Heartburn differential diagnosis: Difference between revisions
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==Differentiating Heartburn from other Diseases== | ==Differentiating Heartburn from other Diseases== | ||
[[Heartburn]] must be differentiated from other | [[Heartburn]] must be differentiated from other diseases that cause [[chest pain]], such as [[acute coronary syndromes]]. | ||
[[Heartburn]] may also be differentiated from other diseases that cause [[dysphagia]] in high risk individuals. | |||
Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. In order to facilitate this, there's a table below which describes the life-threatening causes which must be differentiated: | |||
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Revision as of 16:55, 4 September 2020
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Heartburn Microchapters |
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Heartburn differential diagnosis On the Web |
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American Roentgen Ray Society Images of Heartburn differential diagnosis |
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Risk calculators and risk factors for Heartburn differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]
Differentiating Heartburn from other Diseases
Heartburn must be differentiated from other diseases that cause chest pain, such as acute coronary syndromes.
Heartburn may also be differentiated from other diseases that cause dysphagia in high risk individuals.
Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. In order to facilitate this, there's a table below which describes the life-threatening causes which must be differentiated:
| Heartburn (GERD) | Angina or Heart Attack |
|---|---|
| Burning chest pain, begins at the breastbone | Tightness, pressure, squeezing, stabbing or dull pain, most often in the center |
| Pain that radiates towards the throat | Pain radiates to the shoulders, neck or arms |
| Sensation of food coming back to the mouth | Irregular or rapid heartbeat |
| Acid taste in the back of the throat | Cold sweat or clammy skin |
| Pain worsens when patient lie down or bend over | Lightheadedness, weakness, dizziness, nausea, indigestion or vomiting |
| Appears after large or spicy meal | Shortness of breath |
| Symptoms appears with physical exertion or extreme stress |
While evaluating heartburn and considering gastroesophageal reflux disease (GERD) its most probable diagnosis, there's a diagnostic approach that must be performed in order to exclude other causes, especially in high risk patients, according the the American Journal of Gastroenterology guidelines.[3] :
| Classic symptoms of GERD (heartburn and regurgitation) | If there are warning signs*: upper endoscopy during the initial evaluation | ||||||||||||||||||
| PPI 8-week trial | |||||||||||||||||||
| If better: GERD probable | If refractory, proceed to refractory GERD algorithm | ||||||||||||||||||
* Dysphagia, bleeding, anemia, weight loss and recurrent vomiting are considered warning signs and should be investigated with upper endoscopy.
| Treat GERD: Start a 8-week course of PPI | If there are warning signs*: upper endoscopy during the initial evaluation | ||||||||||||||||||||||||||||||||||||
| Refractory GERD | |||||||||||||||||||||||||||||||||||||
| Optimize PPI therapy | |||||||||||||||||||||||||||||||||||||
| No response: Exclude other etiologies | |||||||||||||||||||||||||||||||||||||
| Typical symptoms: Upper endoscopy | Atypical symptoms: Referral to ENT, pulmonary, allergy specialist | ||||||||||||||||||||||||||||||||||||
| Abnormal: (eosinophilic esophagitis, erosive esophagitis, other) Specific treatment | NORMAL | Abnormal: (ENT, pulmonary, or allergic disorder) Specific treatment | |||||||||||||||||||||||||||||||||||
| REFLUX MONITORING | |||||||||||||||||||||||||||||||||||||
| Low pre test probability of GERD | High pre test probability of GERD | ||||||||||||||||||||||||||||||||||||
| Test off medication with pH or impedance-pH | Test on medication with impedance-pH | ||||||||||||||||||||||||||||||||||||
- High Risk: Men >50 years with chronic gastroesophageal reflux disease symptoms (>5 years), AND:
- Nocturnal reflux symptoms
- Hiatal hernia
- Elevated body mass index
- Tobacco use
- Intra-abdominal distribution of fat
Other causes of heartburn or similar symptoms / associated causes:
Other causes of heartburn include muscular diseases, esophageal diseases, use of medication which may
- Barrett's esophagus
- Cardiotomy
- Caustic agent ingestion with resultant mucosal injury
- Chagas disease
- Cholelithiasis
- Coronary artery disease
- Coughing
- CREST syndrome (Calcinosis Raynaud's phenomenon Esophagus Sclerodactyly Telangiectasias)
- Direct irritation of esophagus:
- Aspirin
- Cigarette smoke
- Citrus fruits, juice
- Ibuprofen
- Spicy foods
- Tomatoes
- Tomato sauces
- Drugs:
- Esophageal fistula
- Esophageal carcinoma
- Esophageal diverticulum
- Foods:
- Alcohol
- Chocolate
- Coffee
- Fatty foods
- Peppermint
- Soft drinks with caffeine
- Tea
- Fundectomy (postoperative)
- Gastrectomy (postoperative)
- Gastritis
- Gastroesophageal reflux disease (GERD)
- Hiatal hernia
- Infectious esophagitis
- Mallory-Weiss tear
- Motility disorders
- Myasthenia gravis
- Peptic ulcer disease
- Pericardial disease
- Pregnancy
- Pulmonary embolism
- Scleroderma
- Strictures, webs or rings
- Vagotomy (postoperative)
References
- ↑ "Heartburn vs. heart attack - Harvard Health".
- ↑ Bösner S, Haasenritter J, Becker A, Hani MA, Keller H, Sönnichsen AC; et al. (2009). "Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study". Int Arch Med. 2: 40. doi:10.1186/1755-7682-2-40. PMC 2799444. PMID 20003376.
- ↑ Katz PO, Gerson LB, Vela MF (2013). "Guidelines for the diagnosis and management of gastroesophageal reflux disease". Am J Gastroenterol. 108 (3): 308–28, quiz 329. doi:10.1038/ajg.2012.444. PMID 23419381.