Heartburn history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2] Ahmed Elsaiey, MBBCH [3]

Heartburn per se is a symptom. It may be accompanied by other symptoms such as: regurgitation, and dysphagia. A positive history of nausea, vomiting, and regurgitation is suggestive of gastroesophageal reflux disease (GERD). Other symptoms of GERD include chest pain, cough, and odynophagia.

• Heartburn is a burning pain in the chest which may radiate toward the mouth. It usually occurs behind the breastbone and it is often associated with a sour taste in the back of the mouth with or without regurgitation.^[1]
• History taking in patients with suspected GERD is important in diagnostic approach.^[1]
• Important history points that increase suspicion towards delayed gastric emptying and GERD include the following:
  • Nausea
  • Vomiting
  • Regurgitation

Common symptoms that may happen along heartburn in patients with typical GERD include the following:^[2]

• Regurgitation
• Dysphagia

Less common symptoms of GERD (atypical GERD) include the following:^[3]

• Chest pain that may look like the angina pectoris pain
• Cough
• Nausea
• Odynophagia
• Hypersalivation 

• When not due to GERD, heartburn that presents with paleness, sudoresis, chest pain that radiates to the left shoulder raises suspicion for acute coronary syndrome, especially in high risk patients (those with hypertension, diabetes, smokers, dyslipidemia).
• CREST syndrome presents with calcinosis, dysphagia, exhaustion, weakness, dyspnea and dizziness.^[4]
• Esophageal cancer patients may also lose weight dramatically and present with progressive dysphagia, first to solid food, and then liquids.