How Different Heartburn Positions Reflect Various Health Conditions

Reviewed by Dr. Winnie Chui

Heartburn, a common and often uncomfortable condition, affects many individuals worldwide. Characterised by a burning sensation in the chest, heartburn occurs when stomach acid flows back into the esophagus, irritating the lining. This reflux can be triggered by various factors, such as certain foods, alcohol consumption, obesity, and even stress. While occasional heartburn is normal, frequent episodes may indicate an underlying health condition requiring medical attention.

In this blog, we will discuss the possible causes of heartburn when presented in certain locations of the chest area and explore the health conditions that may be associated with them. By understanding the link between the location of your heartburn and the diseases that may be related to it can help you recognise when it is time to seek medical intervention.

Cause of Heartburn

Heartburn may be more noticeable in the following situations:

• After a rich, acidic or spicy meal
• Having a late dinner
• Bending over 
• Lying down 

Symptoms of Heartburn

Distinguishing between heartburn and other types of chest pain can sometimes be challenging. If you are unsure about the type of pain you are experiencing, it is advisable to consult a doctor. Additionally, paying attention to accompanying symptoms can help differentiate heartburn from a heart attack or other esophageal disorders. Common symptoms associated with acid reflux-induced heartburn include:

• Burping
• Sour taste in the mouth
• Nausea
• Regurgitation of food
  

• Stomach bloating and overfullness
• Hiccups
• Chronic cough
• Worsening asthma
• Sore throat
• Laryngitis
  
• Difficulty swallowing or the sensation of a lump in the throat
  
• Chest pain resembling angina (noncardiac chest pain)

Heartburn in the Upper Chest

• Gastroesophageal reflux disease (GERD): GERD is a chronic form of acid reflux that affects approximately 20% of the adult population1. This condition is caused by a weak or damaged lower esophageal sphincter (LES), which is responsible for preventing stomach acid from flowing back into the esophagus. When heartburn is experienced primarily in the upper chest, it may be indicative of GERD. Other symptoms of GERD can include regurgitation, difficulty swallowing, chronic cough, and hoarseness.
• Hiatal hernia: A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity. This abnormality can lead to increased pressure on the LES, causing it to weaken and allow stomach acid to reflux into the esophagus. Heartburn in the upper chest, along with other symptoms such as belching, difficulty swallowing, and chest pain, may suggest the presence of a hiatal hernia.

Heartburn in the Middle Chest

• Peptic ulcer: Peptic ulcers are open sores that develop on the stomach lining or the upper part of the small intestine (duodenum). They are often caused by Helicobacter pylori (H. pylori) or long-term use of certain medications (e.g., nonsteroidal anti-inflammatory drugs and oral corticosteroids). A peptic ulcer can cause heartburn-like pain in the middle chest area, along with other symptoms such as bloating, nausea, and fullness after eating. The pain may worsen during the night or on an empty stomach. It is vital to consult a healthcare professional immediately if you suspect a peptic ulcer, as untreated ulcers can lead to serious complications, including internal bleeding or stomach perforation.
• Gastritis: Gastritis is an inflammation of the stomach lining.  Various factors, including bacterial infections, excessive alcohol consumption, and certain medications can trigger it. Gastritis can cause heartburn-like pain in the middle chest area and other symptoms like indigestion, loss of appetite, and nausea. In some cases, gastritis may lead to stomach ulcers or an increased risk of stomach cancer. Tests such as endoscopy or breath tests may be ordered by your doctor and treatment options may include medications to reduce stomach acid and antibiotics to treat H. pylori infection.

Heartburn in the Lower Chest 

When heartburn is felt in the lower chest area, it could be related to conditions like functional dyspepsia or gastroparesis.

Functional dyspepsia: Also known as non-ulcer dyspepsia or indigestion, functional dyspepsia is a chronic disorder characterised by discomfort or pain in the upper abdomen without an identifiable cause. This condition can cause heartburn-like pain in the lower chest area, along with other symptoms such as bloating, early satiety (feeling full after eating a small amount), and nausea. Although the exact cause of functional dyspepsia is unknown, factors such as stress, irregular eating habits, certain medications, and irritable bowel syndrome may contribute to its development. If there is no evidence of a structural or biochemical disease after investigations and symptoms have persisted for more than 3 months, then you may be diagnosed with this. Treatment for functional dyspepsia often includes lifestyle modifications, such as eating smaller meals, avoiding trigger foods, managing stress, and taking medications to reduce stomach acid or promote gastric emptying.

Gastroparesis: Gastroparesis is a condition in which the stomach muscles do not function properly, leading to delayed gastric emptying and poor digestion of food. This disorder can cause heartburn-like pain in the lower chest area, as well as other symptoms like nausea, vomiting, abdominal pain, and weight loss. Gastroparesis can be caused by various factors, including diabetes, nerve damage, and certain medications. Treatment for gastroparesis may involve dietary changes (e.g., consuming smaller and more frequent meals), medications to stimulate stomach contractions, or, in severe cases, surgical interventions may be needed.

When to Seek Medical Help

While occasional heartburn is common and generally not a cause for concern, it's essential to recognize when your symptoms might be indicative of a more serious condition. Seek medical help if you experience any of the following symptoms:

• Heartburn that persists for more than 4 weeks despite over-the-counter treatments or lifestyle modifications
• Severe, frequent, or worsening heartburn
• Difficulty swallowing or persistent choking sensation
• Unexplained weight loss or loss of appetite
• Vomiting blood or passing black, tarry stools (signs of gastrointestinal bleeding)
• Chest pain accompanied by shortness of breath, cold sweats, or pain radiating to the jaw, neck, or arm (potential signs of a heart attack)

It is crucial to consult a healthcare professional if you have concerns about your heartburn symptoms. Early intervention can help prevent complications and ensure proper management of any underlying conditions.

Prevention and Management

• Maintain a healthy weight: Excess weight, especially around the abdomen, can pressure the stomach and increase the risk of acid reflux.
• Adjust your diet: Avoid common trigger foods, such as spicy or fatty meals, chocolate, caffeine, and alcohol. Opt for smaller, more frequent meals instead of large, heavy ones.
• Don't lie down immediately after eating: Wait at least two to three hours before lying down or going to bed, as this can help prevent stomach acid from flowing back into the esophagus.
• Elevate the head of your bed: Raising the head of your bed by 6 to 8 inches can help prevent acid reflux during sleep.
• Quit smoking: Smoking can weaken the LES and contribute to acid reflux.
• Manage stress: Stress can exacerbate heartburn symptoms, so practicing stress management techniques like deep breathing, meditation, or yoga may be beneficial.

Understanding the location in the chest area of your heartburn and their potential links to various health conditions is crucial for recognising when medical intervention may be necessary. By being proactive about your digestive health and seeking medical help for persistent or severe heartburn, you can ensure timely diagnosis and appropriate treatment. Remember that lifestyle changes, such as maintaining a healthy weight, adjusting your diet, and managing stress, can significantly prevent and manage heartburn symptoms. Always consult your doctor for personalised advice and care.

References

1. Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology, 108(3), 308-328. https://doi.org/10.1038/ajg.2012.44

2. Malfertheiner, P., Megraud, F., O'Morain, C. A., Gisbert, J. P., Kuipers, E. J., Axon, A. T., ... & Gasbarrini, A. (2017). Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report. Gut, 66(1), 6-30. https://doi.org/10.1136/gutjnl-2016-31228

3. Tack, J., & Talley, N. J. (2013). Functional dyspepsia—symptoms, definitions and validity of the Rome III criteria. Nature Reviews Gastroenterology & Hepatology, 10(3), 134-141. https://doi.org/10.1038/nrgastro.2013.1

4. Camilleri, M., & Chedid, V. (2014). Gastroparesis. In Gastroenterology Clinics of North America (Vol. 43, No. 3, pp. 417-433). W.B. Saunders. https://doi.org/10.1016/j.gtc.2014.05.01

5. Ness-Jensen, E., Hveem, K., El-Serag, H., & Lagergren, J. (2016). Lifestyle intervention in gastroesophageal reflux disease. Clinical Gastroenterology and Hepatology, 14(2), 175-182.e1-3. https://doi.org/10.1016/j.cgh.2015.06.037