Severe retro sternal burning sensation, so called heartburn, is a common presentation in current clinical practice. It can be resulted from various causes and sometimes it can mimic angina. However, the commonest cause of heartburn is found to be gastro-esophageal reflux disease. Therefore, it is clear that the heartburn and acid reflux are two different terms even though some people mistakenly considering them as having the same meaning. Heartburn is just a symptom while acid reflux is a disease. This article would be a guide to understand the differences between these two terms.
As mentioned above, heartburn is a symptom. It is a severe burning discomfort felt in retro sternal area often at night. It is often initiated by bending forward, heavy lifting and stooping. Frequency and severity of the heart burn is made worse by lying flat so that the patient tends to sleep with several pillows up to avoid symptoms. A patient with the heartburn may experience a bitter taste in the mouth due to refluxing acid, and may develop cough or choking attacks at night due to aspiration of acid.
It is the most common cause of heartburn, and it is not a symptom. It is a disease. Reflux of acid occurs due to several reasons. One thing is reduced lower esophageal sphincter tone, which permits reflux of acid in instances where the intra abdominal pressure is increased. Other causes responsible are hiatus hernia, delayed esophageal clearance, the composition of the gastric contents, defective gastric emptying, increased intra abdominal pressure such as in obesity and pregnancy, and dietary and environmental factors such as alcohol, fat, chocolate, coffee, smoking and non steroidal anti inflammatory drugs.
Clinically patient with acid reflux can present mainly with heartburn and regurgitation. They may have increased salivation due to reflex salivary gland stimulation. Weight gain is a feature.
In long-standing cases, patient might develop odynophagia and dysphagia probably due to benign acid stricture formation in the esophagus. The other complications include esophagitis, barrett’s esophagus, anemia due to chronic insidious blood loss, gastric volvulus, and adenocarcinoma of the gastro esophageal junction in more complicated cases. Any patient with long standing acid reflux, if developed dysphagia sometime in their life time, should be investigated for adenocarcinoma before the diagnosis of acid stricture is made.
Endoscopy grades gastro-esophageal reflux disease into five grades. Grade 0 is considered normal. Grade 1-4 includes erythematous epithelium, streaky lines, confluent ulcers and barrett’e esophagus respectively.
Management includes life style modifications, antacids, H2 receptor blockers, and proton pump inhibitors, the last being considered as the treatment of choice. In case the medical management fails, surgical options have to be considered such as fundoplication.
What is the difference between heartburn and acid reflux?
• Heartburn is a symptom while acid reflux is a disease.
• Acid reflux commonly presents as heartburn.
• Frequent heartburn that disrupts one’s life style suggests gastro esophageal reflux disease.