Heartburn is a sensation of discomfort due to indigestion. It is usually witnessed as a retrosternal acute burning sensation. It is also known as pyrosis, cardialgia, acid indigestion. About 42% of the United States population has had heartburn at some point.
Heartburn is usually associated with regurgitation of gastric acid (gastric reflux) which is the major symptom of gastroesophageal reflux disease (GERD).
Causes
Heartburn occurs when stomach acid backs up into the tube that carries food from your mouth to your stomach (esophagus).
Normally when you swallow, a band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow down into your stomach. Then the muscle tightens again.
If the lower esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus (acid reflux) and cause heartburn. The acid backup may be worse when you're bent over or lying down.
Differential Diagnosis
Cardiac (heart attack) symptoms and esophageal symptoms can be very similar, as the heart and esophagus share the same nerve supply.
1. Cardiac
Symptoms of heartburn can be confused with the pain that is a symptom of an acute myocardial infarction and angina.
2. GERD
Gastroesophageal reflux disease is the most common cause of heartburn. In this condition acid reflux has led to inflammation of the esophagus.
3. 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).
Treatment
Antacids such as calcium carbonate are often taken to treat the immediate problem, with further treatments depending on the underlying cause. Medicines such as H2 receptor antagonists or proton pump inhibitors are effective for gastritis and GERD, the two most common causes of heartburn. Antibiotics are used if H. pylori is present.
