Heartburn

HEARTBURN (pyrosis, Sodbrennen, heartburn), a distinctive burning sensation along the esophagus. Despite the unclear conditions causing heartburn, as well as its clinical significance and therapeutic measures, this condition has not received sufficient attention. It can be considered proven that heartburn is most often felt when stomach contents are thrown back into the esophagus due to gastric antiperistalsis. If, repeating Reichmann's experiments, a sponge is lowered into the esophagus (on a string, at a distance of 20-25 cm from the edge of the teeth) in patients suffering from heartburn, this sponge is often found to be impregnated with stomach contents. Another condition for the occurrence of heartburn is the peculiar sensitivity of the esophagus to the mass thrown into it from the stomach. In other words, the reflux of stomach contents into the esophagus alone is not sufficient to cause heartburn, since it is known that in many patients, even abundant regurgitation of food does not cause the sensation of heartburn, just as heartburn does not occur when treating with "gastric juice". The chemical irritant entering the esophagus and causing the sensation of heartburn is most often excessively acidic stomach contents (pyrosis hydrochlorica); however, heartburn is also noted with normal HCl content in the stomach contents, as well as with reduced (down to apaciditas) acidity; in these cases, the role of organic acids must be considered. Heartburn is a frequent symptom of various stomach diseases, and in this sense, one can speak of symptomatic heartburn; but sometimes it occurs in the absence of provable specific diseases (essential heartburn). Heartburn as an accompanying symptom is observed in stomach ulcer, duodenal ulcer, stomach cancer, cholecystitis, etc. Dillon considers that although the symptom of heartburn is not an essential differential diagnostic sign, it occurs more frequently in cases of pyloric ulcer than in duodenal ulcer. The appearance of heartburn many hours after eating (so-called "late", "night" heartburn) may indicate food stasis. Heartburn may be one of the manifestations of neurasthenia (stomach neurosis according to Boas, esophagus neurosis according to Rosenheim, etc.). It is precisely in these patients that heartburn proves most persistent and unrelated to the state of gastric secretion. Treatment of heartburn cannot be reduced to any scheme, since its pathogenesis is very different. Where possible, causal treatment is carried out (treatment of the underlying disease - stomach ulcer, duodenal ulcer, stomach cancer, etc.). When prescribing diet, one must always take into account the data from patients' self-observation. In a number of patients, there is individual sensitivity to certain dishes. In some, sugar, honey, jelly, watermelon, black bread cause and intensify heartburn, while others suffer from heartburn mainly after fatty, salty, floury foods. In neurasthenics, the therapeutic effect is achieved by suggestion. Symptomatic therapy aims to neutralize the excessively formed acid with alkalis, reduce fermentation processes, and regulate the motor function of the stomach. From this point of view, sometimes it is impossible to do without prescribing alkalis (Magnesia usta, Natrium bicarbonicum, Calcium carbonicum, etc.), stomach washings, electrization, etc.

B. Rubinstein. Nervous heartburn (pyrosis nervosa), unlike pyrosis hydrochlorica, is a type of heartburn caused not by increased acidity of stomach contents, but by other, not always clear factors. The acidity of gastric juice in these cases may be normal, or even reduced. In such cases, hyperesthesia of the esophageal mucosa is indicated as the cause, but conclusive evidence of this has not yet been obtained. Like other stomach neuroses, nervous heartburn is characterized by an irregular course, sometimes periodic, sometimes more constant; the appearance of nervous heartburn often does not depend at all on food, on its quality and quantity; it sometimes subsides from such food which is known to cause heartburn in many (for example, from sour apples). On the contrary, nervous heartburn does not respond to alkalis. The diagnosis of nervous heartburn is confirmed by the absence of increased acidity of stomach contents, the presence of general neurasthenic signs, as well as its dependence on nervous factors and its disappearance under the influence of psychological rest and various distracting factors. Boas described a similar picture of the disease under the name pyrosis gastrica (Mag-enbrennen), in which the burning sensation is localized not in the esophagus, but in the stomach area.