Differential Diagnosis for Heartburn

The following is a differential diagnosis for heartburn, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): This is the most common cause of heartburn. It occurs when stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of the esophagus, causing discomfort.

• Other Likely Diagnoses

  • Dyspepsia: Often referred to as indigestion or an upset stomach, dyspepsia can cause symptoms similar to heartburn. It may be related to eating too much or too quickly, eating high-fat or spicy foods, or drinking too much alcohol or caffeine.
  • Esophageal Spasm: This condition involves abnormal muscle contractions of the esophagus, which can cause chest pain and difficulty swallowing, mimicking heartburn.
  • Functional Dysphagia: This condition involves difficulty swallowing with no apparent physical cause, which can sometimes be mistaken for heartburn due to the sensation of food getting stuck.

• Do Not Miss Diagnoses

  • Myocardial Infarction (Heart Attack): Although less common, chest pain can be a symptom of a heart attack, especially if it radiates to the arm, neck, or jaw, and is accompanied by shortness of breath, sweating, or nausea. It's critical to differentiate this from heartburn due to its life-threatening nature.
  • Esophageal Perforation: A hole in the esophagus can cause severe chest pain and is a medical emergency. It might be mistaken for severe heartburn but requires immediate attention.
  • Peptic Ulcer Disease: Stomach ulcers or duodenal ulcers can cause burning pain in the upper abdomen, which might be confused with heartburn. If left untreated, these ulcers can lead to serious complications.

• Rare Diagnoses

  • Eosinophilic Esophagitis: A chronic immune system disease in which a type of white blood cell, the eosinophil, builds up in the esophagus in response to an allergen or irritant. This condition can cause difficulty swallowing, food impaction, and heartburn-like symptoms.
  • Zollinger-Ellison Syndrome: A rare disorder characterized by excessive gastric acid secretion due to high levels of gastrin (a hormone that stimulates stomach acid production), leading to severe peptic ulcers and heartburn.
  • Esophageal Cancer: Although very rare, esophageal cancer can cause symptoms that might initially be mistaken for heartburn, such as difficulty swallowing and chest pain. Early diagnosis is crucial for effective treatment.