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Chest pain is a symptom, not a diagnosis, and heart disease always needs to be ruled out. You need an accurate diagnosis to determine what is causing your symptoms.
It's important to know about GERD not only because the disease itself can and should be treated, but also because other conditions and diseases can cause its major symptom, chest pain. The most serious, of course, are heart (cardiac) problems. That's why, if you have frequent or persistent chest pain, it's absolutely essential to have a through medical examination.
Given the seriousness of heart problems, it makes sense for your doctor to run some routine cardiac diagnostic tests. These might include:
- Blood tests
- Electrocardiogram (EKG, ECG, or cardiogram) to measure the heart's electrical activity
- Stress EKG (stress test) - an electrocardiogram made while the person is exercising
- Echocardiogram - sound waves are bounced off the heart to produce still and moving images of it (similar to ultrasound imaging).
Cardiac catheterization is a less routine, more invasive test in which a small tube (catheter) is inserted through a blood vessel and threaded up into the heart, to measure blood flow and pressure.
Several earlier episodes of Second Opinion explored various aspects of heart disease, including the diagnostic tests and preventative medications mentioned in this episode. You'll find lots of valuable information about these topics at:
It makes sense for you to give your doctor as open, honest, accurate, and complete a report of your symptoms and your lifestyle as possible. Make sure you tell your doctor about your eating habits, sleeping habits, lifestyle choices (such as whether and how much you smoke). Never be afraid to discuss the "little details." They may be very important to helping your doctor arrive at an accurate diagnosis.
The main symptom of GERD in adults is frequent heartburn (two or more times per week), especially:
- Heartburn that doesn't respond to the standard over-the-counter (OTC) anti-heartburn medications (often called antacids because they fight the effects of stomach acids)
- Heartburn that returns soon after the OTC medications wear off
- Heartburn that causes you to awaken during the night.
But there are other symptoms that could point to the condition, including:
- Heartburn that doesn't respond to prescription medications
- Difficulty swallowing
- Spitting up or throwing up blood or black material
- Black stools
- Weight loss
- Belching
- Waterbrash (sudden excess of saliva)
- Chronic sore throat
- Laryngitis
- Inflammation of the gums
- Erosion of tooth enamel
- Chronic throat irritation
- Morning hoarseness
- Sour, bitter, or bad taste in the mouth
- Bad breath
Some adults and most children under 12 who have GERD do not have heartburn. Their symptoms may be:
If you have these symptoms, your doctor can do a number of diagnostic tests that can discover the presence of GERD. For more information about diagnosing GERD, go to Key Point 2.)
Although the causes of GERD remain uncertain, we do know what some of the major risk factors for heartburn are. In general, they include:
- Lying down too soon after eating (especially a large meal)
- Conditions that relax or weaken the LES and the diaphragm (the wall of muscle that separates the stomach from the chest and helps the LES keep acid from backing up into the esophagus), such as:
- Hiatal hernia, a condition in which the upper part of the stomach and the LES protrude into the chest by pressing against the diaphragm. This can weaken those muscles, increasing the chance of acid reflux.
- Pregnancy, which puts pressure on the affected muscles and also produces a muscle relaxing hormone
- Excess weight
- Very large meals or high fat meals
- Conditions that cause the stomach to take an abnormally long time to empty, so that its contents have the chance to flow back into the esophagus, such as:
- Diabetes
- Obstruction of the pylorus valve (which controls the flow of stomach contents into the small intestine)
- Nerve, muscle, or connective tissue disorders
- Certain drugs including narcotics, some antidepressants and antihistamines
- Asthma
- The exact connection between asthma and heartburn is not yet understood.
- It may be that labored breathing and coughing in some way cause acid reflux
- Asthma medications may relax the LES, causing acid reflux
- The reverse may be true: acid reflux may increase asthma symptoms
- Zollinger-Ellison syndrome (ZES)
- This rare disorder causes tumors in the pancreas and duodenum (the first part of the small intestine) and ulcers in the stomach and duodenum that produce a hormone (gastrin) that causes the stomach to produce excess acid.
- Some sedatives, antidepressants, and calcium channel blockers for high blood pressure
- Smoking
In addition, certain foods and beverages are known to cause heartburn in some people, including:
- Alcohol
- Caffeinated drinks, including coffee, tea, and soft drinks
- Non-caffeinated coffee
- Carbonated soft drinks
- Chocolate
- Citrus fruits
- Fatty and fried foods
- Garlic and onions
- Mint flavorings
- Spicy foods
- Tomato sauce and tomato-based spaghetti sauce, salsa, chili, pizza, etc.
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