Update: December 2018 You know the burning sensation in the upper part
belly or behind the sternum? Do you know what it is connected with?
occurrence and how dangerous is it? National Association
Gastroenterologists consider this symptom a major factor in the development
рака esophagus. In the absence of adequate therapy, almost 70%
больных развивается это страшное осложнение, treatment которого
It is always very difficult and not always successful.
According to statistics, every sixth citizen of Russia is experiencing a burning sensation
sternum not less than a few dozen times a week. TO сожалению,
only 5-10% of them seek medical help, therefore
Time to find out its cause is not possible.
The result is the lack of proper treatment, which often leads to
tragic consequences. Preventing their development is enough
easy, the main thing is to identify the main disease in time or
harmful factor and properly eliminate these adverse
What is heartburn?
To avoid misunderstandings between
doctor and patient, it is important to clarify the meaning of this term. AT
medical literature, they denote the unpleasant feeling of warmth or
burning of varying duration and strength.
Heartburn is usually located behind the sternum.
(in the middle of the chest) or directly below it, in
�”Epigastric” area. This is where the stomach is located.
the initial part of the esophagus where pathological occur
AT норме, пища проходит по пищеварительному тракту в одном
direction – from the mouth to the rectum. During this time, she
subjected to severe chemical treatment: in the stomach on it
hydrochloric acid acts, and in the small intestine appears
bile and highly active enzymes.
AT пищеводе агрессивные вещества отсутствуют, поэтому его стенки
not protected from their effects. If a person has a cast
partially digested food in the opposite direction (reflux), this
may cause tissue damage and a burning sensation.
Several such episodes per day can be observed in healthy
person AT этом случае, рефлюксы не приводят к возникновению
inflammatory process. If they are repeated often enough
развивается стойкое повреждение тканей esophagus. AT конечном итоге,
this can lead to cell degeneration and cancer.
There are two main causes of the symptom, which
often combined in the same patients. The first is weakness
cardiac sphincter. It is a muscular “flap” between the stomach and
the esophagus, preventing the throwing of acid and food. If she loses
the ability to fully perform its function, refluxes begin
возникать значительно чаще, чем у здорового person
Another reason is excessive production of the stomach.
of hydrochloric acid. In this condition, it ends up in end sections.
of the esophagus in a much larger number, compared with the norm.
The result is more intense tissue damage, even with
relatively few reflux.
These disorders, as a rule, do not develop independently. They
are constant companions of certain diseases
digestive tract. Therefore, when they occur necessarily
the following pathologies should be excluded:
|Disease||What it is?||Symptoms|
|GERD or gastroesophageal reflux disease||A chronic disease in which the sphincter (muscular
obstruction) between the esophagus and the stomach can not fully perform
its function. Because of this, the patient has frequent reflux,
повреждающие ткани esophagus.
TOак правило, ГЭРБ является основной причиной изжоги после приема
Often this symptom can be combined with the following
|Hyperacid gastritis associated with Helicobacter
|ATоспаление внутренней (слизистой) стенки желудка, из-за
exposure to a microorganism. Trying to kill a bacterium organ
produces a greater amount of acid, however this protective
the reaction only has a negative effect. Helicobacter resistant
к ее действию, в отличие от тканей esophagus.
A burning sensation almost always accompanies gastritis and
If the stomach is damaged, it occurs 15-30 minutes after
|Peptic ulcer and 12-intestinal ulcer||This pathology is often the result of hyperacid gastritis,
but differs from it by deeper organ damage – besides
mucous membranes, and the underlying layers may be damaged.
|Hiatal hernia (or hernia of the esophagus)||Pharynx and Stomach connects the esophagus, which runs through the entire
chest cavity before falling into the stomach. If he starts
�“Bulge out” into this cavity along with other digestive
organs (most often it is the initial part of the stomach) develops a hernia
|In 30% of patients, this pathology is hidden, but in the rest
In cases, it manifests as a burning pain behind the sternum.
|NSAID gastropathy||Uncontrolled reception of non-hormonal painkillers are increasingly
leads to negative consequences. These drugs not only take off
pain, but also destroy the natural protection of the stomach from its
own acid. As a result, the walls of the body are injured, and
this serious illness develops.
|The distinguishing feature of NSAID-gastropathy is a strong burning sensation and
very intense pain when taking medication from this group. TO
The causes and treatment of heartburn are closely related. Despite
The fact that the general principles of treatment of these diseases are very similar
among themselves, each of the pathologies has its own characteristics. These nuances
it is very important to consider, since they can have a significant
influence on the result of the actions of the doctor.
Diseases of the digestive tract do not occur spontaneously. TOак
As a rule, their development is promoted by various factors acting on
the digestive system of the body. For a long time
time, their influence may remain invisible to humans.
However, without timely correction, they almost always lead
to the development of the disease.
TO наиболее значимым факторам, которые обязательно следует
exclude in the prevention of pathology include:
- Wrong diet. Even for healthy
body is very important balanced nutrition, but for
the occurrence of heartburn is more important than what we eat.
The main thing is how a person does it. Adverse effect on
condition of the stomach and cardiac sphincter have:
- Rare but abundant meals when a person has
- Incorrect body position during and after meals has
also of fundamental importance. Not recommended to lie down or actively.
move during this process or within 15-20 minutes after
- Sleep, within 2-3 hours after a meal;
- Food in tight clothing. Belts, corsets, tight belts,
bandages – all these devices increase the pressure in the stomach
(more precisely in the abdominal cavity), which is transmitted to the sphincters
- Rare but abundant meals when a person has
- Obesity. Overweight adversely affects
on many organ systems and leads to various disorders, including
The number is the cause of belching and heartburn. With increased mass
body, the patient also has a constantly increased intra-abdominal
pressure (as if wearing a corset regularly). Natural
the result is the development of gastroesophageal reflux
- Frequent constipation.
- Hard physical work.
- Psychological stress. Any stress
increases production of hydrochloric acid. With a combination of bacteria
Helicobacter with this factor significantly increases the risk
development of gastritis / peptic ulcer disease;
- Alcohol and smoking. These bad habits are also
increase the acidity of the stomach, as due to the stimulation of certain
nerve endings, and due to damage to the cells of the body.
When a feeling of “burning” in the upper abdomen or
sternum, first of all, should pay attention to lifestyle
person Eliminating adverse effects on the body, the patient
can prevent the progression of the disease and reduce it
To accurately determine the cause of heartburn after eating or unrelated
with food intake, some diagnostic tests may be required.
procedures. TOак правило, пациенту выдают направления на клинические
blood tests (from finger) and urine. They are required to evaluate
conditions of the body, but do not allow to determine the disease, which
led to a burning sensation. More informative
have the following studies:
- ФГДС (расшифровка – фиброгастродуоденоскопия).
This is the only procedure that allows you to inspect the walls of the esophagus,
the stomach and even the initial part of the intestine; determine their condition
walls and reveal the presence of Helicobacter. It is carried out as follows.
way: the patient is administered through the mouth of a long elastic tube with
camera and light source (fibroscope), and propel up to
required level. If necessary, the doctor may take a sample.
the mucous membrane of the organs, assess the correctness of their structure and
contamination with bacteria;
- Esophageal manometry. With this
techniques assess the condition of the esophageal sphincters and their work,
analyzing the pressure difference between the stomach and the esophagus. TO
Unfortunately, not every hospital in Russia has it,
therefore, if necessary, manometry, the doctor will send
advisory centers or large multi-purpose hospitals;
- pH impedance This study allows
prove the presence of reflux in patients and determine from what they
mainly composed of (acid or bile). It is carried out in flow
24 hours For this purpose, a thin
a device with electrodes at the end through which all
measurements. The method is rarely used due to lack of
necessary equipment in most hospitals of the Russian Federation;
- ЭTOГ. Always remember that feeling
Burning behind the sternum can be associated not only with refluxes, but also
with ischemia of the heart and the development of angina / acute coronary
syndrome Therefore, electrocardiography is recommended for all
patients with similar symptoms.
Carrying out other diagnostic activities, in most
cases, does not provide additional information. To determine the cause
heartburn is enough of these procedures.
TOак снять изжогу
Getting rid of unpleasant sensations is the first thought that
appears in a patient with heartburn. Among the pharmacological
drugs, there is a whole group of drugs called
�”Antacids” quickly relieve this symptom. The principle of their action
is quite simple and consists in the neutralization of reactive
substances that have entered the esophagus or are in the stomach. TOогда
antacids interact with acids (in particular with
hydrochloric acid), a protective film is formed on the surface of the organ,
protecting cells and tissues from damage.
The most common and effective drugs that
have this effect are listed below:
|Medicine||Forms of release||Average pharmacy price rub|
|Gaviscon||Tablets, solution||200-400 rubles for 32 tablets or 150 ml of solution|
|Maalox||300-500 rubles for 32 tablets or 250 ml of solution|
|Rennie||Chewable tablets||150-200 rubles for 12 pieces|
|Gastal||200-250 rubles for 30 pieces|
|Rutacid||130-160 rubles. for 20 pieces.|
|Almagel||Solution||150-180 rubles for 170 ml.|
If you want to immediately remove heartburn, but not at hand
there is no one of the listed funds, you can take one time 3-4
conventional activated carbon tablets or smecta solution
(neosmectin). Taking most of the acid and bile, they
remove these substances from the body without any harm to
epithelium in the digestive tract.
Removing heartburn soda. Almost everyone
knows that this symptom can be eliminated with ordinary soda by dissolving it
in a glass of water or mixed with vinegar, citric acid, etc.
How effective and correct is this? This approach is practically
useless in treating heartburn. After taking the prepared mixture
there is indeed a temporary improvement. For a short time,
the burning sensation recedes, as the acid in the stomach and esophagus
neutralized. However, after a few tens of minutes, the acid
begins to be produced in even greater quantities. It is natural
reaction of the body to alkaline solution. The result – gain
симптомов и повреждения тканей esophagus.
Doctors do not recommend using a variety of popular methods.
treating heartburn. This problem needs to be addressed comprehensively, and after
eliminate unpleasant symptoms proceed directly to
diagnosis of the true cause of the disease and its treatment.
Principles of treatment
TOак уже упоминалось, изжогу могут вызывать различные болезни
digestive tract. Despite это, принципы терапии этих
pathologies are similar. They are aimed at reducing the acidity of the stomach and
restoration of its normal function. In order to achieve this
doctor’s goals recommend taking two groups of drugs:
- Антисекреторные — эти лекарства уменьшают
the amount of acid produced, due to the direct effect on
cells in the wall of the organ. They have optimal effect and low
risk of adverse reactions, so they can be used sufficiently
a long time (several months). Even in the absence of
exacerbations of the disease, they should be taken courses, at least 2
once a year (classically – in spring and autumn). Representatives of this
- Proton pump blockers (first line drugs) –
Lansoprazole, Omeprazole, Esomeprazole, Pantoprazole, Rabeprazole;
- Блокаторы рецепторов (Н2) гистамина (рекомендуются
with the ineffectiveness of proton pump inhibitors) – Famotidine,
Ranitidine, Cimetidine, Nizatidine, Roxatidine.
- Proton pump blockers (first line drugs) –
- Прокинетики – вещества, стимулирующие моторику
digestive tract, including the stomach. Thereby
effect, decreases the number of food casts into the esophagus and its
trauma. Examples of drugs – Ganaton, Itomed, Itopra.
The need for additional therapy is determined by the doctor, in
depending on the specific type of disease. Almost always,
the condition of patients allows the treatment of heartburn at home
conditions. Hospitalization in a surgical hospital may
be required only with the development of complications such as
кровоflow или перфорация язвы.
To prevent the development of diseases of the stomach, duodenum 12
and esophagus, should pay attention to your lifestyle. Have
the vast majority of patients, various pathologies occur
due to exposure to the harmful factors that were listed above.
Bacteria and heredity are of secondary importance in
the development of these pathologies.
TOак правильно профилактировать изжогу? To achieve this goals
The following guidelines should be followed:
- Reduce body weight. To determine the need for yourself in
this event, it is enough to use the formula – weight in
kilograms divided by height in meters squared. Resulting
The number 30 and more indicates the presence of obesity. The norm
values between 18-25 are considered;
- Eliminate overeating;
- After eating for 15-20 minutes to give up physical
loads and position “lying”;
- Haveжин должен быть за 2-3 часа до сна;
- Give up bad habits (drinking alcohol and
- Do not wear corsets, tight belts, belts, etc .;
- Exclude power overload. According to WHO recommendations,
a woman should not lift more than 3 kg, a man – 10
Lifestyle change events are enough for
adequate prophylaxis. The need for drugs
or physiotherapy procedures to date
proven by doctors, so their appointment at this stage can
ATопрос: Насколько опасен оксид алюминия, входящий
в состав препарата Almagel?
Clinical trials conducted by independent experts are not
discovered the toxic effects of this drug on humans but
pregnant women and children under 12 years old are not recommended
how the relevant tests were not performed). In clinical
practice, the side effects of the use of Almagel virtually no
ATопрос: Сколько времени нужно принимать
drugs for high acidity?
The scheme of their appointment is discussed individually with the patient.
In a chronic process, as a rule, they should be taken in
flow всей жизни небольшими курсами (1-2 месяца 2 раза в год при
ATопрос: TOак лучше снимать изжогу беременной
For this there are antacid drugs, the safety of which
proven by clinical studies. TO ним относятся Gaviscon и
ATопрос: Нужно ли соблюдать диету при изжоге?
In most cases, the diet is one of the components
treating the cause of heartburn. It implies the exclusion of fried on
butter, fat, flour and smoked dishes; carbonated and containing
caffeine drinks; alcohol exclusion.