heartburn
Meaning of heartburn: The name is a misnomer, and the overlap with chest pain from the heart is exactly why the two are so often confused.
Definition of heartburn
Heartburn is a burning discomfort felt behind the breastbone, rising from the upper abdomen toward the throat, caused by stomach contents washing back into the esophagus. Acid irritates a lining that has no protection against it. The sensation has nothing to do with the heart, and it typically worsens after large meals, on bending forward and when lying flat.
Why does stomach acid get into the esophagus?
A ring of muscle at the lower end of the esophagus stays shut except when swallowing, and the short segment of tube passing through the diaphragm is squeezed by that muscle too. Together they act as a valve. The ring relaxes briefly many times a day, and when it relaxes while the stomach is full or under pressure, contents wash upward. A hiatal hernia, where part of the stomach slides up through the opening in the diaphragm, removes the second half of the valve. The stomach lining is built to sit in acid; the esophagus is not, so even brief contact registers as burning.
How does it differ from cardiac chest pain?
| Feature | More typical of reflux | More typical of the heart |
|---|---|---|
| Quality | Burning, rising toward the throat | Pressure, tightness or heaviness |
| Trigger | Meals, bending, lying flat | Exertion, cold, emotional stress |
| Accompaniments | Sour taste, belching | Sweating, breathlessness, nausea |
| Spread of the pain | Up behind the breastbone | Into the jaw, neck or left arm |
The patterns overlap enough that neither column decides the matter. Reflux pain can spread to the arm, and cardiac pain can burn, ease after a belch or arrive after a meal. Chest discomfort of this kind is therefore commonly assessed with an electrocardiogram and blood tests before it is attributed to the esophagus, and relief following an antacid is not treated as evidence about the cause.
What happens when it continues for years?
Repeated acid exposure inflames the lower esophagus, and healing can leave a narrowed ring that makes swallowing solid food difficult. In some people the lining responds by changing type, replacing its own flat cells with the column-shaped cells that line the intestine, a swap called metaplasia. That change is Barrett esophagus, and it carries a raised risk of cancer of the lower esophagus, which is why it is monitored once identified. Most people with heartburn never develop it, and the severity of the burning tracks poorly with how much damage is present.
Also known as
Used in a sentence
The patient described heartburn that was worse at night and after large meals.
Good to know
Burning chest discomfort from reflux and pain from reduced blood flow to the heart overlap enough that symptoms alone do not separate them, and relief after an antacid does not exclude a cardiac cause.