Conditions related to heartburn

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, 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 where 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 pain.
  
• 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 remains 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.