Heartburn

Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. The discomfort often rises in the chest and may radiate to the neck, throat, or angle of the jaw.

Because of the dangers inherent in an overlooked diagnosis of heart attack, cardiac disease should be considered first in people with unexplained chest pain. People with chest pain related to GERD are difficult to distinguish from those with chest pain due to cardiac conditions. Each condition can mimic the signs and symptomatic findings of the other. Further medical investigation, such as imaging, is often necessary.

Symptoms of heartburn can be confused with the pain that is a symptom of an acute myocardial infarction (heart attack) or angina. A description of burning or indigestion-like pain increases the risk of acute coronary syndrome, but not to a statistically significant level. In a group of people presenting to a hospital with GERD symptoms, 0.6% may be due to ischemic heart disease.

As many as 30% of chest pain patients undergoing cardiac catheterization have findings which do not account for their chest discomfort, and are often defined as having "atypical chest pain" or chest pain of undetermined origin. According to data recorded in several studies based on ambulatory pH and pressure monitoring, it is estimated that 25% to 50% of these patients have evidence of abnormal GERD.

Functional heartburn is heartburn of unknown cause. It is associated with other functional gastrointestinal disorder like irritable bowel syndrome and is the primary cause of lack of improvement post treatment with proton pump inhibitors (PPIs). PPIs are however still the primary treatment with response rates in about 50% of people. The diagnosis is one of elimination, based upon the Rome III criteria: 1) burning retrosternal discomfort; 2) elimination of heart attack and GERD as the cause; and 3) no esophageal motility disorders. It was found to be present in 22.3% of Canadians in one survey.

Heartburn can be caused by several conditions and a preliminary diagnosis of GERD is based on additional signs and symptoms. The chest pain caused by GERD has a distinct 'burning' sensation, occurs after eating or at night, and worsens when a person lies down or bends over.It also is common in pregnant women, and may be triggered by consuming food in large quantities, or specific foods containing certain spices, high fat content, or high acid content. If the chest pain is suspected to be heartburn, patients may undergo an upper GI series to confirm the presence of acid reflux. Heartburn or chest pain after eating or drinking and combined with difficulty swallowing may indicate esophageal spasms.

Esophageal pH monitoring: a probe can be placed via the nose into the esophagus to record the level of acidity in the lower esophagus. Because some degree of variation in acidity is normal, and small reflux events are relatively common, esophageal pH monitoring can be used to document reflux in real-time.