Stomach Burn

Symptoms

The leading symptoms of stomach burning include an uncomfortable burning sensation behind the breastbone and acid regurgitation. The burning sensation occurs primarily after eating, and pain along the esophagus may radiate. Other accompanying symptoms include hoarseness, coughing, nausea, difficulty swallowing, sleep disturbances, respiratory problems, a foreign body sensation in the throat, and enamel changes. A chronic course is referred to as gastroesophageal reflux disease (GERD). Frequent contact of the mucosa of the esophagus with the acidic contents of the stomach can lead to complications such as inflammation (reflux esophagitis), mucosal changes (Barrett’s esophagus), and esophageal cancer.

Causes

A known cause of the condition is reflux of acidic gastric contents into the esophagus, which is due to weakness or relaxation of the lower sphincter of the esophagus. However, gastric acidity is not usually the underlying cause. There are several known risk factors that promote the development of stomach burn or worsen the symptoms. These include:

Diagnosis

Diagnosis is made under medical treatment based on clinical symptoms, patient history, response to medications, and imaging techniques (e.g., gastroscopy), among other factors. It is recommended to seek medical treatment as early as possible to avoid long-term complications. Diagnosis must exclude similar conditions that cause comparable symptoms. These include gastric and intestinal ulcers, gastritis, gastric cancer, -infection, and cardiovascular disease.

Nonpharmacologic treatment

Various non-drug measures are recommended for treatment:

  • Raise the head end of the bed.
  • Do not eat two to three hours before bedtime.
  • Do not lie down after eating.
  • Reduce the body weight.
  • Do not smoke and reduce alcohol consumption.
  • Avoid tight clothing and pressure on the stomach.
  • Eat small portions and take food slowly.
  • Reduce fats, chocolate, coffee and other triggering stimulants.
  • Avoid triggering drugs.
  • Reduce stress.
  • Drink potato juice.

As a 2nd choice remedy, surgical intervention is possible.

Drug treatment

Antacids neutralize stomach acid and can also form a protective film on the mucosa. The effect is usually rapid, but also lasts only a short time. During treatment, the possible drug-drug interactions must be taken into account. Antacids can inhibit the absorption of other drugs into the body and should therefore be administered at intervals. Active ingredients used include, for example:

  • Magaldrate (Riopan)
  • Hydrous aluminum oxide and magnesium hydroxide (Alucol).
  • Calcium carbonate and magnesium carbonate (Rennie).
  • Hydrotalcite
  • Sucralfate (Ulcogant, out of commerce) forms a protective layer on the surface of the mucosa of the esophagus, stomach and intestines and is thus indirectly antacid.
  • Sodium alginate (Gaviscon) forms a gel foam in the stomach, which floats like a raft on the stomach contents and acts as a barrier against the acid.

Proton pump inhibitors inhibit the secretion of gastric acid by binding to the proton pump in the stomach’s occupant cells. They are potent and should usually be taken half an hour before eating. PPIs are metabolized via CYP450 and corresponding drug interactions are possible. The most common possible adverse effects include headache, dizziness, indigestion, and skin rashes:

H2 receptor antagonists inhibit secretion of acid and pepsin in the stomach. The effects are based on binding to histamine H2 receptors:

  • Ranitidine (Zantic, generic, off label).
  • Cimetidine (off label)

Prokinetics increase pressure in the upper esophageal sphincter, improve gastric motility, and speed gastric emptying: