It’s just heartburn. There is no need to worry. Or is there?
Most people who diagnose themselves with heartburn are right. Heartburn, or gastroesophageal reflux disease (GERD), is usually experienced as a burning sensation in the chest. Many patients feel that it starts in the lower chest or upper abdomen and goes up to the middle of the chest. Some experience regurgitation, a bitter taste in the mouth, or chest pain.
However, other causes of heartburn or chest pain can be mistaken for GERD. The most important and probably the most common is heart-related chest pain (angina). Symptoms can be indistinguishable from GERD, although the pattern is often different. GERD is usually related in some way to food: either it gets worse after eating (especially spicy foods, coffee, alcohol, chocolate, tomato or citrus products) or it gets better with food (as food absorbs some of the stomach acid, therefore relieving the burning temporarily).
Heart-related chest complaints often present a different pattern. Activities that require more oxygen, such as walking, climbing steps, or carrying food, can cause pain during or after exercise. Heartburn that comes from the stomach usually doesn’t cause shortness of breath, while a heart-related burning sensation often interferes with breathing. Either type of pain (angina or GERD) can radiate to the left arm, jaw, or neck, or be accompanied by nausea or belching. Heart problems tend to tire people, while stomach problems do not. Rest 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 deep breathing. Sometimes GERD will cause wheezing as acid from the stomach moves up through the esophagus and then leaks into the bronchial tubes. And certainly a patient can have GERD and asthma. GERD medications (Prilosec, Prevacid, Zantac, Pepcid, antacids, etc.) generally relieve acid-related chest discomfort and may even help with wheezing. Asthma medications can decrease or eliminate chest discomfort and wheezing, but they will not help GERD.
Another common cause of chest discomfort is costochondritis, or inflammation of the joints where the bony ribs connect to cartilage or where the ribs connect to the breastbone (breastbone). Costochondritis is usually tender to the touch, but it can also hurt when you breathe deeply. Pleurisy usually hurts when you breathe deeply, but it 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 drugs, which often make GERD worse, often 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 acid reflux disease (and that’s only occasionally), it’s best to see your doctor.
Copyright 2010 Cynthia J. Koelker, MD