A differential diagnosis refers to the
process of differentiating between two or more conditions that share similar
signs or symptoms. Conditions that may cause heartburn, and which may share
other symptoms too, include:
- Gastro-oesophageal reflux disease
(GORD): a condition that occurs when acid or
other stomach contents frequently flow back up into the oesophagus, affecting a
person’s quality of life.
- Achalasia: a rare disease in which
the normal muscular activity of the oesophagus is disturbed because of muscle
or nerve degeneration. This may delay the passage of food through the stomach,
leading to heartburn.
- Acute gastritis: where the lining
of the stomach is temporarily inflamed. This often occurs as a result of
drinking too much alcohol, or eating and drinking other irritating substances.
- Chronic gastritis: where the
lining of the stomach is chronically inflamed. This is often associated with smoking
and chronic alcoholism.
- Atherosclerosis: a disease of the
arteries in which fatty plaques develop on the inner walls of the arteries.
When the arteries close to the heart are narrowed because of these plaques, you
may experience chest pain similar to heartburn.
- Oesophageal cancer: a disease in
which cancer cells form in the tissues of the oesophagus.
- Oesophageal motility disorders: a
broad class of diseases that involve abnormal contractions of the muscles in
the oesophagus, as well as the upper and lower oesophageal sphincters.
- Oesophageal spasm: or painful
contractions within the oesophagus. This can feel like sudden, severe chest
- Oesophagitis: where the oesophagus
is inflamed. This may be caused by GORD, vomiting, surgery, medication or a
number of other factors.
- Gallstones: These are hard masses
composed of bile pigments, cholesterol and calcium salts that form in the gall
bladder. The exact cause of gallstones remain unclear, although it may be
linked to excess cholesterol or bilirubin (produced when red blood cells are
broken down) in the body.
- H. Pylori infection: where a type
of bacteria called Helicobacter pylori
infects the stomach.
- Intestinal malrotation: a
congenital anomaly in which the intestines are twisted, causing obstruction.
- Irritable bowel syndrome (IBS): a
common condition characterised by recurrent abdominal pain as well as
constipation, bloating and/or diarrhoea.
- Peptic ulcer disease: where
there’s a breach in the lining of the digestive tract caused by pepsin and
acid. Pepsin is an enzyme in the stomach that begins the digestion of proteins.
- Heart attack: heartburn can be one
of the symptoms preceding a heart attack. If the pain stretches to your arms,
neck, jaw or back, get help immediately.
- Hiatal hernia: where a part of the
stomach protrudes through a small opening (hiatus) in the diaphragm (the layer separating
the abdomen from the chest cavity). This prevents the muscle fibres of the
diaphragm from closing the lower end of the oesophagus. The oesophagus remains
open, allowing stomach acid to flow up into it.
- Reviewed by Dr
Estelle Wilken,Senior Specialist in Internal Medicine and Gastroenterology at
Tygerberg Hospital. - March 2017