Acid Reflux, GERD or Angina?

4/14/2022

How can I tell, and should I be concerned?
By: M. Scott Brashier, D.O.

It’s your birthday, and you just finished celebrating with a big meal and cup of coffee. What comes next is something that was definitely not on the menu – the worst case of heartburn you’ve ever experienced. But wait…could that pain be something more serious?

One of the more difficult tasks confronting physicians is distinguishing among the various possible causes of chest pain. Nearly 20 percent of patients who see their primary care physicians for chest pain have gastrointestinal problems. But, there are even distinctions between the possible GI-related causes. Heartburn, GERD and acid reflux are similar, but not necessarily the same conditions.

Acid reflux refers to the backward flow of stomach acid into the esophagus – the tube that connects the throat and stomach. During an episode of acid reflux, you may taste regurgitated food or sour liquid at the back of your mouth, or feel a burning sensation in your chest.

GERD, or gastro-esophageal reflux disease, is a more severe and chronic form of acid reflux. The most common symptom of GERD is frequent heartburn. Other signs and symptoms may include regurgitation of sour food or liquid, difficulty swallowing, coughing, wheezing and chest pain, especially when lying down at night.

Occasional heartburn or reflux can be treated with over-the-counter antacids, or medications such as H2-receptor blockers (like Pepcid AC) or proton pump inhibitors (like Prilosec). But, if the condition becomes chronic, or you suspect you may have GERD, talk to your doctor about some of the new, minimally invasive procedures that can provide relief, such as the TIF procedure.

Angina, on the other hand, can be a signal of a more dangerous heart condition.

While there is overlap in the various symptoms, there are some indicators both common and unique to GERD and angina. If your chest pain is centered beneath your breastbone, gets worse with exertion, improves with rest or radiates to both arms, it is more likely to be angina. Chest pain that gets worse when lying down or bending over is more likely to be caused by GERD. There are also certain diagnostics and physical findings that may point to one condition or the other.

If you find yourself suffering from GERD, or just occasional heartburn, here are some simple diet and lifestyle changes you can make, that will often address the problem without medication or treatment:

• Defy gravity. Don’t lie down within three hours of eating – that’s when acid production is at its peak. Plan early suppers, and avoid bedtime snacking.
• Eat small meals - especially late in the day. Make your main meal of the day the midday meal.
• Experiment with trigger foods. Foods that trigger reflux differ from person to person. Start by removing fatty foods, onions and chocolate. Coffee, colas, tomatoes and citrus juices may also irritate the esophagus or stimulate excess stomach acid production. Try removing one or two foods at a time until you find what works best for you. Peppermint may relax the circular muscle between the esophagus and the stomach (the lower esophageal sphincter), and allow stomach acid to migrate into the esophagus.
• Watch your weight. Losing even a modest amount of weight can reduce the intensity or frequency of symptoms. Excess weight gain and abdominal pressure during pregnancy are a common cause of reflux – once the weight is lost after birth, the condition typically goes away.
• Reduce your stress levels. Stress makes reflux, and just about every other medical condition, worse. Practicing yoga or meditation is an excellent non-medical treatment for occasional or modest reflux.

You don’t have to live with heartburn or gastric discomfort. These conditions are more common than you probably think, and your physician can help you discover both the cause and the solution. For more information on heartburn care and heartburn surgery, visit our website.

The bottom line is, unless you have significant risk factors for - or an existing diagnosis of - heart disease, the most likely culprit for your pain after that big celebration meal is heartburn. But if the pain is unfamiliar, and the cause is uncertain, call 9-1-1. Better safe than sorry.

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