Heartburn

Diagnosis

Healthcare providers typically identify heartburn based on its description, and for occasional or mild cases, further investigation may not be necessary. However, if there is a suspicion of a chronic condition, examination of the esophagus for potential signs of damage may be necessary.

Tests that may be ordered include:

• Upper endoscopy: Also known as an EGD procedure, this procedure examines the upper gastrointestinal (GI) tract, spanning from the esophagus through the stomach and reaching the upper section of the small intestine. Administered with medication for comfort, the endoscope is guided down the throat to inspect for indications of esophagitis, hernia, or Barrett’s esophagus.
  Endoscopy examinations provide an internal view of the organs by inserting an endoscope, a slender tube equipped with a small, illuminated camera, into the body. It is possible to take a biopsy sample of tissue for analysis.
• X-ray: This diagnostic imaging technique is used to visualize the structure and condition of the esophagus and stomach.
• Ambulatory acid probe tests: A tiny computer that is worn around the waist or on a strap over the shoulder is connected to an acid monitor. This is inserted into the esophagus to determine the duration and timing of stomach acid reflux into the esophagus.
• Esophageal motility testing: Esophageal pressure and movement is assessed by this test.

Treatment

Occasional heartburn can be managed at home using over the counter (OTC) medications and lifestyle changes. However, frequent heartburn may necessitate prescription medications for effective treatment.

Heartburn medications include:

• Antacids: Although they are not capable of healing an esophagus that has been damaged by stomach acid, they can provide rapid relief from heartburn by neutralizing stomach acid. These medications often contain ingredients that treat various symptoms. For instance, simethicone helps with gas, and magnesium helps relieve mild constipation.
• H2 blockers: Such as cimetidine and famotidine, work to decrease stomach acid levels. Although not as fast-acting as antacids, H2 blockers may offer longer-lasting relief.
• Proton pump inhibitors: This include esomeprazole, lansoprazole, and omeprazole. These are potent acid-blocking medications that also facilitate the healing of tissues. These may be prescribed as the initial treatment if the heartburn is notably severe or if there are indications of tissue damage in the esophagus.

Other treatments for heartburn include antibiotics or antivirals for infections, topical steroids or dupilumab to address inflammation, and low-dose neuromodulators along with complementary therapies for functional heartburn.

In cases where GERD does not respond to medication or as an alternative to long-term medication, procedures such as Nissen fundoplication, transoral incisionless fundoplication, or LINX device may be suggested.