HEARTBURN — feeling of heat or burning on the course of a gullet, in retrosternal or epigastriß area, caused by irritation of receptors of a gullet most often at a reflux esophagitis in connection with a functional cardiochalasia.
And. there is usually through a nek-swarm time after food, especially plentiful, and is more often observed after the use of spicy food; at many patients And. cause sweet kissels, sweet tea, newly-baked black bread, hot pies, the overroasted fat products.
At patients with a cardiochalasia strengthening is noted And. in horizontal position, at inclinations of a trunk, i.e. in the provisions promoting gastroesophagal to a reflux (see). Often And. it is combined with eructation (see).
Origins And. it is studied insufficiently fully. N. Reichmann for the first time assumed, as. arises owing to a pelting in a gullet of a gastric juice, especially at the increased contents in it free salt to - you. Further it was shown that feeling And. it can be caused by stretching of distal department of a gullet a cylinder or bystry administration of liquid, including neutral or alkalescent. At the same time cases when introduction to a gullet of the patients suffering are described And., salt solution or 0,1 N of HCl solution did not cause And., however it appeared after introduction of a gastric juice. These observations are considered as the evidence of communication of an origin And. with active proteolytic action of a gastric juice on a mucous membrane of a gullet.
Ezofagomanometrichesky researches, and also measurements of pH in a gullet showed that at most of the patients suffering And., weakening of a cardial sphincter is noted and decrease in pH in distal department of a gullet to 4 and is quite often observed below. It indicates value in an origin And. gastroesophagal reflux. It is established, however, as. arises not at all patients with a gastroesophagal reflux, and generally at those from them at whom comes to light esophagitis (see).
The data set a wedge, and special researches allows to conclude that in absolute majority of cases And. the reflux esophagitis is a symptom of an esophagitis, most often.
Most often And. it is observed at patients about a reflux esophagitis at the axial (sliding) hernia of an esophageal opening of a diaphragm, and also at the diseases proceeding with a hyperoxemia of a gastric juice (a peptic ulcer, gastritis with the increased secretory function of a stomach).
At a peptic ulcer of a stomach and duodenum And., according to different authors, meets in 60 — 80% of cases. At a part of patients with a peptic ulcer emergence And. it can be connected with quite often (approximately in 20%) the hernia of an esophageal opening of a diaphragm accompanying this disease. In the majority of cases of a peptic ulcer And. it is caused by throwing of an acid gastric juice in a gullet owing to a functional cardiochalasia at the expressed hyper motility of a stomach.
Very often And. it is observed at hron, cholecystitis, cholelithiasis, sklerodermichesky damage of a gullet, and also after stomach operations with a pishchevodnozheludochny anastomosis (a proximal resection of a stomach, an ezofagokardiostomiya, etc.). At rentgenol, a research at many of these patients the gastroesophagal reflux comes to light and signs a reflux esophagitis are quite often noted.
Sometimes at patients about a reflux esophagitis And., observed many years, becomes less intensive or disappears absolutely, being replaced by feeling of a delay of food (especially dry or badly chewed) in a gullet that is regarded as the adverse sign testimonial of formation of a peptic stricture of a gullet.
In rare instances And. arises at patients with an achlorhydria in a stomach and even with an akhiliya. In these cases, and also at pyloric stenoses the reason And. there can be an education in a stomach of a large number organic to - t (oil, milk, etc.) as a result of fermentative processes. It is known also, as., observed at patients with an achlorhydria at pernicious anemia, disappears after treatment by polyneuramin 12 . And. happens also at the persons who transferred a total gastrectomy that is probably connected with hit in a gullet of pancreatic juice and bile.
At toxicosis of the first half of pregnancy And. it is most often caused by irritation of a gullet acid contents of a stomach in connection with frequent, sometimes pernicious vomiting. To emergence And. in the second half of pregnancy the increase in intra belly pressure facilitating a reflux of gastric contents in a gullet promotes.
The burning sensation behind a breast reminding And., it can be caused not by damage of a gullet, and diseases of a nervous system, coronary insufficiency, etc. Character of the feeling felt by the patient is not always clear. Probability And. is confirmed if the feeling is quickly stopped by reception of antiacid means, and also as a result of statement of two functional and diagnostic tests: tests with irrigation of a mucous membrane of distal department of a gullet of 0,1 N solution salt to - you (or the gastric juice of the same patient taken the day before) and tests with inflating in a gullet of the rubber barrel strengthened on the end of a stylet. First test And. it is provoked more often. Indirect objective confirmation of existence at the patient I. detection at it a gastroesophagal reflux with the help rentgenol, researches or rn-metriya is.
Treatment the patients suffering And., it is directed to a basic disease. Before establishment final nozol, the diagnosis to lay down. recommendations at And. are based on the assumption of existence of an esophagitis. It is shown mechanically, thermally and chemically sparing diet, and at sharply expressed And. — frequent fractional food with restriction in food of carbohydrates and a nek-eye increase in easily assimilable fats (butter, corn oil). The patient with the kept secretory function of a stomach appoint antiacid drugs and adsorbents: hydrosodium carbonate, magnesium oxide, trisilicate of magnesium, calcium carbonate, etc. Also alkaline mineral waters are shown.
And., connected with an alkaline reflux from a duodenum (at akhilichesky gastritis, states after a subtotal resection of a stomach and so forth), in some cases eliminate weak solutions organic to - t or small doses divorced salt to - you.
Also drugs with the knitting and enveloping action — bismuth nitrate the main, 0,06% the solution of silver nitrate, white clay, vinylene interfering development of an esophagitis are used.
Bibliography: Vasilenko V. of X., Grebenev A. L. and Salman M. M. Diseases of a gullet, M., 1971, bibliogr.; Grebenev A. L. ides of river. To a question of the mechanism of heartburn, in book: Aktualn, vopr, gastroenterol., under the editorship of V. of X. Vasilenko, t. 4, page 34, M., 1971; Gastroenterology, ed. by H. L. Bockus, v. 1, Philadelphia, 1974; S leisenger M. H. a. Fordtran J. S. Gastrointestinal disease, Pathophysiology, diagnosis, management, Philadelphia, 1973
A. L. Grebenev.