Most healthy individuals have experienced heartburn: the sensation of a hot. burning retrosternal discomfort often accompanied by the reflux of bitter-tasting gastric fluid into the mouth. It commonly occurs after meals or on bending or lying on the left side and is particularly frequent during pregnancy or following recent weight gain. Heartburn is caused by the reflux of acid, pepsin or bile into the oesophagus and is attributable to a combination of relaxation of the lower oesophageal sphincter and increased intra-abdominal pressure. Many patients with heartburn have no evidence of oesophagitis on oesophagoscopy. However, oesophagitis may develop resulting in pain on swallowing (odynophagia) or food sticking during swallowing (dysphagia). Heartburn is also commonly experienced by patients with duodenal ulceration. When accompanied by reflex salivation, known as waterbrash, the mouth fills with tasteless saliva, in contrast to the bitter lasle of acid reflux: waterbrash is an uncommon symptom which if present, strongly suggests duodenal ulcer disease.
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