Great Information, Real Community, Better Living.
 Main Page
 Reflux News
Feature Story
 Education Center
 Living with GERD Center
 Pharmacology Center
Dr. Jamie Koufman  Reflux

Dr. Jamie Koufman:
Treating Reflux with Diet.
About Heroes
 Join the Discussion in  Our Forums
Reflux1 Forums
Patient Stories
Frequently Asked
Online Resources
Locate a Specialist
Video Library
Search the Body1 Network
September 20, 2020  

  • Print this Article
  • Email this Article
  • Links/Reprints
  • Acid Reflux May Not Be the Only Cause of Heartburn

    Acid Reflux May Not Be the Only Cause of Heartburn

    April 28, 2004

    By Stephanie Riesenman for Reflux1

    While heartburn is usually associated with acid reflux, new research suggests that in some people with frequent heartburn, the pain may also be caused by abnormalities in the esophagus.

    "Acid is only one of the many causes of heartburn," said Dr. Ravi Mittal, Professor of Medicine at the University of California San Diego. "Acid does not explain heartburn in all patients."

    Dr. Mittal and colleagues at the Veterans Affairs Medical Center in San Diego compared two diagnostic tests for heartburn in 93 patients. The first was the Bernstein test, which involves the injection of acid into the esophagus to see if it produces heartburn symptoms. The other is called pH monitoring, where patients keep a diary of their heartburn symptoms—a symptoms index (SI)—over a 24-hour period while researchers monitor the acidity of their esophagus.

    Because some patients had positive scores in one test and not the other, the researchers concluded that not all heartburn is caused by acid reflux.

    "If acid was the major cause of spontaneous heartburn," the researchers write, "then all the patients with a positive SI should have a positive Bernstein test, which was not the case."

    Instead, 58 of the 93 patients reported symptoms of heartburn over a 24-hour period, a positive SI. Of those 58 patients, only 35 had a positive Bernstein test score. In all 93 patients with chronic heartburn, only 49 had a positive Bernstein test during the study.

    "For people with spontaneous heartburn who do not respond to a Bernstein test or acid infusion into the esophagus, the cause of heartburn is unlikely to be acid," said Dr. Mittal.

    The researchers’ previous work on the causes of heartburn showed that distension of the esophagus—which they accomplished using a balloon in one study—produced symptoms of heartburn. The researchers explained that acid reflux might induce spontaneous heartburn through distention of the esophagus, and that the amount of distention is dependent on the volume of the reflux, which cannot be measured by pH monitoring.

    "Some of these patients do not respond to acid infusion in the esophagus, suggesting that acid may be an innocent bystander and not the real cause of heartburn," said Dr. Mittal.

    Another cause of heartburn may be something he called "esophageal dysmotility," or a sustained esophageal contraction, which may or may not be triggered by the presence of acid in the esophagus.

    The suggestion that something other than acid reflux causes heartburn is also supported by the fact that acid-suppressing medications, such as the proton pump inhibitors (PPI) and histamine receptor (H2) blockers, don’t work for everyone with heartburn. In fact, only 65% of the patients in the study who were on PPI’s reported dependable relief while taking the drugs.

    "If a patient’s symptom of heartburn does not get better with proton pump inhibitors they should be carefully looked at for other abnormalities," said Dr. Mittal.

    Dr. Mittal and his colleagues conducted their study at the Veteran’s Affairs Medical Center in San Diego. Their research is published in the March issue of the American Journal of Gastroenterology.

    Last updated: 28-Apr-04


  • Add Comment
    Interact on Reflux1

    Discuss this topic with others.
    Feature Archives
    Next 5 Features ...

    More Features ...
    Related Multimedia

    Interview with Dr. Cohen: Focusing on the Esophagus

    Interview with Dr. Foley: Heartburn

    Interview with Dr. Cohen: What is Heartburn? 2

    More Features ...
    Related Content
    Acid Reflux is Not Always the Cause of Heartburn

    From Crackers and Water to Pizza and Chocolate: A Reflux Survivor’s Story

    Which Direction to Turn with GERD

    From Acid Reflux to Esophageal Cancer – New Discovery Heralds Hope

    Acid Reflux May Be Caused By More Than Just Food Choices

    More Features ...
    Home About Us Press Jobs Advertise With Us Contact Us
    © 2020 Body1 All rights reserved.
    Disclaimer: The information provided within this website is for educational purposes only and is not a substitute for consultation with your physician or healthcare provider. The opinions expressed herein are not necessarily those of the Owners and Sponsors of this site. By using this site you agree to indemnify, and hold the Owners and Sponsors harmless, from any disputes arising from content posted here-in.