Heartburn or Heart Attack?

By SeeFoon Chan-Koppen

Dato' Dr Yeoh Huat CheeAccording to Dato’ Dr Yeoh Huat Chee, Gastroenterologist and Consultant Internal Medicine Specialist at KPJ Ipoh Specialist Hospital, determining whether you’re having heartburn or heart attack is critical in saving lives.

Most of us have had heartburn at some time or another in our lives . An over-indulgent meal, with heavy oily food, cream, cheese, fries, spicy food, alcohol will do it for some (especially this writer) but according to Dr Yeoh, there are ways to ascertain what that burning sensation is; to first eliminate the dangerous possibilities and then treat the discomfort after.

Dr Yeoh who received his FRCP from both Glasgow and Edinburgh and has been practicing in KPJ Ipoh Specialist Hospital  since 1993, says that cardiac pain will travel up to the jaw and radiate to the left inner arm and at the first sign of this it is imperative to get to a hospital  or the Emergency department. An ECG or Electrocardiogram and blood test called Trop T to diagnose heart attack will show whether the person is having a heart attack. This is especially important for people who have any of the following indicators like a family history of heart attacks, high blood pressure, high cholesterol and who smokes.

 Another type of gastric pain may be caused by gallstones or a problem with the gall bladder, in which case the pain may radiate up the right shoulder and to the back. Again if the pain is intense, affecting sleep, and sometimes vomiting, then a trip to the hospital is advised where an ultrasound scan will determine whether gallstones are present or other gallbladder issues.

 Other types of gastric pain may be caused by Helicobacter pylori (H. pylori), a bacteria that burrows into the cells of the stomach lining and cause gastritis. H. pylori is a common cause of gastric ulcers, gastritis and duodenal ulcer. Also, those infected have an increased risk of duodenal ulcer, stomach cancer and lymphoma.

 An invaluable piece of advice from Dr Yeoh on avoiding infection from H. pylori is to to be meticulous in your hygiene. “Never share food or drink. This is the most common way of getting infected. When you’re eating at communal dinners, always use serving spoons,” he emphasised.

 So what about kissing I asked cheekily? “No problem,” was the reply, “because the oesophageal sphincter is not open.” That is not kissing and eating/drinking at the same time, where the gastric juice with H. pylori  re-fluxes into the mouth.

“The good news is that H. pylori can now be detected very easily through a simple breath test which is 98% accurate. If you do have the bacteria, it can be eliminated with prescribed antibiotics,” he added.

The same cannot be said for an ulcer which needs to be diagnosed through a gastroscope both for the stomach and duodenal ulcer. This is not such a dreaded procedure as it is now done under mild sedation while the doctor inserts a scope down your throat into the stomach and along the way looks at the condition of your oesophagus.

 “If everything looks normal from a gastroscope, then non-erosive reflux oesophagitis (primarily heartburn) and has to do with lifestyle factors such as alcohol, coffee, tea, oily rich food and spicy food consumption but most importantly it is stress which causes the cardio oesophageal sphincter – which is the ‘door’ between the stomach with all its strong acid and the oesophagus – to not close properly, allowing the acid to spill over into the oesophagus and back up to the throat area giving rise to the burning sensation we call acid reflux”.

 So what can we do to minimise heartburn other than making lifestyle changes I asked Dr Yeoh?

 “Well for starters I would advise people to avoid taking Chinese Rheumatic medicine. They contain steroids and NSAIDS (non steroidal anti-inflammatory drugs) which create havoc with your digestive system. In fact I would recommend that people over 60, to avoid NSAIDS.

 “For those who have been prescribed Proton Pump inhibitors (PPI) like Nexium or the Histamine 2 Blockers like Zantac, I would recommend that they go for a gastroscope if their symptoms have not subsided after 2 weeks.”

 Gastrointestinal cancer is another ‘big C’ issue that Dr Yeoh confronts on a regular basis and the advice he gives is to avoid eating too much red meat. Do avoid seared, smoked,  preserved and barbecued meats, salted fish, salted vegetables and don’t eat too many deep fried foods.

 “H. pylori combines with the nitrates used in preserving meat as in sausages, hams and other items and turns into carcinogens in the stomach. Grilling, barbecuing and frying create compounds called heterocyclic amines (HCAs), polycyclic aromatic hydrocarbons (PAHs), advanced glycation endproducts (AGEs) and these have been linked to cancer.

 “In general, my advice is to eat healthy to stay healthy. Add some regular exercise and go for a check-up when you have gastric pain,” Dr Yeoh concluded.

Dato’ Yeoh Medical and Gastro Clinic
Suite L2-16 KPJ Ipoh Specialist Hospital
26, Jalan Raja DiHilir, 30350 Ipoh, Perak
Tel: 05-2408777  Ext: 130
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