When Heartburn Isn’t Heartburn

It’s just heartburn. There’s no need to worry. Or is there?

Most people who diagnose themselves with heartburn are correct. Heartburn, or gastroesophageal reflux disease (GERD), is usually experienced as a burning sensation in the chest. Many patients feel it starting low in the chest or upper abdomen, moving up to the mid-chest. Some experience regurgitation, a sour taste in the mouth, or chest pain.

However, other causes of heartburn or chest pain may be confused with GERD. The most important and probably the most common one is heart-related chest pain (angina). The symptoms may be indistinguishable from GERD, although often the pattern is different. Usually GERD is in some way related to food: either it’s worse after eating (especially spicy foods, coffee, alcohol, chocolate, tomato-based products, or citrus) or it improves with eating (as food absorbs some of the stomach acid, thus relieving the burning temporarily).

Chest discomfort related to the heart commonly exhibits a different pattern. Activities that require more oxygen, such as walking, going up steps, or carrying groceries, may bring on the pain during or after exercise. Heartburn coming from the stomach doesn’t usually cause shortness of breath, whereas a heart-related burning sensation often does interfere with breathing. Either type of pain (angina or GERD) may radiate into the left arm, jaw, or neck, or be accompanied by nausea or belching. Heart problems tend to make people tired, whereas stomach problems do not. Resting often relieves angina (heart pain) but usually does little for GERD.

Sometimes people experience burning in the chest as a result of asthma, COPD, bronchitis, or pneumonia. This discomfort is often associated with shortness of breath or taking a deep breath. At times, GERD will cause wheezing, as the stomach acid ascends through the esophagus then leaks back into the bronchial tubes. And certainly a patient can have both GERD and asthma. Medication for GERD (Prilosec, Prevacid, Zantac, Pepcid, antacids, etc.) usually relieves acid-related chest discomfort and may even help wheezing. Medication for asthma may decrease or eliminate chest discomfort and wheezing but will not help GERD.

Another common cause of chest discomfort is costochondritis, or inflammation of the joints where the bony ribs connect to the cartilage, or where the ribs connect to the sternum (breast bone). Costochondritis is usually tender to touch, but may also hurt when taking a deep breath. Pleurisy usually hurts to take a deep breath but is not tender to the touch. GERD itself generally does not cause tenderness, unless there is associated irritation of the stomach or an ulcer. Anti-inflammatory medications, which often make GERD worse, frequently relieve the symptoms of costochondritis.

A person with GERD, COPD, and angina may have trouble discerning the cause of their chest pain. Unless you have clear-cut acid reflux disease (and that only occasionally), it’s best to see your doctor.

Copyright 2010 Cynthia J. Koelker, M.D.