By Dr. Katie E. Golden, MD
Many people come to the emergency department (ED) with symptoms of chest pain thinking ‘is this just heartburn, or is it something more serious?’ Thankfully, most people will also leave with a reassuring workup and no major problems. And for some of these people, their ED provider will further diagnose a likely case of acid reflux (also known as gastroesophageal reflux disease, or GERD).
But before you walk out the door thinking you’re in the clear and everything is fine, there are some important things to know about acid reflux. So let’s get our facts straight and clear up some misconceptions about this common condition.
Heartburn is a symptom, not a diagnosis.
The word ‘heartburn’ means different things to different people. Someone who is having a heart attack might describe their chest pain as heartburn. To someone else, heartburn may just be a vague feeling in their chest they get when stressed. The point is — the feeling of heartburn doesn’t not necessarily mean acid reflux.
As ED providers, we see people with heartburn symptoms every day. And they are pretty good at knowing what sounds like a true case of GERD, and what could potentially be something else. But we are not perfect. At the end of the day, GERD is a clinical diagnosis when it is made in the ED. This means that it is made based on symptoms, rather than a test that confirms the diagnosis.
All this is to say that you should stay vigilant. Don’t ignore worsening or changing symptoms, which could be a sign that something else is going on that did not show up on your initial testing in the ED. You should see your provider right away, or return to the ER, if you are experiencing:
- New or worsening chest pain
- Jaw, arm, or upper back pain
- Vomiting
- Fever
- Any breathing symptoms or shortness of breath
Reflux is not the same thing as a stomach ulcer
When someone experiences the symptoms of GERD, they often think this means they have a stomach ulcer. But reflux and ulcers are actually two different conditions. When someone has reflux, stomach acid is traveling back up into the esophagus (the tube that connects the mouth to the stomach). When someone has an ulcer, their stomach acid is irritating or eroding the inner lining of the stomach.
GERD (or reflux) is much more common than stomach ulcers. And the symptoms tend to be different. When someone has GERD, they tend to experience a burning, acid-like sensation in their stomach area or chest. This tends to be triggered, or worsen, with eating or drinking.
Ulcers, on the other hand, tend to feel a little different. Many people don’t have any symptoms from an ulcer. But if they do, they tend to have a gnawing pain that stays in the stomach area (rather than travel into the chest). And for many people, this pain improves when eating.
The causes and treatments are slightly different for these two different conditions. This is one more reason to follow up with your regular provider for more testing after you leave the ED. (More on this below.)
GERD treatment involves taking medications. And also avoiding triggers.
If you have reflux, there are many over-the-counter medications that can help relieve your symptoms. These include:
- Calcium carbonate (like TUMS or Maalox). These medicines help to temporarily neutralize the acid in your stomach. But they are best for people who experience reflux infrequently. More frequent episodes usually require something a little stronger.
- H2 blockers (like Pepcid, Zantac, and Tagamet). These medicines block histamine from stimulating the stomach to produce acid. They are often recommended for new or milder cases of reflux. But if taken for several weeks, they can become less effective.
- Proton pump inhibitors (like Prilosec, Nexium, or Protonix). These are best for moderate to severe cases of reflux, or when other medicines are not working. They take a little bit longer to work then the above medicines, but over time they decrease the amount of acid produced by your stomach.
But avoiding things that worsen your reflux is just as important as taking medicine to relieve it. Everyone’s triggers tend to be a little different, so pay attention to the way different foods or drinks affect your symptoms. Common triggers include:
- Coffee
- Alcohol
- Spicy foods
- Fried foods
- Acidic produce, like tomatoes and citrus fruit
- Peppermint
- Chocolate
It may also help to eat smaller meals, and avoid laying down right after you eat. And avoid snacking or eating right before bed. No, it won’t help if you drink a glass of milk alongside the oreos in bed.
Follow up! GERD is not benign
Many people will be quite relieved to walk out the ER with a likely diagnosis of reflux — especially if they went in thinking they may be having a heart attack. But this does not get you off the hook from following-up with your regular provider. It’s important to take this condition seriously for a few key reasons.
First, a follow-up will ensure you get any additional testing you may need. Some of these tests might include
- H.pylori testing. Even though reflux and stomach ulcers are different conditions, some people may have both. And one of the most common causes of stomach ulcers in the US is a bacteria called h.pylori. It lives in your stomach and can affect the stomach lining and acid production. When present, it should be treated with antibiotics and antacids to prevent further complications.
- Endoscopy. This is the most definitive way to diagnose GERD. It can also check for any complications of GERD, or rule out other causes of your symptoms.
- More testing on your heart. Remember that a diagnosis of reflux in the ED is a hypothesis. FOr many people, it is still important to get additional testing on your heart that cannot be performed in the ED.
It is also important to know that GERD is a chronic condition. And if left untreated, it can lead to serious complications. This includes a condition called Barrett’s esophagus, which happens when the lining of your esophagus starts to change because of constant exposure to acid. And if left untreated for years, this can increase your risk of esophageal cancer.
So before you pop a TUMS and try to forget your ER visit happened, call your regular provider to get an appointment on the books. And keep it, even if your symptoms improve or go away.