Can heartburn be a sign of pregnancy?
Due to the constant chemical irritation of the stomach acid on the esophageal mucosa by heartburn, an inflammation of the esophagus (reflux esophagitis) can develop over time. Severe inflammation heals by scarring. Severe hub formation, in turn, can lead to narrowing of the esophagus (scar stenosis), which impairs the transport of food into the stomach.
In 10% of cases of reflux esophagitis, a beret – esophagus (synonym endobrachy esophagus = shortening of the esophagus) develops. This leads to a change in form and function of a part of the esophageal cells due to chronic irritation of the mucous membrane (metaplasia). In the case of the esophagus, metaplasia represents a transformation of the natural squamous epithelium of the esophagus (inner cell layer, protective layer) into a cylindrical epithelium.
This transformed tissue is less resistant, so that an ulcer (ulcer) of the esophagus can easily develop if the stimulus is sustained. This esophageal ulcer (berett-ulcer), which crosses several cell layers, can lead to life-threatening blood loss. In the worst case, such a beret ulcer can develop into a malignant oesophageal tumor (esophageal carcinoma).
In principle, however, there is the possibility of cell hollowing, i.e. the metaplasia is reversible when the chronic irritation of the mucous membrane ceases. The vagus nerve (nervus vagus), which runs in the direct vicinity of the esophagus and supplies all organs (lungs, heart, etc.) up to the diaphragm parasympathetically (part of the vegetative nervous system), can also be irritated during heartburn (reflux).
It is therefore not unusual for some patients to report chronic coughing or that their pre-existing asthma has worsened. The reason for this is that the irritated vagus nerve causes the bronchi to contract (bronchoconstriction). However, chronic coughing and hoarseness are often also caused by disease-related irritation of the throat and vocal cords.
A mixed picture of both causes can be present. The irritation of the vagus nerve can also lead to a spasmodic contraction of the coronary vessels (coronary spasm). The heart pain triggered by this is very similar to a heart attack pain (angina pectoris), so that it can be difficult to distinguish it from a heart disease.
In very rare cases of heartburn, reflux of bile acids or secretion of the pancreas (leaches) into the esophagus can occur. Alkaline burns have a greater potential for damage than acid burns because they spread more easily in the tissue. Treacherously, this can result in far greater tissue damage, despite less discomfort compared to acid burns.
In addition, heartburn can lead to a narrowing of the esophagus because the mucous membrane of the esophagus is irritated by stomach acid, which can lead to inflammation of the esophagus. A suspected diagnosis of heartburn can be made quickly on the basis of the symptom complex described above. In unclear cases or to determine the extent of the damage, additional diagnostics are necessary: Sonography (ultrasound): This is a simple and quickly performed examination procedure to evaluate individual reflux episodes, gastric emptying and to detect a hiatus hernia.
The sonography is radiation-free, therefore no side effects are to be expected and the ultrasound examination can be repeated as often as desired. Long-term esophageal pH-metry: The measurement for heartburn diagnosis is performed by a ph-electrode for acid measurement, which is placed into the esophagus via the nose for 24h. Every 4-6 seconds the electrode measures the pH value in the part of the esophagus near the stomach.
A portable recording device, which creates a long-term profile, records how often reflux events occur and how strong the acid is. If the pH value is less than 4, a reflux event is most likely present. This examination method does not provide information about the extent of mucous membrane damage that has already occurred.
X-Ray Breischluck (upper gastrointestinal passage): To diagnose complications such as scars and constrictions (stenoses), the X-Ray Breischluck is suitable as a non-invasive imaging procedure. In the presence of stenoses (constrictions), hourglass-like narrowing of the esophagus can be detected in the X-ray image. In addition, statements about transport disorders of the esophagus and about gastric emptying are possible.Endoscopy (Oesophago-gastro-duodenoscopy): The “endoscopy” (endoscopy) of the oesophagus, the stomach and the upper parts of the small intestine is the method of choice for the direct assessment and classification of mucous membrane damage in the correct diagnosis of heartburn.
Images are transmitted to a monitor via a tube camera (endoscope). During the endoscopy, tissue samples (biopsy) can be taken from suspicious areas of the mucosa. Tissue examination under the microscope (histological findings) is more meaningful than the (macroscopic) findings recorded with the naked eye.
It is only in the histological examination that evidence of a tissue transformation (metaplasia) or the detection and type of tumor can be provided. In addition, a therapy can be carried out, e.g. the stopping of bleeding mucosal ulcers.
- Trachea (windpipe)
- Right lung (lung)
- Diaphragm (diaphragm)
- Throat
- Oesophagus
- Left lung
- Stomach
Classification of mucosal damage according to Savary and Miller Grade I: circumscribed, single, superficial mucosal damage (erosions) Grade II: longitudinal, connected mucosal damage (longitudinal confluent erosions) Grade III: circular mucosal damage (circular erosions) Grade IV: ulcer (ulcer), stenosis (constriction), brachyesophagus (see )Amber test: If, in spite of pathological symptoms, an inconspicuous endoscopic finding does not confirm the suspected diagnosis of reflux disease (10-15% of patients), the amber test can help to confirm the diagnosis.
This test simulates an acid effect on the mucous membrane of the esophagus. A probe is used to drip a slightly corrosive acid onto the esophageal mucosa from the outside. If this causes symptoms that correspond to those of the underlying disease, a reflux disease (reflux esophagitis) is very likely.
In these cases, there is chemical hypersensitivity of the esophagus. Oesophageal manometry: In rare cases, the function of the lower sphincter muscle must be checked by means of pull-through pressure measurement. In this case, a thin tube (catheter) is first inserted through the nose into the stomach and then slowly pulled back towards the mouth, whereby the patient must swallow some water regularly.
When the catheter is pulled back, the internal esophageal pressure is permanently measured at the end of the catheter. A computer graphic shows the pressure conditions along the course of the esophagus. Dysfunctions of the oesophagus can be diagnosed in this way. A reflux disease is therefore only indirectly detected by the detection of an esophageal dysfunction.
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