Heartburn or pyrosis is a painful and burning sensation in the esophagus, just below the breastbone usually associated with regurgitation of gastric acid. The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn is also identified as one of the causes of chronic cough, and may even mimic asthma. Despite its name, heartburn actually has nothing to do with the heart. It is so called because of a burning sensation of the breastbone where the heart is located although some heart problems do have a similar sensation to heartburn. Compounding the confusion is the fact that hydrochloric acid from the stomach comes back up the esophagus because of a problem with the cardiac sphincter, a valve which misleadingly contains the word "cardiac," referring to the cardia as part of the stomach and not, as might be thought, to the heart.

Biochemical

Ambulatory pH Monitoring

A probe can be placed via the nose into the esophagus to record the level of acidity in the lower esophagus. Because some degree of variation in acidity is normal, and small reflux events are relatively common, such monitors (like pieoroscopy) can be used to document reflux in real-time.

Mechanical

Manometry

In this test, a pressure sensor (manometer) is passed through the mouth into the esophagus and measures the pressure of the lower esophageal sphincter directly.

The esophageal mucosa can be visualized directly by passing a thin, lighted tube with a tiny camera known as an endoscope attached through the mouth to examine the esophagus and stomach. In this way, evidence of esophageal inflammation can be detected, and biopsies taken if necessary. Since an endoscopy allows a doctor to visually inspect the upper digestive tract the procedure may help identify any additional damage to the tract that may not have been detected otherwise.

A small sample of tissue from the esophagus is removed. It is then studied to check for inflammation, cancer, or other problems.

Prevention

Relief is often found by raising the head of the bed, raising the upper body with pillows, or sleeping sitting up. Avoid pillows that raise the head only, as this does little for heartburn and places continuous strain on the neck. Eating a big meal causes excess stomach acid production, and attacks can be minimized by eating small frequent meals instead of large meals especially for dinner. To minimize attacks, a sufferer may benefit from avoiding certain foods that stimulate excess acid secretion and/or relax the opening between the stomach and esophagus. Acid fruit or juice, fatty foods, pretzels, coffee, tea, onions, peppermint, chocolate, or highly spiced foods are to be avoided, especially shortly before bedtime. While there are clearly other health-related benefits associated with dietary interventions a zealous recommendation for dietary restrictions is not evidence-based, and there is stronger support for reducing the symptoms of acid-reflex found in behavioral changes such as eating less and elevating your head while sleeping. Tight clothing around the abdomen can also increase the risk for heartburn because it puts pressure on the stomach, which can cause the food and acids in the stomach to reflux to the LES.