Oscar M. Laudanno and Daniel Finkelstein

Heartburn is a semiological term that designates the existence of a burning or acid sensation in the epigastric region. It is very important that the patient points out the area in which he experiences burning or heartburn, so as not to confuse it with heartburn, which is the burning sensation related to the sternal region.

For the patient, the terms gastric acidity or heartburn have the same meaning, which is why he considers them as synonyms. At one time it was believed that gastric burning was due to hyperchlorhydria, but when the existence of achlorhydria patients who sometimes report both heartburn and gastric burning was verified, this symptom lost value to guide hyperchlorhydria.

The symptom is very frequent in patients without organic pathology who are erroneously diagnosed as carriers of gastritis. The truth is that the sensation, in patients with gastritis, occurs when there is an episode of acute exacerbation, generally of exogenous cause: aspirin, food, alcohol, cigarette, etc. Once the cause has been eliminated, the discomfort should disappear automatically. Burning sensation can have a rhythm, like epigastric pain, in ulcerative syndrome, where it appears on an empty stomach and calms with the intake; in these circumstances a gastroduodenal ulcer should be suspected.

Its presence is frequent in subjects who ingest medications in a chronic way, such as non-steroidal analgesics, corticosteroids, reserpine, digitalis, antidepressants, immunosuppressive drugs, all oral anti-tuberculosis drugs, oral antidiabetics, bluephidine, antibiotics, etc. Many of these drug-taking patients have chronic gastritis as the underlying disease, and in them the symptom appears during an acute outbreak.

In addition to epigastric pain, the patient with gastric or duodenal ulcer frequently presents epigastric burning, generally attributable in gastric ulcer to duodenogastric reflux or alkaline gastritis; in duodenal ulcer, on the other hand, it is due to hyperchlorhydria and hypersecretion of gastric juice. The symptom is also often observed in large drinkers of mate, generally sweet, in whom the stomach, when distended by water, secretes hydrochloric acid and causes acidity; on the other hand, tobacco produces hypotonia of the pyloric sphincter, with biliary regurgitation, and therefore generates alkaline gastritis, causing the burning sensation.

Large coffee drinkers frequently experience this discomfort, because caffeine produces hyperchlorhydria, and it is frequent that when ingesting white drinks, cognac, whiskey, many subjects present acidity; This is because they are based on chronic gastritis, where the direct action of alcohol on an inflamed mucosa causes the appearance of the symptom. It is also very common for heartburn to occur after eating large or compound meals; This phenomenon is due to the fact that there is an increased secretion of bile with duodenal reflux, which is sometimes accompanied by belching with a rotten egg taste.

The burning sensation caused by the intake of cucumber, radishes, garlic and onion is due to the alkalinity of these foods, as well as their difficult grinding, which leads to a greater production of acid by the stomach.

Spicy foods, such as chili peppers and pepper, may eventually cause the symptom; but it has been shown that they are cytoprotectors of the gastric mucosa and that their ingestion is beneficial. The same is true for alcohol, which at medium doses -for example 250 ml of wine per meal- shows a similar protective effect on the lining cells of the stomach.

Many patients have heartburn caused by sitophobia characterized by a phobic fear of ingested food. Finally, there is the patient with gastric cancer, early or advanced, where the heartburn symptom can lead to the diagnosis of this condition.

In the case of a patient with acidity, all routine analyzes and a serial double-contrast esophagogastroduodenal radiography should be requested.