9 Serious Conditions That Can Feel Like Heartburn
What exactly is heartburn, anyway?
Heartburn—or gastroesophageal reflux or acid reflux—is a painful burning feeling in your chest or your throat, according to the US National Library of Medicine (USNLM).
Basically, heartburn happens when your esophagus (the tube that carries food from your mouth to your stomach) relaxes too much and stomach acid comes back up into your esophagus, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It can be managed by making changes to your diet, like cutting back on coffee and alcohol, or through medications.
Having heartburn every once in a while, like after a spicy meal or taking a nap too soon after eating, is normal; but if it occurs more than twice a week for more than a few weeks, it's time to see a doctor–in that case, you could have gastroesophageal reflux disease (GERD), a chronic, sometimes damaging form of heartburn.
But GERD isn't the only issue that is related to heartburn. Many other conditions—some even life-threatening—can mimic the feeling of heartburn. Here, nine other conditions that heartburn could be masquerading as—and when to see your doctor about it.
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Angina, which is chest pain or discomfort caused by a lack of blood flow to the heart, according to the American Heart Association (AHA), can feel like indigestion or heartburn.
"The major key is if you're getting heartburn when you're doing strenuous or moderate activity," says Ryan Madanick, MD, a gastroenterologist and assistant professor of medicine at the University of North Carolina School of Medicine, in Chapel Hill. And if you have additional symptoms, such as sweating or difficulty breathing, it’s likely time to seek medical attention.
If you're 50 or older and getting heartburn—especially if you haven't had this kind of pain before—it can also raise suspicion of angina, as can other heart disease risk factors like hypertension, diabetes, or a family history of heart disease.
Gallstones are hard, small, pebble-like masses that develop in your gallbladder, according to the NIDDK. Although gallstones don't always cause symptoms, a stone blocking your bile duct can hurt, usually in the middle or upper-right side of the abdomen.
Pain may be cramping, dull, or sharp, and often strikes minutes after you eat. It’s usually more intense than heartburn and may last longer.
If you're experiencing stomach pain after meals that doesn't improve after you take an over-the-counter acid-suppressing medication, gallstones should be suspected, says Joel Richter, MD, a gastroenterologist and chairman of the department of medicine at Temple University School of Medicine, in Philadelphia.
Stomach ulcers, also known as peptic ulcers, are sores on your stomach lining that can cause a gnawing, burning sensation, usually felt in the upper abdomen. The pain can find its way up to the chest, Dr. Madanick says. The pain is often more dull and persistent than heartburn.
Acid-suppressing medications may relieve ulcer pain. But ulcers are often caused by Helicobacter pylori, a type of bacteria that inflames the stomach lining, so you will need to take antibiotics to clear the infection.
Long-term use of certain anti-inflammatory drugs (such as aspirin, ibuprofen, and naproxen), and osteoporosis drugs called bisphosphonates, can also cause stomach ulcers. In this case, your doctor might prescribe medications called proton-pump inhibitors (PPIs) to reduce acid in your stomach, according to the NIDDK.
A hiatal hernia occurs when a portion of the upper stomach pokes through the diaphragm into the chest cavity, rather than staying in the abdominal cavity where it belongs.
This can push food and stomach acid up into the esophagus, causing heartburn-like pain and GERD, according to the NIDDK. Your doctor may be able to diagnose it with an X-ray or other imaging.
Other signs of hiatal hernia include chest pain, belching, and nausea. If you have heartburn due to hiatal hernia, your doctor will typically prescribe acid-suppressing drugs, and recommend lifestyle changes like eating smaller meals, avoiding alcohol, and not eating right before bed. In rare cases, surgical repair may be warranted.
RELATED: Heartburn and Other GERD Symptoms
Esophageal cancer is rare, but its incidence is rising rapidly in the United States, Dr. Madanick says. While heartburn-like pain may be caused by esophageal cancer in rare cases, the most common symptom is difficulty swallowing, according to the American Cancer Society.
"If you have heartburn, it might be a sign of esophageal cancer, but it's highly unlikely," he says. Your doctor may decide to order an upper endoscopy to examine your esophagus if you've got long-standing heartburn, especially if you smoke or drink heavily, both of which are risk factors for esophageal cancer.
This test involves passing a tube with a light and a camera at one end down your throat into your esophagus. During the test, your doctor can look for abnormal areas as well as collect tissue samples to test for cancer.
Poor control of diabetes can lead to nerve damage, which can affect the workings of your digestive tract. This is called gastroparesis, and it dramatically slows the movement of food through the stomach to the intestines. This can cause heartburn, as well as other symptoms like nausea, vomiting, and feeling full right away after eating, the NIDDK explains.
Treatment can include dietary changes such as eating smaller meals, avoiding fat and fiber, medications, and, for people with very severe symptoms, inserting a feeding tube or an implanted device that emits electrical pulses mimicking stomach contractions.
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Esophagitis, or inflammation of the esophagus, can result from frequent acid reflux. This condition can in turn lead to more heartburn, as well as difficulty swallowing.
The esophagus can also become inflamed from taking certain painkillers and osteoporosis medications, particularly if the pills are taken without water, allowing them to remain in the esophagus. In rarer cases, certain infections and radiations can cause the condition, according to the National Center for Biotechnology Information (NCBI).
A third type of esophagitis, called eosinophilic esophagitis, occurs when white blood cells known as eosinophils invade the esophagus. The chronic condition is often allergy- and asthma-related, so treatment requires identifying and avoiding the offending foods with the help of a gastroenterologist or allergist. Doctors may also prescribe steroid medications to ease inflammation, according to the American Academy of Allergy, Asthma, and Immunology (AAAAI).
RELATED: 10 Reasons You Have a Sore Throat
Pleuritis or costochondritis
Inflammation of the lining of the lungs and chest cavity, known as pleuritis or pleurisy, can cause heartburn-like chest pain. Pleuritis should be suspected "if the pain or burning gets worse when you take deep breaths or move around," Dr. Madanick says.
Pleuritis is most commonly caused by a viral or bacterial infection, and resolves when the infection does, according to the National Heart, Lung, and Blood Institute (NHLBI).
Costochondritis—an inflammation of the cartilage anchoring ribs to the breastbone—can cause sharp pain along the breastbone or sternum. It can be related to injury or infection, and typically is treated with anti-inflammatory medicines, pain relievers, and rest.
Although anxiety won't cause GERD, it can cause heartburn and make GERD symptoms worse, Dr. Madanick says. What’s more, panic attacks can sometimes directly cause chest pain, according to the American Heart Association (AHA).
A person can have both anxiety-related heartburn and GERD-related heartburn. "One of the signs that it's not just reflux is that treating the reflux problem doesn't make it any better," he says.
Reducing anxiety and stress through, for example, exercise, relaxation, and therapy, can also ease heartburn.
Dr. Madanick says that, as with other conditions that masquerade as GERD, "many times the only times we will see a patient…is when the over-the-counter medications haven't worked, because the medications tend to be very effective for treating simple heartburn."