.

Heartburn

14256

11 September

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication.In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment prescription, you should contact your doctor.

Heartburn – the causes of the appearance, in what diseases it occurs, diagnosis and treatment methods.

Heartburn is a feeling of burning, heaviness, or pain behind the breastbone. This condition significantly impairs the quality of life, reduces efficiency, and disrupts sleep.

What diseases cause heartburn?

The development of heartburn can be based on a variety of reasons that need to be identified for diagnosis and treatment.

Gastroesophageal reflux disease

This disease is accompanied by reflux of stomach contents into the esophagus, the walls of which are more sensitive to an acidic irritant environment than the gastric mucosa.

Gastroesophageal reflux disease is quite common in the adult population and, if untreated, can lead to persistent narrowing of the esophagus, bleeding, and ulcers.

The development of the disease is based on impaired motility, or dyskinesia of the gastrointestinal tract. First of all, this is a dysfunction of the lower esophageal sphincter and a violation of the motility of the esophagus. Periodic uncontrolled relaxation of the lower esophageal sphincter causes stomach contents to enter the esophagus, which can be exacerbated by esophageal hernia, which increases the frequency of reflux.

Hernia of the hiatus also causes heartburn. In this case, it may be accompanied by belching, throwing the contents of the stomach into the oral cavity. Pain that occurs in the lower sternum can radiate to the back, left shoulder and left arm, as with angina pectoris. Pain or burning sensation often occurs when lying down, when bending forward, after eating, that is, when intra-abdominal pressure rises.

Stomach ulcer. Heartburn in gastric ulcer can occur due to increased production of hydrochloric acid in the stomach and its reflux into the esophagus, especially at night. This condition is called nocturnal acid breakthrough, and it seriously aggravates the condition, causing chest pain and burning and disrupting sleep.

Cancer of the cardiac stomach.

In this condition, heartburn may be the dominant symptom.

First, there is a burning sensation and “scratching” when food passes through the esophagus.Then there is difficulty in swallowing, pain behind the sternum, often radiating to the region of the heart.

Hypersensitive esophagus.

Heartburn can be a symptom of an increased sensitivity of the lining of the esophagus.

This individual feature can be explained by an increased perception of pain by the receptors of the esophagus, a violation of the integrity and increased permeability of the mucous membrane, a violation of the perception and processing of incoming signals in the central nervous system.

Functional heartburn. This concept has appeared relatively recently and denotes heartburn, which excludes gastroesophageal reflux disease, structural and movement disorders of the esophagus. The mechanisms for the development of such heartburn are not yet clear and can be explained by both increased sensitivity of the esophagus and the peculiarities of the nervous system. At the same time, there is no connection between heartburn and diseases of the esophagus and gastrointestinal motility.

Other possible causes

Functional dyspepsia

Under functional dyspepsia, conditions are combined that are caused by a temporary disruption of the activity of the stomach, duodenum and pancreas.

The causes of the disease are disorders of gastric secretion, gastrointestinal motility, increased sensitivity of the mucous membrane. Complaints of patients with dyspepsia include: pain or discomfort in the epigastric region, heaviness, feeling of fullness after taking the usual amount of food, bloating, diarrhea, nausea, vomiting, belching, heartburn. Various toxicoinfections can also provoke functional dyspepsia. An important role in the onset of the disease belongs to psychosomatic disorders.Patients with functional dyspepsia are often anxious. Given that the symptoms of the disease can disappear after taking antacids, doctors often note the leading role of the acid factor, which triggers the pathological process. When examining such patients, it is often not possible to detect organic diseases (ulcers, tumors or pancreatitis).

Taking medications. This is a fairly common cause of heartburn.At the same time, such a symptom is caused by drugs that reduce the tone of the lower esophageal sphincter: non-steroidal anti-inflammatory drugs, glucocorticosteroids, calcium antagonists, beta-blockers, anticholinergic drugs, theophylline, progesterone, antidepressants, nitrates, doxycycline, quinidine.

Conditions accompanied by increased intra-abdominal pressure. These conditions include pregnancy, enlargement of the liver, spleen, chronic obstructive pulmonary disease.The result is a change in the position of the stomach and easier entry of its contents into the esophagus.

Which doctors should I contact?

Heartburn can be a sign of a serious illness, therefore, self-medication with prolonged and repeated manifestations of it is unacceptable.

If heartburn occurs at least twice a week, it is imperative to visit
therapist or
a gastroenterologist for a referral for an examination of the gastrointestinal tract.If a concomitant anxiety-depressive state is identified, a consultation with a neuropsychiatrist is necessary.

Diagnostics and examinations

As a rule, upon presentation of complaints of heartburn, observed for at least three months, the gastroenterologist conducts a survey of the patient about the time, frequency, and provoking factors of heartburn. First of all, as with other diseases, the doctor prescribes a general blood test and a biochemical blood test.

preliminary results of the analysis of the national population study

Prevalence and features of clinical manifestations of gastroesophageal reflux disease in the Republic of Mordovia (according to the research “MEGRE”) Text of a scientific article in the specialty “Health Sciences”

CLINICAL GASTROENTEROLOGY

clinical gastroenterology

PREVALENCE AND FEATURES OF CLINICAL MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE IN THE REPUBLIC OF MORDOVIA (ACCORDING TO THE DATA OF THE RESEARCH “MEGRE”)

Zvereva S.I.

Mordovia State University named after N.P. Ogarev

Zvereva Svetlana Ivanovna

430017, Saransk, st. Veselovsky, 17, apt. 1

E-mail: [email protected]

SUMMARY

The article presents the results of a study conducted as part of the first population study of the prevalence of gastroesophageal reflux disease in Russia using the Mayo Clinic questionnaire.A high prevalence of gastroesophageal reflux disease among the inhabitants of Saransk was revealed. A comparative analysis of the symptoms of the disease was carried out taking into account the gender and age of the respondents.

Keywords: gastroesophageal reflux disease; prevalence; heartburn. SUMMARY

In the article are shown the results of the study being the first of the detailed population-based study of the prevalence of gastroesophageal reflux disease in Russia based on the reflux questionnaire Mayo Clinic.The high prevalence of gastroesophageal reflux disease was determined among the inhabitants of Saransk. We made the comparative analysis of the symptoms of the disease with regard for sex and age of the respondents.

Keywords: gastroesophageal reflux disease; prevalence; heartburn.

Gastroesophageal reflux disease (GERD), due to its extremely high prevalence and negative impact on the quality of life of patients, is a serious problem of gastroenterology [1; 2].According to the Montreal Agreement (2006), GERD is a condition that develops when reflux of stomach contents causes symptoms that bother the patient and / or complications [3]. The main symptoms of the disease are heartburn, belching, regurgitation, odonophagia, dysphagia. In recent years, increased attention in the clinical picture is paid to the extraesophageal manifestations of GERD – bronchopulmonary, cardiac, otorhinolaryngological and dental.

GERD is a multifactorial disease.The main pathogenetic mechanisms of its development are: a decrease in the antireflux barrier function of the lower esophageal sphincter,

violation of the motor function of the proximal parts of the digestive tract, inhibition of the esophageal clearance, which is understood as the ability to remove acid refluxant from the esophagus by peristaltic waves and neutralize it with hydrocarbonates of esophageal mucus, the damaging effect (aggressiveness) of refluctate thrown from the stomach into the esophagus, and primarily pepsin, as well as a decrease in the resistance of the esophageal mucosa [4 – 8].In practice, among the factors contributing to the development of GERD, most often mentioned are hiatal hernia, overweight and obesity, smoking, and taking certain medications.

The urgency of the problem of GERD is determined not only by the high prevalence and severity of symptoms, which have a significant impact on the quality of life of patients,

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but also a high risk of complications, which include erosion and ulcers of the esophagus, bleeding, penetration, strictures of the esophagus and Barrett’s esophagus, considered by experts as a precancerous condition [8; nine].

According to international statistics, in recent decades there has been a significant increase in the prevalence of GERD in various regions of the world [2; 10 – 12]. In the USA and Belgium, only endoscopically positive GERD is detected in 21 – 27% of the population, in Japan – in 16.5%, in a number of Asian countries – about 3 – 6% [10; 13]. In some regions of Russia, according to sample studies, up to 48.5% of men and 51.4% of women periodically experience heartburn [14].According to LB Lazebnik, DS Bordin, AA Masharova, the prevalence of GERD in Moscow was 23.6% [15]. At the same time, it is believed that the true level of morbidity is even higher if we consider that a significant part of patients ignore the manifestations of the disease, do not go to the doctor, and are observed by other specialists for a long time about extraesophageal manifestations of GERD [15; sixteen].

The prevalence of the disease in Russia, including Mordovia, has been insufficiently studied until recently, which is associated with a large variability of clinical manifestations – from episodic heartburn to vivid clinical signs of complicated reflux esophagitis.It is especially important to study the prevalence of GERD symptoms among people who consider themselves practically healthy and do not seek medical help. In this regard, the Central Scientific Research Institute of Gastroenterology in Moscow and the Scientific Society of Gastroenterologists of Russia conducted the country’s first Multicenter Study Epidemiology of Gastroesophageal Reflux Disease in Russia (MEGRE). The study examined the epidemiology of GERD in seven cities of the Russian Federation: Moscow, St. Petersburg, Krasnoyarsk, Kemerovo, Kazan, Ryazan, and Saransk.To objectify the information obtained, the interviewing method was used using the expanded and culturally adapted questionnaire of the Mayo Clinic, translated into Russian. The selection of respondents was carried out by the method of random sampling from the telephone directory.

Statistical processing of the obtained materials was carried out using the Statistica 6.0 software package and included the creation of a database, an automated check of the quality of information preparation and statistical analysis.The criterion for statistical significance was the p <0.05 level. The mean values ​​and standard deviations were determined. The significance of differences in nonparametric data was assessed using Pearson's x2 test.

The study included 1400 residents of Saransk aged 17 to 75 years (average age 35.3 ± 13.2 years), including 478 men (average

age – 34.8 ± 13.8 years) and 922 women (average age 32.5 ± 12.8 years).The distribution of respondents by sex and age is presented in table. 1.

Analysis of the results showed that heartburn with varying frequency and severity was noted by 51.1% of the respondents. Diagnostically significant heartburn and / or regurgitation with a frequency of once a week or more during the last 12 months were identified in 13.4% of respondents.

The results of our study in Saransk are comparable with the results obtained by other participants in the MEGRE study.The prevalence of GERD in different cities of Russia was approximately the same (11.3 – 14.3%) [17].

Daily heartburn occurred in 31 (2.2%) respondents, several times a week – in 70 (5.0%), once a week – in 21 (1.5%), several times a month – in 153 (10 , 9%), once a month – in 138 (9.9%), less often than once a month – in 302 (21.6%) respondents. The data obtained differed slightly from the results of other researchers. According to L.B. Lazebnik, Yu.V. Vasilieva, I. V. Manannikova (2005), heartburn was noted: daily – in 7.5% of cases, occurring once a week – in 10.0%, once a month – in 22.1%, at least once a year – in 39.6% of cases [18]. According to the results of an epidemiological study of GERD in Kazan [19], heartburn once a week – in 24.9%, several times a week – in 6.8%, daily – in 0.6% of respondents. According to the results of a large-scale study conducted in the United States (A Gallop Survey on heartburn across America), 44% of American adults experienced heartburn at least once a month, 20% at least once a week, and 7% of those surveyed suffer from heartburn every day [20] …

The results of the survey showed that the prevalence of GERD signs among the respondents in Saransk depended on age. With age, the frequency of symptoms such as sour throat sensation, chest pain and dysphagia increased, reaching maximum values ​​in the group of respondents over 60 years old. The prevalence of heartburn and regurgitation reached its maximum values ​​in the age group from 50 to 59 years, and then decreased (Fig.one). The data obtained do not contradict the results of other researchers [20].

Most often, heartburn was combined with a sensation of acid in the throat and pain in the chest. The latter confirms the importance of differential diagnosis of pain of cardiac and esophageal origin, as well as the need for simultaneous daily monitoring of intraesophageal pH and ECG for differential diagnosis of these conditions. In this case, one should take into account the possibility of a combination of these diseases in the same patient.The combination of heartburn with a sensation of acid in the throat was observed in 96 (51.3%) respondents, with regurgitation – in 50 (26.7%), with chest pain – in 92 (49.2%), with dysphagia – in 46 (24.6%).

CD

The intensity of symptoms identified in respondents with signs of GERD was assessed as follows: “slightly” – did not pay attention, if not reminded; “Average” – worries, but does not interfere in everyday life; “Strong” – sometimes interferes with everyday life; “Very strong” – often interferes with everyday life.

According to our results, the majority of respondents rated their heartburn as moderate (48%) and strong (36%) intensity, heartburn was much less common, disturbing respondents “slightly” (9%) and “very strongly” (7%) (fig. 2).

The distribution of the intensity of other symptoms of GERD among the respondents was similar. The sensation of acid in the throat “slightly” bothered in 18.8% of cases, “medium” – in 50%, “strongly” – in 22.9% and “very strongly” – in 8.3% of cases.The pain behind the breastbone “slightly” bothered in 8.6% of cases, “medium” – in 50%, “strongly” – in 27.4% and “very strongly” – in 14% of cases. Regurgitation of mild intensity occurred in 34% of the respondents, medium – in 44%, strong – in 20% and very strong intensity – in 2% of the respondents. The severity of dysphagia in 15.2% of respondents was mild, in 56.5% – moderate, in 27.1% – strong and 6.6% – very strong.

When comparing the frequency and intensity of the main symptoms with the age of the respondents with signs of GERD, a positive correlation was found for most of them (tab.2).

With increasing age of respondents with signs of GERD, the frequency and severity of heartburn, chest pain, sore throat sensation increased, the frequency of regurgitation increased

and the intensity of dysphagia. Persistent, progressive, or troublesome dysphagia may be a sign of complications such as esophageal stricture or cancer and warrant a detailed evaluation of the patient.

Analysis of the data obtained showed that the frequency of GERD symptoms depended on the gender of the respondents. Signs of GERD were found in 14.0% of women and somewhat less frequently in men (X2 = 0.94, p = 0.33). In the age groups from 30 to 39 years old and over 60 years old, this difference was significant (Fig. 3). They were more common among women. Comparison of the frequency of heartburn, chest pain, acid sensation, regurgitation and dysphagia with the gender of respondents with signs of GERD are presented in Table.3. It can be seen from the results in the table that all symptoms of GERD, with the exception of regurgitation, were significantly more common among women.

Body mass index (BMI) was used to study the relationship between GERD and overweight and obesity. BMI less than 19 indicated a lack of body weight; from 25 to 29.9 – about overweight, from 30 to 39.9 – about obesity. Overweight was found in 117 (8.4%) respondents. Among them, GERD symptoms occurred in 18.7% of cases, that is, more often (p <0.01) than in respondents with a normal body weight (6.4%) (Fig.4).

A survey was conducted among the respondents to identify the connection between GERD and bad habits. 8.0% of all respondents smoked, 38.2% drank coffee regularly, alcohol consumption was noted by 58.6% of the respondents (Table 4). In the group of respondents with signs of GERD

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No. 09/2010 EXPERIMENTAL AND CLINICAL

AGE AND SEX CHARACTERISTICS OF RESPONDENTS OF AN EPIDEMIOLOGICAL STUDY OF GERD PREVALENCE IN SARANSK

Age groups of respondents, years Total Men Women

n% n% n%

17 – 19 293 20.9 82 17.2 211 22.9

20 – 29 466 33.4 161 33.7 305 33.1

30 – 39 136 9.7 44 9.2 92 9.9

40 – 49 251 17.9 91 19.0 160 17.4

50 – 59 178 12.7 66 13.8 112 12.1

60 and older 76 5.4 34 7.1 42 4.6

Total 1400 100 478 100 922 100

Table 2

DEPENDENCE OF FREQUENCY AND INTENSITY OF SYMPTOMS ON AGE OF RESPONDENTS WITH SIGNS OF GERD

Correlation dependence of symptom frequency Correlation dependence of symptom intensity

g R g R

Heartburn 0.34 <0.05 0.31 <0.05

Chest pain 0.19 <0.05 0.25 <0.05

Sensation of acid in the throat 0.19 <0.05 0.26 <0.05

Regurgitation 0.17 <0.05 0.04> 0.05

Dysphagia 0.03> 0.05 0.24 <0.05

coffee lovers, as well as smokers and drinkers were significantly more frequent.

Among the respondents who participated in the study and met the GERD criterion, the majority of respondents had a significantly reduced quality of life. Nevertheless, only 45% of them went to the doctor with complaints of heartburn, the remaining 55% ignored

the significance of this symptom or self-medicated. Among those who consulted a doctor, 25% did it 1 – 2 times, 7.5% – 3 – 5 times, less than 1% – 5 – 6 times, 2.8% – more than 10 times in the last year.Underestimation of the severity of the respondents’ symptoms of GERD and, as a consequence, low referral to medical institutions contributed to

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Fig.3. Prevalence of GERD depending on gender and age of respondents * – p <0.05 between men and women

irrational and uncontrolled use of drugs for relieving heartburn, which is confirmed by the results obtained. Antacids (19%) and H2-blockers (13%) were drugs for eliminating heartburn, which were taken by the inhabitants of Saransk (without taking into account the adequacy of doses and duration of administration). Only 4% used proton pump inhibitor therapy.

Thus, we can conclude that a significant part (51.1%) of Saransk residents experience heartburn to one degree or another. Clinical features,

characteristic of GERD, occur in 13.4% of the population, and more often in women. With age, the frequency and intensity of the main symptoms of GERD increases. Age, being overweight, drinking coffee, alcohol and smoking are significant contributing factors to the development of GERD.

Given the high prevalence of the disease in this category of persons and the threat of complications in the absence of adequate therapy, it seems necessary to recommend

Table 3

DEPENDENCE OF MAIN SYMPTOMS ON SEX IN RESPONDENTS HAVING SIGNS OF GERD

Male, N = 58 Females, N = 129 Total, N = 187 Comparison between males. and wives.

N% N% N% X2 P

Heartburn 31 53.4 91 70.5 122 65.2 5.16 0.0232

Chest pain 24 41.4 77 59.7 102 54.5 5.40 0.0201

Sensation of acid in the throat 30 51.7 93 72.1 123 65.8 7.37 0.0066

Regurgitation 37 63.8 75 58.1 112 59.9 0.53 0.4656

Dysphagia 9 15.5 38 29.5 47 25.1 4.13 0.0421

Table 4

RESPONDENT HABITS RATE

Habits All respondents, N = 1400 (100%) Signs of GERD1 X2 R

no, N = 1261 (100%) yes, N = 139 (100%)

Smoking 112 (8.0%) 89 (6.7%) 23 (12.3) 5.42 0.0199

Coffee consumption 423 (38.2%) 383 (31.6%) 40 (21.4%) 7.97 0.0048

Alcohol consumption 821 (58.6%) 696 (57.4%) 125 (66.8%) 5.99 0.0144

Note: 1 Heartburn and / or regurgitation once a week or more.

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active detection of GERD symptoms during periodic medical examinations in the population. Knowledge of the characteristics of clinical manifestations in patients with GERD, the degree of influence of factors contributing to the development of the disease,

arm doctors with clear diagnostic criteria, determining the prognosis of the course of the disease, the occurrence of possible complications, approaches to treatment and prevention, which must be used in everyday practice.

REFERENCES

1. Lazebnik LB Heartburn and gastroesophageal reflux disease: problems and solutions // Ter. arch. – 2008. – No. 2. – S. 5-11.

2. Lazebnik L.B., Bordin D.S., Masharova A.A. Modern understanding of gastroesophageal reflux disease: from Genval to Montreal. // Experiment. and wedge. gastroenterol. – 2007. – No. 5. – S.4-10.

3. Vakil N., van Zanden S. V., Kahrilas P. et al. The Monreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus // Am. J. Gastroenterol. – 2006. – Vol. 101. – P. 1900-1920.

4. Ivannikov O.I., Isakov V.A., Maev I.V. Rational diagnosis and therapy of gastroesophageal reflux disease // Ter. arch. – 2004. – No. 2. – S. 71-75.

5. Sheptulin A.A. Gastroesophageal reflux disease: from myths of the past to realities of the present (In memory of A.L. Grebenev) // Klin. honey. – 2003. – No. 6. – S. 4-8.

6. Dent J., Brun J., Fendrick A.M. et al. An evidence-based appraisal of reflux disease management – the Genval Workshop Report // Gut. –

1999. – Vol. 44, suppl.2. – P. 1-16.

7. Mayev I.V., Kazyulin A.N., Petukhov A.B. and other Extraesophageal manifestations of gastroesophageal reflux: Textbook. allowance. – M .: VUNMTs, 1998 .– 39 s

8. Zimmerman Ya.S. Clinical gastroenterology: selected sections. – M .: GEOTAR-Media, 2009 .– 416 p.

9. Vasiliev Yu.V. Barrett’s esophagus and esophageal adenocarcinoma // Experimental.and wedge. gastroenterol. – 2007. – No. 2. – S. 65-73.

10. Isakov V.A. Epidemiology of GERD: East and West // Experimental. and wedge. gastroenterol. Special issue. – 2004. – No. 5. – P. 2-6.

11. Lim L.G., Ho K.Y. Gastroesophageal reflux disease at the turn of millennium // World J. Gastroenterol. – 2003. – Vol. 9, No. 10. — P. 2135-2136.

12.Isakov V.A. A new paradigm of GERD and long-term therapy with proton pump inhibitors // Experimental. and wedge. gastroenterol. – 2006. – No. 4. – P. 53-58.

13. Bohmer C.J., Klinkenberg-Knol E.C., Niezen-de-Boer R.C. et al. The prevalence of gastro-oesophageal reflux disease based on non-specific symptoms in institutionalized, intellectually disabled individuals // Eur. J. Gastroenterol. Hepatol. – 1997. – Vol. 9, No. 2. – P. 187-190.

14.Allescher H.D. Diagnosis of gastroesophageal reflux // Schweiz. Rundsch. Med. Prax. – 2002. – Vol. 91, No. 18. – P. 779-790.

15. Kurilovich S.A., Reshetnikov V.O. Epidemiology of diseases of the digestive system in Western Siberia. – Novosibirsk,

2000 .– 165 p.

16. Lazebnik L.B. Society against heartburn // Experimental. and wedge. gastroenterol.- 2007. – No. 4. – S. 5-10.

17. Babak O. Ya., Shaposhnikova Yu.N. Esophageal and extraesophageal manifestations of GERD: the basics of diagnosis and treatment. – Kharkov: Kharkov state. honey. un-t, 2005.

18. Lazebnik L.B., Vasyliev Y.V., Masharova A.A. et al. The prevalence of gastroesophageal reflux disease in Russia. Proceeding of the 16th United European Gastroenterology Week, 2008; Abstract: P1036 Citation: Gut.- 2008. – Vol. 57, Suppl II. – A 312.

19. Lazebnik L.B., Vasiliev Yu.V., Manannikov I.V. Gastroesophageal reflux disease: epidemiology, clinical aspects, treatment issues // Reference. polyclinic doctor. – 2005 – No. 3.

20. Guryleva M.E., Abdulkhakov R.A., Akhunov I.N. Study of the prevalence of gastroesophageal reflux disease in a large industrial center of Russia (by the example of Kazan) // Society.health and health. – 2008. – No. 2. – S. 9-11.

21. Heartburn across America: a Gallop Organization National Survey. – Princeton NJ: Gallop Organization, 1988.

90,000 Brotherhood New Year’s Heartburn

A new round of deterioration in Russian-Ukrainian relations has affected a broad “public sphere”. Several formally unrelated events – in particular, the arrest in Kiev due to possible involvement in terrorist activities of the Russian civil activist Anastasia Leonova, abuse of the Russians by the adviser to the President of Ukraine Yuri Biryukov, the subsequent explosion of mutual accusations on social networks – led, it seems, to further delimitation.This time – between the patriotic Ukrainian majority and a part of the fraction of Russian society that sympathizes with the Ukrainian “revolution of dignity”, criticizes the policies of Vladimir Putin, but is unable to bring about changes in their country.

It seems that the words spoken in Russia, even in the most affectionate and joking tone, about “fraternal peoples” (not to mention “one people”) in Ukraine are perceived with resentment turning into contempt. New cliches are being born: to the Russian ones about the “younger Ukrainian brother”, the Ukrainian one about “eternal Russian slaves” has been added.Irina Bekeshkina, a Kiev sociologist, director of the Democratic Initiatives Foundation , reflects on the old and new reasons for the deterioration of Russian-Ukrainian public relations in an interview with Radio Liberty.

– Before the start of the Russian aggression, the attitude of Ukrainians towards Russians was very good. All this collapsed after the annexation of Crimea and after Russia began to provide assistance to militants in eastern Ukraine. Now, to be honest, they treat Russia badly in Ukraine: only 16 percent of our respondents say they have a good attitude towards Russia.About 60 percent of those surveyed have a negative attitude. The number of Ukrainians who have a negative attitude towards Russia in recent months – after a strong “failure” – basically keeps at the same high level, with little dynamics: the attitude is gradually continuing to deteriorate.

– Recently, the Russian-Ukrainian “people’s” conflict has escalated – here’s a new series of mutual reproaches. The Ukrainians say (I very tentatively define this group) to the Russian liberal community: do not meddle with us with advice at all, go about your business in Russia.Russians are offended that their good – in their understanding – attitude towards Ukraine in Kiev is not appreciated.

Ukrainians are annoyed by such Russian rhetoric: well, guys, first you leave our land, and then we will talk about something

– I will talk about what annoys Ukrainians. First of all, the discrepancy between the official rhetoric and the real situation. In Russia they say: yes, Donbass is Ukraine, everything needs to be resolved peacefully. It is quite obvious that Russia no longer needs Donbass, it wants to “stretch out” from there, but retaining its face and not spoiling its reputation.Ukrainians are annoyed by such Russian rhetoric: well, guys, you first leave our land, and then we will talk about something. First, return Crimea, because no one in the world has ever recognized the annexation of Crimea as legal. And then, it turns out, you can shoot at us, rob us – and be called “our brothers.” The rhetoric associated with the still Soviet vocabulary about “fraternal peoples”, “sister republics” is now categorically not supported in Ukraine. At least as long as the war is going on, as long as people in Russia do not adequately assess what happened in Ukraine, of course, the situation will not change.

– The situation does not change either in the conflict zone or in relations between the two countries, but criticism of Russians and Russia from Ukraine is growing, sometimes it is very emotional and, I will say, provocative. Is there an element of fatigue from the situation here, from the fact that two years after the ouster of Viktor Yanukovych from power, the situation in the economy and social sphere in Ukraine is not getting much better?

Irina Bekeshkina

– Our daily life has become sharply worse after the collapse of the hryvnia – this happened exactly a year ago, after which prices have approximately doubled.Recently, everything has been at a stable level. Rather, the irritation comes from the fact that the conflict is not resolved in any way, everything has dragged on. The Minsk agreements are based, first of all, on a ceasefire, but every day, despite the so-called truce, despite the fact that there is no intense fighting in Donbass, we open the Internet and see: five people were wounded, one was killed; four wounded, two killed.

– A little over a year ago, we spoke with you that, despite the difficult situation, most of the Ukrainian population remains optimistic.Are these moods, the expectation of the best, are weakening or remain stable in Ukrainian society?

– They are getting a little weaker. At the end of last year, we took measurements and asked: what feelings do people experience when they think about the future of Ukraine? It found that there is approximately 50-50 between hope and anxiety: 39 percent feel hope and 39 percent anxiety. In general, optimism still remained, but it became somewhat less.

– Do you think that the impulse of the “revolution of dignity” has been lost or is it still preserved?

We have a free press, and people actually see who was arrested, how much was stolen, from whom the next $ 150 million was found.They see it every day – and compare it with how hard they have to survive

– We recently conducted such a survey: how do you think society has changed over the past two years, how have you yourself changed? Half of the respondents answered that over the past two years, the readiness of people to defend their interests and rights has grown. When we asked the same about them, the result was somewhat more modest: 33 percent answered that their own willingness to defend their rights had increased.Obviously, this is a direct result of the “revolution of dignity”.

– Do people blame the authorities for the slow pace of reforms, or is it mainly the “external aggressor”?

– More still internal factors. After a relative truce was established in Donbass – although I would not call it a truce, but rather a “trench war”, as it was during the First World War – people blame the country’s problems more on its leadership, which does not carry out the necessary reforms. The most important thing is, of course, the fight against corruption.We have a free press, and people see who was arrested, how much was stolen, from whom the next $ 150 million was found. They see it every day – and compare it to how hard they have to survive. This, of course, is impressive, – said Irina Bekeshkina, a Kiev sociologist in an interview with Radio Liberty.

Moscow psychologist Olga Makhovskaya does not consider the problem of cooling Russian-Ukrainian relations to be eternal – there are no constructive concepts of “always” and “never” in life:

Trains between the two countries are still running, although, admittedly, they are noticeably empty.

– I am inclined to ease this plot, to attribute the aggravation of the discussion to the post-New Year’s syndrome.Psychologists before the New Year warn: the conflict is growing during this period, we even recommend that in the first week after the holidays not to make important decisions, not to make statements of principle. We only notice the “media tip” of the iceberg, but there is still a flow of Russian-Ukrainian contacts that we do not see. Trains between the two countries are still running, although, admittedly, they are noticeably empty. It seems to me that the people who are involved in this flow and need it (and there are millions of them) will have enough endurance and intelligence, they will still highly value this relationship, counting on improvement, albeit in the long term.This trend also exists, and it seems to me that it needs to be strengthened, and we must not forget about it.

In any case, as a psychologist, I must urge everyone to endure. No need to sit idly by, it’s time to decide on the topographic map of the conflict who you are with. There are four options: one – you take the position of the Ukrainian side, the second – the Russian side, the third – you are not with one or the other, but against everyone or on your own, “my house is on the edge”, and the fourth – you are trying all the same build bridges. This is the most difficult work, both mental and physical, it takes time and effort.It is very easy to ignite a conflict, and then its train drags on for a long time. Here’s what is important: the real foundation is laid by integralists, they are always there, as a rule, there are 15-20 percent of them in the total flow of contacts. A final rift, a rupture forever between Russia and Ukraine, is actually impossible.

“We will never be brothers.” Spring 2014

– Why then? Well, there are two large neighboring countries. With some admission I will say: the majority of the population of one country despises the population of another country, reproaches them with servility and arrogance.And the majority of the population of another country looks down on the first country, considers its population to be unreasonable “younger brothers”, if not one people with them, only of less quality. At the same time, naturally, countries cannot go anywhere. Why do you think that these moods of the majority will mix over time?

Interest – what is the neighbor behind the fence? – formed historically, and it cannot be put anywhere

– We’ll have to treat some factors as background, they will fade into the background when new promising stories appear, including political ones.There is such a rule: when someone acts deliberately provocatively, with the aim of annoying public opinion, to make a name for himself, do not feed such a troll, understand that this is a variant of media trolling. The history of relations between Russians and Ukrainians has such a long history that this in itself implies a strategy of cooperation.

All the same, going back to their history, Russians and Ukrainians on a biographical level cannot separate from each other. Even if some Ukrainian patriot complains about his relative from Russia, about his lack of understanding, it is still an addiction.The problem of both people now is that they are not engaged in self-determination, but in determining through each other, both look at their neighbors. Situationally, we can worry about conflicts, scold each other, not understand each other, close doors to each other, but time will pass – and we begin to miss each other. Interest – what is the neighbor behind the fence? – formed historically, and it cannot be put anywhere.

– My Kiev expert says something else: until the war in Donbass is over, until Moscow returns Crimea to Kiev, Ukrainians cannot expect an improvement in the attitude towards Russians.Does this contradict what you are saying?

Olga Makhovskaya

– We just mean different time perspectives. Yes, I agree that the normalization of relations between people should be preceded by some very serious political decisions, and, probably, these relations will become normal only after a generation. But how do you put the question: have we quarreled forever or not? I think not forever. At the same time, our human policy must be active, we must apologize to our Ukrainian friends, realizing that they are in more pain, we need to behave more patiently and more restrained than them, since the victims are they, not us.

However, an attempt to mothball this story will only lead to the fact that, psychologically, we will constantly change the roles of the victim and the invader. In the aggression on the part of some Ukrainian public figures – presidential advisers and the like – of course, one reads an attempt to take revenge. These are just signs of a change in role: we want to do with you exactly as you did with us, only in this we see the solution to the problem.

Appeal of Ukrainian students to Russian students.January 2015

– The dispute is in fact over the ability of Ukraine and the Ukrainians to make those decisions about their future that they deem necessary. However, family vocabulary is often used: brothers or neighbors, one nation or two nations, love, quarrel, divorce. To what extent is it generally correct to apply the scheme of family relations to socio-political situations?

– This is, of course, a romantic metaphor. The inner world of a person is arranged in such a way that there are three schemes of approach to relationships – any, both family and international.The first is a childish, romantic approach: we all love each other, we will do everything together, and we have a common land. The second extreme is a rigid delimitation: either it will be as we want, or not at all; you are against us, we are against you, everyone will push their point of view, this is such a fanatical approach. Unfortunately, the Russian side set just such a tone in relation to Ukraine, behaved with an ultimatum. The third, intermediate option, with which I associate prospects, is associated – I am speaking in very general terms – with a kind of bargaining, with the discussion of very specific, point situational problems.

There are many such topics for mutual discussion and exchange, more than blocked questions. And here, too, everyone will defend their own, but will defend pointwise, without transferring to national interests. There are enough problems on which national identity does not depend, they are calculated in terms of money, they require a limited, and not a national, human resource. It seems to me that the entire civilized world lives by these principles. Most of all I would be upset by the absence of any dialogue; whenever a harsh language of insults and ultimatums sounds, I understand that you just need to stop communication, it is unpromising.Not a single problem will be solved, and the resource will be depleted.

Appeal of Russian students to Ukrainian students. February 2015

– It seems to me that there is another factor that provokes hopeless disputes and conflicts on the same topic: psychological fatigue of both parties. In Russia, there is a hopeless and endless Putin for those who do not love Putin; lovers of Putin are paying for their feelings with international isolation and life in a “besieged fortress.” In Ukraine, reforms are slow and difficult, citizens are annoyed by corruption and self-interest of the new authorities…

– You know, when people are busy with survival, they no longer have time for demarches on social networks. I quite imagine that somewhere in the Ukrainian hinterland, people today are doing the same thing that they were doing 10 years ago. The role of the eternal victim – whether Russia, Yanukovych, or other external circumstances – has been mastered to such an extent that they simply have to plow, without raising their heads, in order to feed their family, to solve the almost peasant task of feeding the family. Of course, there is fatigue. Here’s what is important: the years pass quickly, new and new Russians and Ukrainians are growing.I would most of all pay attention to them: how constructive are these young people, is a Russian-Ukrainian dialogue possible in terms of their ideas about the world? – says Olga Makhovskaya, Moscow psychologist , in an interview with Radio Liberty.

Fragment of the final edition of the “Freedom Time” program

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