Heartburn differential diagnosis: Difference between revisions
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**Intra-abdominal distribution of fat | **Intra-abdominal distribution of fat | ||
</br> | </br> | ||
Other causes of heartburn or similar symptoms / associated causes: | |||
* [[Asthma]] | * [[Asthma]] | ||
* [[Barrett's esophagus]] | * [[Barrett's esophagus]] | ||
* Cardiotomy | * [[Cardiotomy]] | ||
* Caustic agent ingestion with resultant mucosal injury | * Caustic agent ingestion with resultant mucosal injury | ||
* [[Chagas disease]] | * [[Chagas disease]] | ||
* [[Cholelithiasis]] | * [[Cholelithiasis]] | ||
* [[Coronary artery disease]] | * [[Coronary artery disease]] | ||
* [[Coughing]] | * [[Coughing]] | ||
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**Spicy foods | **Spicy foods | ||
**Tomatoes | **Tomatoes | ||
**Tomato | **Tomato sauces | ||
* [[Drugs]]: | * [[Drugs]]: | ||
**[[Albuterol]] | **[[Albuterol]] | ||
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**[[Theophylline]] | **[[Theophylline]] | ||
* Esophageal | * Esophageal fistula | ||
* [[Esophageal carcinoma]] | * [[Esophageal carcinoma]] | ||
* [[Esophageal diverticulum]] | * [[Esophageal diverticulum]] | ||
* Foods: | * Foods: | ||
**[[Alcohol]] | **[[Alcohol]] | ||
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* [[Hiatal hernia]] | * [[Hiatal hernia]] | ||
* Infectious [[esophagitis]] | * Infectious [[esophagitis]] | ||
* [[Mallory-Weiss tear]] | * [[Mallory-Weiss tear]] | ||
* Motility disorders | * Motility disorders | ||
* [[Myasthenia gravis]] | * [[Myasthenia gravis]] | ||
* [[Peptic ulcer disease]] | * [[Peptic ulcer disease]] | ||
* [[Pericardial disease]] | * [[Pericardial disease]] | ||
* [[Pregnancy]] | * [[Pregnancy]] | ||
* [[Pulmonary embolism]] | * [[Pulmonary embolism]] | ||
* [[Scleroderma]] | * [[Scleroderma]] | ||
* Strictures, webs or rings | * Strictures, webs or rings | ||
Revision as of 17:29, 1 September 2020
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Heartburn Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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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 causes of chest pain. 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:
| 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:
- Asthma
- 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.