Heartburn

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


Heartburn is usually associated with regurgitation of gastric acid (gastric reflux) which is the major symptom of gastroesophageal reflux disease (GERD). It may also be a symptom of ischemic heart disease, though this is true for only 0.6% of those experiencing heartburn.

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Definition

The terms dyspepsia and indigestion are often used interchangeably with heartburn, though some sources emphasize a distinction. Dyspepsia is defined as a combination of epigastric pain and heartburn. Heartburn is commonly used interchangeably with gastroesophageal reflux disease rather than just to describe a symptom of burning in one's chest.

Differential diagnosis
Cardiac and esophageal causes may share similar symptoms as these two structures have the same nerve supply.

Cardiac disease is one of the first conditions that must be excluded in patients with unexplained chest pain given that patients with chest pain related to GERD cannot be distinguished from those with chest pain due to cardiac conditions. 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.[10] 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.

GERD
Gastroesophageal reflux disease is the most common cause of heartburn. In this condition acid reflux has led to inflammation of the esophagus.

Functional heartburn
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 based upon the Rome III criteria of 1) burning retrosternal discomfort 2) absence of GERD as the cause 3) no esophageal motility disorders. It was found to be present in 22.3% of Canadians in one survey.

Cardiac
Heartburn is recognized as a symptom of an acute myocardial infarction and 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.

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