GERD Chest Pain: Diagnosis, Symptoms And Medical Treatment 

GERD Chest Pain

GERD chest pain is most commonly misinterpreted as a person is having a heart attack. However, chest pain can also be caused by less serious medical conditions or could either be Gastroesophageal reflux disease (GERD) chest pain or acid reflux chest pain. When acid from the stomach regurgitates into the esophagus it is known as acid reflux. Acid reflux experienced more than twice a week is likely to be GERD. 

GERD and acid reflux can cause heartburn, which is a common type of noncardiac chest pain. It is a painful burning sensation in the center of the chest, behind the breastbone or sternum. Heartburn is not the same as a heart attack. A heart attack is a life-threatening medical emergency, whereas heartburn is not. 

In order to confirm that the chest pain is a non-cardiac pain such as GERD chest pain or acid reflux chest pain and not a cardiac pain, it is important to diagnose other symptoms.

Symptoms that indicate GERD and Acid Reflux chest pain

• Bad breath
• Pain or difficulty swallowing
• Nausea and vomiting
• A hoarse voice
• Belching or hiccups
• Bloating
• A sore or irritated throat
• An unpleasant or sour taste in the mouth

Diagnosis

It is easy to determine if heartburn (chest pain) is a result of GERD. Doctors and physicians may recommend:

• X-ray (to view the shape and condition of the esophagus and stomach).
• Endoscopy (to check for abnormalities in the esophagus. A tissue sample (biopsy) may be taken for analysis).
• Ambulatory acid probe tests (to identify when, and for how long, stomach acid backs up into the esophagus). An acid monitor that is placed in the esophagus connects to a small computer that you wear around your waist or on a strap over your shoulder.
• Oesophageal motility testing (to measure movement and pressure in your esophagus).

Lifestyle changes and home remedies   

In order to help ease heartburn, several lifestyle changes and home remedies can be adopted:

• Maintain a healthy weight: Excess body weight tends to put pressure on the abdomen, pushing up the stomach and therefore causing the acid to back up into the esophagus.
• Avoid tight-fitting clothes: Tight-fitting clothes put pressure on the abdomen as well as the lower oesophageal sphincter, a muscle responsible for ensuring that the acid stays in the stomach and does not back up to the esophagus.
• Avoid foods that trigger heartburn: Especially fatty and spicy foods.
• Avoid lying down after your meal: It is important to wait for at least three hours. The easiest way to do this is to ensure you avoid late meals and you go for a short walk post-eating so that your food can digest.
• Elevate the head of your bed: This is important if you regularly experience heartburn at night or especially when you are trying to sleep. If it is not possible to elevate the head of the bed, insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with extra pillows is not usually effective.
• Avoid smoking and alcohol: Both, smoking cigarettes and drinking alcohol decrease the lower oesophageal sphincter’s ability to function properly.
• Avoid large meals: Eat several small meals throughout the day instead.
• Check your medication: Regular use of anti-inflammatory and pain medication (except acetaminophen) contributes to heartburn.

Medical Treatment

There are several over-the-counter (OTC) medications that can help relieve heartburn:

1. Antacids:

help neutralize stomach acid and provide quick relief. Mild heartburns can be soothed with an antacid containing calcium carbonate or magnesium. They help neutralize stomach acid and provide quick relief. Some antacids also prevent acid reflux itself. The ones containing magnesium may also help in healing stomach ulcers.

They come in the form of liquids and pills. However, antacids cannot heal the damage caused to the esophagus by stomach acid. Antacids can also cause diarrhea and constipation. Antacids that contain calcium carbonate, magnesium hydroxide, and aluminum hydroxide help reduce these side effects. In case you suffer from chronic kidney disease, avoid antacids with magnesium. Some antacids contain salt and must be taken only for occasional chest pain. 

2. H-2-receptor antagonists (H2RAs):

can reduce the amount of acid the stomach makes. The body does not respond to H2RAs as quickly as it does to antacids, but the former may provide relief for a longer period of time. It is possible that physicians sometimes recommend taking an antacid and H2RAs together.

H2 blockers are for short term use, usually less than 2 weeks. H2 blockers are consumed before meals or at bedtime in order to avoid chest pain.  They come in the form of liquids and pills.

All H2 blockers work the same, therefore, if one is not helping with your heartburn, it is likely that another will not help either. However, it is possible that switching to a higher dose prescription will help. Some H2RAs can interfere with other drugs such as antiseizure medicines, blood thinners, and medicines for heart rhythm problems.

It is therefore advised to speak to a doctor before taking an H2 blocker if you are consuming any of the above-mentioned medication. Side effects of H2 blockers are mild and can include constipation, diarrhea, headache, nausea, and vomiting.

3. Proton pump inhibitors:

such as lansoprazole (Prevacid 24HR) and omeprazole (Nexium 24HR, Prilosec OTC) are used to prevent frequently occurring heartburns (more than twice a week). They lower the amount of acid made by the stomach. Proton pump inhibitors often work better than H2RAs and can be taken for longer periods of time as well. They are available over-the-counter and by prescription. Proton pump inhibitors are to be taken once a day on an empty stomach, usually 30 to 60 minutes before breakfast for them to work best.

The most common side effects of proton pump inhibitors are mild and include diarrhea, headache, nausea, vomiting, and stomach pain. By using proton pump inhibitors, the chances of getting an infection of the intestines or lungs are high. These medicines are also linked to hip and spine fractures. The risk is highest for people who have been taking the medicines for a year or more.

If your heartburn is not getting better or your medicines are causing side effects that you cannot tolerate, it is possible that you may need surgery. However, surgery is a rare case when it comes to heartburn.