- How long have you had heartburn?
Why: to determine if acute or chronic.
- What exactly do you mean by heartburn?
Why: typically heartburn is a burning discomfort behind the sternum (breastbone) that radiates to the throat, associated with acid reflux, aggravated by heavy meals, swallowing hot and cold fluids, stooping, lying flat and lifting and straining, more likely to occur at rest than with exertion. Heartburn may be due to gastro-esophageal reflux, oesophagitis, hiatus hernia, peptic ulcer, scleroderma, pregnancy, obesity, smoking and alcohol, caffeine and some medications.
- Is there anything that makes the heartburn worse?
Why: can help distinguish gastro-esophageal reflux (heartburn) from other causes of abdominal discomfort e.g. eating food may aggravate a gastric ulcer; eating fried or fatty foods will aggravate biliary disease, esophageal disorders and functional dyspepsia.
- ( dyspepsia when no specific cause can be demonstrated); bending over will aggravate gastro-esophageal reflux; alcohol will aggravate gastro-esophageal reflux, oesophagitis, gastritis, peptic ulcer and pancreatitis
- Is there anything you have found that makes the discomfort better? Gastro-esophageal reflux is usually relieved by antacids within several minutes
- What effect do food, milk and antacids have?
Why: if discomfort is relieved by food and antacids may suggest duodenal ulcer, hiatus hernia and oesophagitis. If discomfort is brought on by food may suggest cholecystitis, gastric ulcer or reactions to toxins in food such as MSG or sulfites.
- What effect do coffee, onions and garlic have?
Why: aggravate gastro-esophageal reflux.
- What effect does a big meal have?
Why: aggravate gastro-esophageal reflux.
- What effect does drinking alcohol have?
Why: aggravate gastro-esophageal reflux, gastritis and peptic ulcers.
- What effect does exercise have?
Why: chest discomfort precipitated by exercise may suggest angina as cause of discomfort if brought on by exertion. Exercise may also precipitate heartburn.
- Do fried or fatty foods make it worse?
Why: aggravate gallstones.
- Do hot spicy foods effect it?
Why: aggravate gastro-esophageal reflux, gastritis and peptic ulcers.
- Does the problem come on at night soon after you go to bed?
Why: would suggest gastro-esophageal reflux.
- Does it wake you at night?
Why: may suggest gastro-esophageal reflux or peptic ulcer.
- Does bending over such as in gardening make it worse?
Why: suggests gastro-esophageal reflux.
- Are you under a lot of stress or have a lot of worry?
Why: may aggravate indigestion due to affecting motility and suggests gastro-esophageal reflux, peptic ulcers.
- Do you rush your meals?
Why: may aggravate indigestion.
- Do you chew your food properly?- if not, may aggravate indigestion
- Are you pregnant?
Why: pregnancy increases the risk of gastoesophageal reflux due to a relaxation of the lower esophageal sphincter.
- Past medical history?
Why: e.g. scleroderma (rare but important cause of oesophagitis), irritable bowel syndrome, gallstones, chronic pancreatitis, achalasia, hiatus hernia, pernicious anemia (may increase the risk of stomach cancer).
- Medications?
Why: e.g. non-steroidal anti-inflammatory medications (2-4 times the risk of gastric ulcers), anticholinergics, aspirin, calcium channel blockers, corticosteroids, digitalis, lipid lowering medications, narcotics, slow release potassium supplements, theophylline, tricyclic antidepressants and tetracycline - may all cause gastro-esophageal reflux.
- Nicotine smoking?
Why: cigarette smoking is an important cause of reducing the pressure of the lower esophageal pressure and thus increasing the risk of gastro-esophageal reflux. Smoking also increases the risk of peptic ulcers.
- Alcohol history?
Why: alcohol is an important cause of reducing the pressure of the lower esophageal pressure and thus increasing the risk of gastro-esophageal reflux. Alcohol may also increase the risk of peptic ulcers.
