Most people are probably familiar with the burning sensation in their chest that can sometimes come from eating certain foods. Whether it is heartburn or indigestion, however, can be confusing because the symptoms overlap. In fact, the terms are used synonymously in many circles. Medically, heartburn and indigestion are overlapping yet distinct entities. Heartburn is just one of several possible symptoms of indigestion. Understanding the language of heartburn and indigestion can help you and your doctor discuss your symptoms and decide on the appropriate next steps.
Heartburn Is a Key Symptom of Acid Reflux
Heartburn, or that burning sensation typically located just behind or below the breastbone, is caused by acid reflux -- the upward splashing of acidic contents of the stomach back into the esophagus. The resulting irritation of the esophagus creates burning symptoms that are often accompanied by other symptoms, such as a sour taste in the mouth, regurgitation and belching. Technically, the word heartburn can refer specifically to the chest discomfort. However, many people talk about their heartburn, indigestion and any accompanying symptoms together as a single problem.
Indigestion Doesn't Always Involve Reflux
Indigestion conveys that a person is having unpleasant stomach symptoms, perhaps associated with his intake or a specific meal, but not necessarily so. Occasional heartburn from acid reflux is very common, so for many people who say they have indigestion, it's likely they are referring to acid reflux symptoms. However, many possibilities other than acid reflux can make a person feel like there's something wrong with their stomach. For some, the medical term dyspepsia is a better fit than heartburn for these symptoms. Dyspepsia is a burning discomfort in the stomach, sometimes likened to hunger pains -- except that it occurs on a full stomach, too. Like acid reflux, dyspepsia may be accompanied by a variety of other symptoms, including belching, bloating and feelings of gassiness, nausea or fullness.
The Causes May Differ
Heartburn is caused by reflux of acidic stomach contents into the esophagus, where it causes irritation and burning. A muscular ring at the bottom of the esophagus called the lower esophageal sphincter normally prevents reflux, but sometimes it fails to form a good seal. There are many foods that can trigger heartburn, such as fatty foods, spicy foods and alcohol -- which is known to cause relaxation of the sphincter muscle. Common medications such as beta-blockers and calcium channel blockers also relax the lower esophageal sphincter and may contribute to heartburn.
When acid reflux is not the cause of indigestion or dyspepsia, often there is no other reason found -- that is, there is no evidence of a disease or any visible harm to the tissues. However, some cases of dyspepsia do arise from specific illnesses, including:
- stomach or intestinal ulcers or cancer
- infection of the stomach with H. pylori bacteria
- other conditions that cause inflammation of the stomach lining
- hiatal hernia, a problem in which the stomach bulges into the chest cavity
- problems with muscular contractions of esophagus and stomach
- problems with the pancreas or the flow of bile
- certain medications such as nonsteroidal antiinflammatory drugs, or NSAIDs
Like GERD, indigestion is often triggered by eating too much or too quickly, or by certain foods such as fatty foods or alcohol. Indigestion is also more likely to occur if you are feeling stressed or anxious.
Another similarity between the terms -- and a general precaution -- is that chest discomfort due to a heart attack may be incorrectly attributed to either heartburn or indigestion instead.
The Next Steps May Differ
While occasional heartburn or indigestion happens to most people at some point, symptoms that occur frequently or over an extended period of time need to be evaluated by your doctor, as they could indicate a serious illness.
In some cases, heartburn and indigestion respond to lifestyle changes. Avoiding trigger foods, shedding excess weight, not eating too close to bedtime and elevating the head of the bed are all potentially helpful. Eating smaller meals, eating more slowly, not smoking or consuming alcohol and reducing stress may be helpful as well. Heartburn also responds to over-the-counter and prescription medications that suppress stomach acid.
If the underlying cause of your symptoms is unclear, additional tests may be needed in some instances and an endoscopy may be performed. Endoscopy is a procedure in which a slender tube containing a camera is slid down the throat to examine digestive tract lining. Testing can also determine the presence of H. pylori bacteria. If your doctor identifies an underlying cause of indigestion, a specific treatment program may be recommended.
Medical advisor: Jonathan E. Aviv, M.D., FACS