Pain in the upper abdomen that is worse before meals and during the night might be due to a peptic ulcer. The major cause of ulcers is an infection of the stomach by the bacterium Helicobacter pylori...

Heartburn / reflux

Reflux oesophagitis - ulcers due to reflux
An area of ulceration at the junction between the oesophagus and the stomach
Reflux oesophagitis - ulcers due to reflux

Heartburn is the symptom of “burning discomfort” behind the “breastbone”.

  • Heartburn results from acid in the oesophagus.
    • The stomach is designed to handle acid but the oesophagus has a different lining and is more sensitive to the effects of acid.
    • This sensitivity to acid varies significantly from person to person.
  • The basic abnormality is weakness of the valve between the oesophagus and the stomach.
    • This "valve" is designed to allow food into the stomach but to prevent acid and food refluxing back into the oesophagus.
    • Weakness of the valve (sphincter) does not improve over time; in fact - it may tend to weaken further over the years.
    • This “valve” function is adversely affected by a hiatus hernia. A hiatus hernia is when the top part of the stomach is sitting up in the chest instead of being below the diaphragm. This causes the valve to be working at a disadvantage (not as effective for reasons that are not entirely clear).

  • Reflux may be aggravated by
    • fatty foods; spicy foods
    • alcohol
    • smoking
    • chocolate
    • peppermint
    • caffeine
  • Some drugs can aggravate reflux;
    • Asthma treatments.
    • Anti-inflammatory drugs.
    • Calcium channel antagonists - given for high blood pressure.
  • Stress does not cause reflux but can make the symptoms more distressing.



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