Noncardiac Chest Pain From GERD: Causes and Treatment

What Is Noncardiac Chest Pain Caused by GERD?

Chest pain can be frightening. For many people, the first thought is, "Is it a heart attack?" While chest pain can signal a serious heart problem, it is not always related to the heart.

One of the most common symptoms of gastroesophageal reflux disease (GERD) is chest discomfort. This type of pain is called noncardiac chest pain (NCCP). It originates from the esophagus rather than the heart.

What Is GERD and How Does It Lead to Chest Pain?

GERD is a condition in which stomach acid frequently flows back into the esophagus (food pipe), irritating its lining. This acid irritation can cause chest pain. In some cases, GERD can cause chest pain. This happens when stomach acid irritates the esophagus, leading to a burning, tight, or pressure-like sensation in the chest that can sometimes resemble heart-related pain.

Because the esophagus and heart share similar nerve pathways, GERD-related chest pain can sometimes feel like heart-related chest pain, making it difficult to tell the difference.

GERD-related chest pain does not always occur with heartburn and may appear hours after eating or without any obvious trigger.

What Are the Symptoms of GERD-Related Noncardiac Chest Pain?

Chest pain caused by gastroesophageal reflux disease (GERD) or acid reflux is often described as a burning, tight, or pressure-like feeling behind the breastbone. It may spread upward toward the throat or remain in the center of the chest.

Symptoms of GERD-Related Noncardiac Chest Pain

• A feeling of pressure or heaviness in the chest.

• Tightness, squeezing, or discomfort in the chest.

• Heartburn or indigestion.

• Pain behind the breastbone.

• Pain that spreads to the neck, back, shoulders, or arms.

The pain may occur after a large meal or during periods of stress. It can last for a few seconds, several minutes, or even a few hours.

How to Tell GERD Chest Pain Apart From a Heart Attack?

It can be difficult to tell the difference because GERD-related chest pain and heart-related chest pain can feel very similar. However, certain clues may suggest that acid reflux is the cause.

GERD-related chest pain often:

• Occurs after eating a large meal.

• Gets worse when lying down.

• It is accompanied by heartburn, acid regurgitation (backflow of stomach acid), or a sour taste in the mouth.

• Improves after taking antacids or acid-reducing medications.

What Are the Risk Factors That Increase GERD-Related Chest Pain?

You may be at a higher risk of experiencing GERD-related chest pain if you:

• Have frequent acid reflux or chronic GERD.

• Have high levels of anxiety, stress, or depression.

• Have digestive disorders (irritable bowel syndrome, a chronic GI disorder with abdominal pain and gastric issues).

• Have a sensitive esophagus that reacts strongly to small amounts of acid.

• Suffer from sleep problems or poor-quality sleep.

• Regularly smoke or use tobacco.

• Drink alcohol.

• Eat large meals, especially close to bedtime.

• Being overweight or obese can increase pressure on the stomach and promote acid reflux.

Other Conditions That Can Cause Noncardiac Chest Pain

Although GERD is the most common cause, noncardiac chest pain can also result from:

• Inflammation of the esophagus (esophagitis) caused by infections, medications, or allergies.

• Esophageal muscle spasms can cause chest pain and difficulty swallowing.

• Gas and bloating may create pressure and discomfort in the chest.

• Chest wall or rib inflammation, such as costochondritis.

• Psychological conditions, including anxiety and panic attacks, can trigger or worsen chest pain.

• Certain lung conditions may also cause chest discomfort.

How Is Gerd-Related Noncardiac Chest Pain Diagnosed?

As GERD-related chest pain can feel similar to a heart attack, doctors first make sure that the pain is not coming from the heart.

To rule out heart-related causes, your doctor may perform the following:

• Blood tests.

• An electrocardiogram.

• An exercise stress test.

• A heart CT (computed tomography) scan or other heart imaging tests.

To check for GERD or other esophageal conditions, the doctor may recommend:

• Upper endoscopy. It is done to examine the esophagus and stomach.

• Esophageal pH monitoring. It is done to measure acid levels in the esophagus.

• Esophageal manometry is used to evaluate how well the esophageal muscles work.

• Ultrasound or other imaging tests, if needed.

What Are the Treatment Options for GERD-Related Noncardiac Chest Pain?

Treatment for GERD-related chest pain depends on the underlying cause of the chest pain. The best treatment depends on the cause of the chest pain, so a proper medical evaluation is important before starting treatment.

Common treatment options include:

• Use of proton pump inhibitors (PPIs). They are commonly used to decrease stomach acid and help heal irritation in the esophagus. Other medications, such as H2 blockers and antacids, may also provide relief.

• If chest pain is caused by esophageal spasms or abnormal muscle movement, medications or specialized procedures may be used to relax or widen the esophagus.

• In some cases, low doses of certain antidepressants may be prescribed to reduce pain sensitivity in the esophagus and help manage chronic chest pain.

• Stress, anxiety, and depression can worsen chest pain. Counseling, relaxation techniques, cognitive behavioral therapy (CBT), and other mind-body therapies may help improve symptoms.

What Are the Dietary and Lifestyle Changes That Relieve GERD Chest Pain?

Lifestyle changes can reduce acid reflux and related chest pain. They are:

• Avoid trigger foods. Reduce spicy foods, fatty foods, chocolate, caffeine, citrus fruits, and carbonated drinks.

• Eat smaller meals instead of large meals.

• Avoid lying down for at least two to three hours after eating.

• Elevate the head of your bed if symptoms occur at night.

• Maintain a healthy weight.

• Quit smoking and limit alcohol consumption.

• Wear loose-fitting clothing around the waist and abdomen.

• Manage stress through exercise, meditation, or relaxation techniques.

What Are the Complications of Untreated GERD-Related Chest Pain?

If GERD is not treated, it can damage the esophagus and lead to several complications, including:

• Esophagitis: Inflammation and irritation of the esophageal lining, which can cause pain and difficulty swallowing.

• Esophageal Ulcers: Open sores in the esophagus that may cause painful swallowing, chest discomfort, and bleeding.

• Barrett's Esophagus: Long-term acid reflux can change the cells lining the esophagus, increasing the risk of esophageal cancer.

• Dental Erosion: Stomach acid can gradually wear away tooth enamel.

• Chronic Cough and Throat Problems: Ongoing reflux may lead to a persistent cough, hoarseness, sore throat, or laryngitis.

When to Go to the Emergency Room for Chest Pain?

If you experience persistent chest pain, it could be a sign of a heart attack or another serious condition. Seek emergency medical care if you have:

• Sudden severe chest pain.

• Shortness of breath.

• Chest pain that gradually spreads to the back, arms, or shoulders.

• Sweating, dizziness, or fainting.

• Nausea or vomiting along with chest pain.

• Chest pain that does not improve or keeps getting worse.

• Even if you suspect GERD, it is important to rule out heart-related causes first.

Conclusion

GERD is one of the most common causes of noncardiac chest pain and can cause burning, pressure, or discomfort in the chest when stomach acid irritates the esophagus. As GERD-related chest pain can closely mimic heart-related chest pain, it is important not to self-diagnose. If you frequently experience chest pain, heartburn, or acid reflux symptoms, do not ignore them. Consult a specialist doctor for an accurate diagnosis and a proper treatment plan.

Key Takeaways

• Gastroesophageal reflux disease (GERD) is a common cause of noncardiac chest pain.

• GERD chest pain occurs when the stomach acid flows back into the esophagus, causing irritation and discomfort.

• The chest pain linked to GERD is often described as a burning, tight, or pressure-like feeling in the middle of the chest, and it can sometimes mimic heart-related chest pain.

• The pain may become worse after eating a large meal, lying down, bending over, or consuming foods and drinks that trigger acid reflux.

• Seek emergency treatment if pain is sudden, persistent, or spreads to the arm, neck, or back.