Burning sensation in the chest and throat

The burning sensation in the chest, known in medical terms as right, is the most common digestive symptom encountered among the population. Although this is often the hallmark (GERD), the differential diagnosis of pain plays an important role in establishing appropriate therapy and preventing potentially life-threatening complications. . Article content\n \n \n . ro or from the SfatulMedicului mobile application (iOS, Android)\n . The consequence of the alteration of these mechanisms causes the reflux of the duodeno-gastric content at the level of the distal esophagus, triggering the sensation typically described as \.

Heartburn is characterized by a burning pain, located retrosternal, with possible radiation in the neck, with onset often after the ingestion of fatty meals, alcohol or hot or spicy foods. The pain is accentuated by lying down or bending over and improves with antacids. Patients with heartburn often have regurgitation or belching. In the long-term evolution, symptoms such as dental erosions, the feeling of globus, dysphonia (hoarseness) or cough, can be a sign of chronic reflux, with extraesophageal rumbling. Dysphagia (difficulty swallowing), odynophagia (pain when swallowing), loss of appetite or weight loss can signal a more severe underlying pathology, which requires urgent medical attention.

Although the burning sensation in the chest is generally a consequence of GERD, medical consultation is indicated in order to exclude potentially severe pathologies, causing pain of a similar nature. Frequently, patients who present themselves to the emergency room with relatively intense chest pain actually have atypical symptoms, so the cardiac origin of the pain is the first mandatory step in the doctor's diagnostic orientation. , especially the lower one and in female patients, can be manifested by gastrointestinal symptoms, which is why the therapeutic window should not be missed. Pain of cardiac origin does not change with position, is independent of food and does not respond to antacids. Others, such as esophageal motility disorders, esophageal diverticulum, ulcers, duodenitis, digestive cancers, pancreatitis, gallstones, may include similar pains in the clinical picture, but their diagnosis can be refuted by specific investigations.

The factors that influence the occurrence of GERD and secondary heartburn are generally environmental factors. A higher incidence was observed in the western population, through the prism of a diet rich in fats, alcohol, chocolate, spicy foods and hot liquids. Anatomical factors, such as hiatal hernia or increased intra-abdominal pressure, found in obesity and pregnancy, in turn contribute to the initiation and worsening of heartburn. Less common causes of heartburn include altered esophageal motility, connective tissue diseases, and some medications such as nonsteroidal anti-inflammatory drugs, calcium channel blockers, or antidepressants. .

The diagnostic approach to the cause of heartburn generally requires referral to a gastroenterologist. Intense pain, however, can cause the patient to come to the emergency room, the approach thus becoming a multidisciplinary one, involving the emergency physician, the gastroenterologist, the cardiologist and in selected cases, other specialists. The diagnosis of the patient begins with the history, which must include all the characteristics of heartburn, together with any other symptoms that the patient reports. The personal and family antecedents of the patient, as well as the lifestyle, will be noted. It is important for the doctor to determine if the patient has medication at home, as certain medications can either influence diagnostic tests or contribute to heartburn.

Laboratory analyzes can provide minimal information in the case of GERD, but they are useful in the differential diagnosis of myocardial ischemia and other digestive pathologies accompanied by pain in the upper abdominal floor, such as acute or chronic, or. In the case of women of childbearing age, the detection of a pregnancy can direct the specialist to the diagnosis of gastroesophageal reflux, extremely common in pregnant women. is essential for excluding retrosternal pain of cardiac origin, especially in women, who often present atypical manifestations of myocardial infarction. Studies show that a significant percentage of patients who come to the emergency room for high-intensity retrosternal pain actually have a severe episode of GERD. Although there is no gold standard in the diagnosis of heartburn and reflux disease, the upper one is the investigation of choice in patients with reflux, especially those with atypical or alarming symptoms, in order to exclude complications such as esophagitis, Barrett's esophagus, esophageal cancer or stenoses.

It should be noted, however, that a significant percentage of patients may have symptoms of reflux (heartburn, regurgitation), without typical lesions of esophagitis, falling into the category of endoscopic-negative reflux disease. can be useful in patients with dysphonia. Monitoring esophageal pH for 24 hours by pH-metry is useful in quantifying reflux episodes and correlating them with symptoms, but it is usually reserved for GERD refractory to treatment. Esophageal manometry can confirm or exclude motility disorders or impaired persistence as the etiology of heartburn. Barite transit, currently rarely used, can detect a hiatal hernia, tumors, strictures or significant esophagitis, but its role in the diagnosis of reflux disease is limited.

The therapeutic trial, using proton pump inhibitors, can be introduced empirically in patients with high clinical suspicion of GERD and the absence of alarm symptoms, without other additional investigations, but recent studies disapprove this approach. Failure of empiric therapy indicates the need for further evaluation. The complications of reflux disease vary in severity, but adequate and early treatment is the key to their prevention. In evolution, gastroesophageal reflux disease can evolve into esophageal erosions and ulcers, strictures and Barrett's esophagus. Barrett's esophagus represents the transformation of the esophageal epithelium into an intestinal-type epithelium, which over time can undergo dysplastic changes and later malignant transformation.

Esophageal adenocarcinoma is a formidable complication and has an incidence of approximately 0. 5% per year in Barrett's patients. The treatment of GERD and the improvement of the burning sensation in the chest require the combination of pharmacological therapy with lifestyle modification. In the case of reflux disease as the cause of heartburn, following a medical consultation, the gastroenterologist can prescribe antacid medication to relieve the immediate symptoms and proton pump inhibitors (PPIs) or H2 receptor antagonists to treat the cause. While antacids neutralize gastric acid, PPIs and anti-H2 reduce gastric secretion.

The therapeutic dose, the agent used and the duration of the therapy are established by the doctor following specialist investigations, the cause of the heartburn, as well as the patient's tolerance and comorbidities. It is not recommended to administer them without a prior consultation, considering the potential adverse reactions or interactions with personal medication. Lifestyle changes play an important role in improving heartburn. Patients are advised by the doctor to adopt a digestive protection diet, which involves avoiding the consumption of fatty, fried, spicy foods, minced meat, alcohol, hot liquids, citrus fruits. It is also recommended to avoid the supine position immediately postprandial and physical exercises that increase abdominal pressure (such as sit-ups).

Left lateral decubitus can improve reflux. Weight loss is encouraged in overweight patients, and smoking should be stopped. The use of drugs such as non-steroidal anti-inflammatory drugs or aspirin should also be avoided. Calming teas (mint, chamomile) can have a short-term effect, but are not supported by sufficient scientific studies. In the case of patients with heartburn and GERD refractory to medical therapy, especially those with hiatal hernia, endoscopic therapy or reflux surgery may be options to consider.

Also, morbidly obese patients amenable to bariatric surgery showed a significant reduction in the symptoms of reflux disease after the intervention. In conclusion, the burning sensation in the chest is a symptom, which, although it usually indicates the presence of gastroesophageal reflux disease, requires referral to a gastroenterologist, for proper diagnosis, differentiation from potentially severe pathologies, as well as appropriate therapy, in association with the modification . Bibliography\r\n\r\n\n\n \n \n\n \n \n \n\n \n \n . Narcisa Maria Zamfirescu\n . Mirela Stoian\n .

PANTELIMON (former 23 August Hospital)\n \n \n . Andrei Haidar\n . Radu Mihai Voiosu\n . .