Heartburn is a symptom that's a result of acid reflux and the more severe condition gastroesophageal reflux disease (GERD).

GERD occurs when the lower esophagus gets irritated from the build up of continued acid reflux, explains Frank Gress, MD, chief of the Gastroenterology Division at SUNY-Downstate Medical Center in New York City.

Is It Always GERD?

Not always. It could be a heart problem. People may experience chest pain, and not heartburn, but they're not differentiating that and it could be cardiac in origin, says Gress.

"The problem with heartburn is people describe it in many different ways," he explains. "Some people describe it as a burning pain, other people describe it as a sharp pain in their chest, and others describe it as chest pain." Typically, when a patient has those kinds of symptoms, there are two main culprits:

Cardiovascular problems, such as ischemia, heart attack, and angina. "It's sometimes challenging to differentiate those pains and diagnose what it is," says Gress. Patients will go through a series of tests, including cardiac imaging tests and stress tests, to make sure they didn't have a heart attack.

Esophageal problems. Once a heart condition has been ruled out, a patient will be referred to a gastroenterologist for a series of GI tests. These include upper endoscopy, manometry, and pH studies to make the diagnosis.

In his experience, Gress says most of the time heartburn is a symptom of reflux disease, but there is a percentage of patients that get heartburn due to a cardiac problem. That's why it's important to see your doctor for a definitive diagnosis.

Have Heartburn? Now What?

If you get heartburn once or twice a month, you can usually point to a big meal or food as the culprit. The most common foods that tend to cause problems include:

  • Alcohol
  • Spicy foods
  • Garlic
  • Onions
  • Chocolate
  • Peppermint
  • Coffee

However, if you experience heartburn once or twice a week—or start to experience it more frequently—you need to see your doctor.

The main reason (besides a heart problem) is that research has shown that people who have constant heartburn related to GERD over time (five years or more) are more likely to develop complications of GERD.

Those include:

  • Barrett's esophagus. A pre-malignant lesion that occurs in the esophagus.
  • Ulcerations in the esophagus.
  • Erosive esophagitis, strictures, or ulcers, in the lower esophagus.
  • Esophageal cancer.

Those complications can create long-standing problems in the esophagus. So if you have reflex or heartburn for more than five years, your doctor will most likely order an endoscopy to assess any damage to the esophagus.

Your primary care physician is the best place to start, advises Gress. He or she knows your health history and will know what your personal risk factors are—and whether those risk factors include cardiac disease. If they do, you would get a work-up from a cardiologist first before seeing a GI.

Dr. Frank Gress reviewed this article.




Frank Gress, MD, Chief of Gastroenterology Division at SUNY-Downstate Medical Center.