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Is it Heartburn or Something Else? How to Tell the Difference


One common symptom of gastroesophageal reflux disease (GERD) is heartburn-like pain. But a number of other conditions can cause that burning feeling in your chest.

Most often, your family doctor will be able to identify whether you have heartburn or GERD by doing simple tests.

Nine other conditions that can cause heartburn-like pain

  • Angina-- chest pain caused by lack of blood flow to the heart, can feel a lot like heartburn.

The biggest clue is if you get heartburn when you are doing strenuous or moderate activity. 

Also if you are over age 50 and get heartburn—especially if you have never had this kind of pain before—increases suspicion of angina. Suspicions are also raised for those who are younger but have heart risk factors such as hypertension, diabetes, or a family history of heart disease

  •  Gallstones-- a stone blocking your bile duct can cause pain,normally in the middle or upper-right side of the abdomen. Pain may be cramping, dull, or sharp, and often happens minutes after you eat.

If you have stomach pain after meals that doesn't get better after you take an over-the-counter acid-suppressing medication, gallstones should be suspected.

  • Ulcers-- cause a gnawing, burning sensation, usually felt in the upper abdomen. The pain can radiate up to the chest.

Acid-suppressing medications may help ulcer pain, but ulcers are most often caused by Helicobacter pylori, also known as H. Pylori, a bacteria that inflames the stomach lining, so you will need to see your family doctor and take antibiotics to clear the infection.

  • Hiatal Hernia-- happens when part of the upper stomach pushes through the diaphragm into the chest cavity, rather than staying in the abdomen where it belongs.

This condition pushes food and stomach acid up into the esophagus, causing heartburn. Other symptoms of hiatal hernia include chest pain, belching, and nausea. Your family doctor will typically prescribe acid-suppressing drugs, and recommend lifestyle changes such as eating smaller meals, avoiding alcohol, and not eating right before bed. Surgical repair may be needed in some cases.

  • Esophageal cancer-- this is a rare condition, but its presence is increasing in the United States.

Although having this condition is highly unlikely, if you have longstanding heartburn, and especially if you have risk factors for this condition such as smoking or drinking heavily, your family doctor may decide to order an upper endoscopy to examine your esophagus. 

  • Diabetes-- Poor control of diabetes can lead to nerve damage, which can affect the nerves of your digestive tract. This is called gastroparesis, and it dramatically slows the movement of food through the stomach which can cause heartburn.

For gastroparesis, treatment can include lifestyle changes like eating smaller meals, avoiding fat and fiber and taking medications. The key here is to get your blood sugar under control and your family doctor can help you with this goal.

  • Esophagitis-- Frequent acid reflux can cause inflammation of the esophagus. This condition can lead to more heartburn, as well as difficulty swallowing.

The esophagus can also become inflamed from taking certain medications, particularly if the pills are taken without water, allowing them to remain in the esophagus. Be sure to take medications with plenty of water. A third type of esophagitis, called eosinophilic esophagitis, occurs when white blood cells invade the esophagus. Your family doctor can assist in treatment for this. 

  • Pleurisy-- also known as pleuitis, this condition is an inflammation of the lining of the lungs and chest cavity and can cause heartburn-like chest pain. Pleuritis should be suspected if the pain or burning gets worse when you take deep breaths or are up moving around.

Pleuritis is usually caused by a viral or bacterial infection, and resolves when the infection does.

  • Costochondritis-- inflammation of the cartilage anchoring ribs to the breastbone causes sharp pain along the breastbone or sternum. It can be due to injury or infection, and typically is treated with anti-inflammatory medicines, pain relievers, and rest.


  • Anxiety-- I can't emphasize this condition enough. Although anxiety does not cause GERD, it can cause severe heartburn and make GERD symptoms worse. A person can have both anxiety-related heartburn and GERD-related heartburn. Stress and anxiety exacerbates this condition. One sign it's not just reflux is that treating the reflux problem doesn't make it any better.

Reducing stress and anxiety can ease heartburn. Try exercise, meditation, therapy, yoga, tai chi, or deep breathing.

Your family doctor can help you get to the root of the problem. Especially if acid-reducing medications have not helped, or if your heartburn-type pain is recurring, it is important to sit down and have a good discussion with your family physician about your specific symptoms and how to get to feeling better. 


Dr. Paul Leavitt is a Board Certified Family Doctor and practices at Leavitt Family Medicine in Hendersonville, TN. At Leavitt Family Medicine, we are here for you, for all of your medical and health care needs. We welcome your questions and comments and invite you to visit us at Let us know how we can help you today!


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