Similarities of Heartburn, Gastroesophageal Reflux (Gerd) and Cardiac Chest Pain

By: Douglas Mendez, MD, M.Sc. & Denisse Hernandez, MD, C.N.H.P., ND, M.Sc.
Heartburn Is a condition that affect close to 42% of the United States population. It is defined as a burning sensation in the mid-chest or upper central abdomen. The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw. Heartburn, also known as acid indigestion is usually due to regurgitation of gastric acid (gastric reflux) into the esophagus and is the major symptom of gastroesophageal reflux disease (GERD).

Indigestion is a more complex term that includes heartburn along with a number of other symptoms. Sometimes is defined as a combination of epigastric pain and heartburn. which is frequently referred to as gastroesophageal reflux disease rather than just to describe a symptom of chest burning or chest pain.

Chest pain of any cause is a reason for concern, so that it should be differentiated to rule out a hidden more serious problem. Heart attack and esophageal symptoms are very similar, as they share the same nerve supply.
Given the inherent dangers of an overlooked diagnosis of heart attack, the first thing that should be considered in people with unexplained chest pain is the possibility of cardiac disease. Very often the use of imaging is necessary to stablish a final diagnosis.

The 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. An observational study reported that 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. Gastroesophageal reflux disease is the most common cause of heartburn. In this condition acid reflux has led to inflammation of the esophagus.

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, it occurs after eating or at night, and worsens when a person lies down or bends over. It is also common in pregnant women, and may be triggered by consuming food in large quantities, or specific foods containing certain spices, high fat, 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.

The diagnosis of heartburn consists of three basic steps:

1-The administration of a GI cocktail of viscous lidocaine and an antacid, relief the symptoms in 5 to 10 minutes after its administration. This increases the suspicion that the pain is of esophageal in origin. However, it does not rule out a potential cardiac cause, as 10% of cases of discomfort due to cardiac causes are improved with antacids.

2- Biochemical: 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.

3- Mechanical: A- Manometry: in this test, a pressure sensor (manometer) is passed via the mouth into the esophagus and measures the pressure of the lower esophageal sphincter directly.

B- Endoscopy: Visualization of the esophageal mucosa directly by passing an endoscope (lighted tube with a camera attached at its end) through the mouth to examine the esophagus and stomach. In this way, evidence of esophageal inflammation can be detected, and biopsies taken if necessary. Since an endoscopy allows a doctor to visually inspect the upper digestive tract the procedure may help identify any additional damage to the tract that may not have been detected otherwise.

C- Biopsy: Small tissues are taken from the esophagus and studied for signs of inflammation, cancer, or other problems.

Treatment:

Antacids such as calcium carbonate are often taken to treat the immediate problem, with further treatments depending on the underlying cause. Medicines such as H2 receptor antagonists or proton pump inhibitors are effective for gastritis and GERD, which are the two most common causes of heartburn. Antibiotics are used if Helicobacter pylori is present.
References:
1. “Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults”. The National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2015-07-24.
2. “heartburn” at Dorland’s Medical Dictionary
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4. “Heartburn”. National Library of Medicine. Retrieved 2015-07-24.
5. Duvnjak, edited by Marko (2011). Dyspepsia in clinical practice (1. Aufl. ed.). New York: Springer. p. 2. ISBN 9781441917300.
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7. “Pyrosis definition – MedicineNet – Health and Medical Information Produced by Doctors”. MedicineNet. Retrieved 19 November 2015.
8. Kato H, Ishii T, Akimoto T, Urita Y, Sugimoto M (April 2009). “Prevalence of linked angina and gastroesophageal reflux disease in general practice”. World J. Gastroenterol.

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