Chest pain can be a sign of a heart attack. If you have chest pain or discomfort, don’t assume it’s reflux: call 911. The CDC lists the main heart attack symptoms as chest pain or discomfort that lasts more than a few minutes or goes away and comes back; feeling weak, light-headed or faint; pain or discomfort in the jaw, neck, back, or one or both arms or shoulders; and shortness of breath. Unusual tiredness and nausea or vomiting can also occur, particularly in women.
Once a heart problem has been ruled out, acid reflux is one possible cause of chest pain. In the video above, gastroenterologist Dr. Olufemi Abiodun explains how this kind of chest pain is investigated and treated, and a patient describes going from nighttime chest pain to an active life.
Reflux can show up as chest pain
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, reflux happens when stomach contents come back up into the esophagus. Gastroesophageal reflux disease (GERD) is the more severe, long-lasting form, in which reflux causes repeated bothersome symptoms or leads to complications. A common symptom is heartburn, but NIDDK notes that other symptoms may include chest pain.
In the video, Dr. Abiodun says it is well documented that chest pain may be the only sign of acid reflux in some patients.
The patient in the video describes chest pain that woke her at night. Sitting up didn’t help, and the pain was severe enough that she went to the emergency room, thinking she was having a heart attack. Going to the emergency room was the right call: chest pain needs to be checked right away.
How the cause is found
Dr. Abiodun explains that after an office consultation, other causes of chest pain had to be ruled out first. The next step for this patient was an upper endoscopy. It showed a fairly normal esophagus, with some nonspecific irritation of the stomach lining.
NIDDK describes an upper GI endoscopy as a procedure in which a doctor uses a flexible tube with a camera to see the lining of the esophagus, stomach and first part of the small intestine. What to expect, according to NIDDK:
- You’ll likely be given a sedative to help you stay relaxed and comfortable.
- The procedure typically takes 10 to 20 minutes.
- Afterward, you may have bloating, nausea or a sore throat for a short time.
- You’ll need someone to drive you home, because the sedative takes time to wear off.
- The risks are low. They include a reaction to the sedative, a tear (perforation) in the lining of the upper digestive tract, and bleeding.
The patient in the video says she was asleep during the endoscopy, didn’t feel anything, and woke up without throat pain.
Other tests may be used to confirm GERD. NIDDK says esophageal pH monitoring is the most accurate way to detect stomach acid in the esophagus.
Treatment
Lifestyle changes. NIDDK says lifestyle changes may reduce symptoms, such as losing weight if you’re overweight, raising the head of your bed, quitting smoking and changing your eating habits.
Medicines. According to NIDDK and Mayo Clinic, the main options are:
- Antacids, which can relieve mild symptoms. NIDDK advises not using them every day or for severe symptoms without talking with your doctor.
- H2 blockers, which lower the amount of acid the stomach makes.
- Proton pump inhibitors (PPIs), which lower stomach acid more strongly and can help heal the lining of the esophagus.
Mayo Clinic advises telling your care provider if you start taking a nonprescription medicine for GERD.
How Dr. Abiodun uses medicine. In the video, Dr. Abiodun describes treating continuously until the patient is comfortable. After that, for patients with fewer symptoms, the advice may be to take the medicine only as needed, which Dr. Abiodun calls “on-demand” therapy. The example given: if you’re planning a big dinner with a couple of glasses of wine on a Saturday night, you might take the medicine that morning. Your own doctor will tell you whether this approach is right for you.
Surgery. If symptoms don’t improve with lifestyle changes and medicines, or if you want to stop long-term medicines, NIDDK says your doctor may recommend surgery.
The patient’s outcome
After the endoscopy, the patient says she was properly diagnosed and given the right medicine. She no longer wakes up at night with chest pain, works full time, spends time with her family and teaches Zumba.
Questions to ask your doctor
- Have heart problems and other causes of my chest pain been ruled out?
- Do I need an upper endoscopy or other tests, and what will they show?
- Which medicine should I take, and for how long?
- Can I take it only when I need it once my symptoms are under control?
- Which foods, drinks or habits might be triggering my symptoms?
- Which symptoms mean I should seek urgent care?
- What are my options if medicines don’t help?
Dr. Abiodun is a gastroenterologist in the Dallas-Fort Worth area. See Dr. Abiodun’s Best Docs Network profile for more about the practice.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
