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Heartburn: When do you need to see a doctor?

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Greasy, luscious food, which is heavy in the stomach, and on top of it still a digestive liquor – this is a “lovely” program for the stomach, which often leads to heartburn. As long as the symptoms occur only occasionally and disappear spontaneously, they are considered harmless.

If one of the acid stomach contents frequently hits, there may be a reflux disease behind the heartburn. In addition to frequent heartburn, symptoms of this disease often include thinning gowns, morning hives, documented voices, hoarseness and a bad taste in the mouth. Such complaints should definitely be clarified by a doctor.

Heartburn: What is the doctor doing?

To clarify heartburn, the doctor first conducts a detailed discussion with the patient. So he can raise his medical history (anamnesis). In the conversation, the doctor asks, among other things, how long the heartburn already exists, how often it occurs and if, for example, it strengthens when lying down. He also asks about any other complaints and known medical conditions and whether the patient is taking any medication.

After the anamnesis interview, a physical examination follows.

Assuming the physician based on the history of adult patients with a reflux disease and there are no alarm symptoms (pain when swallowing, frequent vomiting, anaemia, etc.), he can immediately prescribe proton pump inhibitors ( empirical PPI therapy without further investigation ).

However, when alarm symptoms occur, serious complications may be behind it (such as narrowing of the esophagus, bleeding mucous ulcers, Barrett’s esophagus, etc.). For clarification, further investigations are necessary. The same applies if the doctor is not sure about the diagnosis of reflux disease or if the patient is still a child.

Possible further investigations include:

  • Reflection of the esophagus and stomach: The doctor gently pushes the patient a tubular instrument (endoscope) over the mouth into the esophagus and down into the stomach. At the front end of the endoscope, there is a light source and a small video camera. So the doctor can examine the mucous membrane of the esophagus and stomach accurately. He pays attention, for example, to inflamed, reddened area, narrowing of the esophagus and bleeding ulcers. If required, tiny instruments can also be inserted via the endoscope to remove tissue samples (biopsies) of conspicuous areas. These are then examined microscopically in the laboratory.
  • 24 Hour pH Metry: In this procedure, a fine probe is inserted over the nose into the patient’s esophagus and placed just before the stomach entrance. It stays in place for 24 hours and continuously measures acidity in the lower esophagus during this time. This is how to detect acid reflux from the stomach.
  • 24-Hour pH Metry MII: This variant of the previously described 24-hour pH-metry can be used to detect not only the reflux of acidic gastric contents but also of non-acidic gastric contents. Occasionally, this can also lead to disease symptoms. Incidentally, the abbreviation MII stands for “multichannel intraluminal impedance measurement”.
  • Esophageal pressure measurement : In so-called esophageal manometry, a fine probe with pressure sensors is inserted into the esophagus and then gradually withdrawn, while the patient drinks small amounts of water. Thus, the function of the esophageal muscles can be determined for each section. This test is recommended only in certain cases, such as in patients with heartburn, difficulty swallowing, and pain behind the sternum.

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