Heartburn
Directly behind the left atrium of the heart a part of the esophagus runs. One of the most common causes of left-sided burning in the thorax is the reflux – i.e. the reflux – of stomach acid from the stomach, through the oesophagus, in the direction of the larynx. During this process, the gastric acid also passes through the narrow passage behind the heart, which is why heartburn is often misinterpreted as a “heart complaint”.
However, this assumption is obvious, as the burning and stabbing pain that heartburn causes makes one think of a heart attack. However, patients describe the symptoms of a heart attack in such a way that they feel breathlessness and fear of death, which – even in the case of severe heartburn – is usually not the case. If the burning sensation also occurs immediately after eating, this is a further indication of heartburn and not a cardiac event.
This type of pain is then called “postprandial pain” – that is, pain after eating. In heartburn, the acidic stomach fluid slowly rises up the esophagus and irritates the chemoreceptors of the esophageal epithelium (the uppermost layer of skin of the esophagus) – this is then felt as pain or burning in the area behind the breastbone. While once-only heartburn is still harmless, repeated ascents of gastric acid into the esophagus can cause permanent damage to the skin and mucous membrane located there.
Gastric acid contains hydrochloric acid, one of the strongest acids found in nature. It serves to decompose the food pulp in the stomach. However, while the stomach has protective mechanisms against self-digestion, the oesophagus is at the mercy of the acid.
Complications of chronic heartburn include not only inflammation and burning but also bleeding and cancer of the oesophagus. The therapy for heartburn consists of taking antacids, i.e. acid-binding drugs, and proton pump inhibitors (PPI). A well-known member of the PPI group is pantoprazole, or generally drugs with the suffix -prazole.
Burning in the chest through the stomach
The stomach can also be responsible for an unpleasant burning sensation in the chest. This is usually caused by gastritis – an inflammation of the stomach. A distinction is made between three forms of gastritis.
Type A gastritis is triggered by autoimmune processes – the body fights against itself, so to speak. The cause is unknown. However, type A gastritis is usually asymptomatic, so it does not cause any pain.
Type B gastritis is caused by bacteria and is based on an infection with the bacterium “Helicobacter pylori“. This bacterium prefers to settle in the stomach entrance – the “pylorus” – and causes an inflammation and possibly also an increased production of gastric acid. Stomach acid, in turn, causes a burning sensation that can rise from the stomach area to the chest and cause severe pain.
However, type B gastritis is usually asymptomatic, the only thing that can occur more often is unpleasant bad breath. The therapy is done with antibiotics – multiple therapy, for which several different treatment schemes exist. The most important representative of gastritis in this case is type C gastritis.
In addition to a feeling of fullness in the upper abdomen, it causes a constant belching, which does not bring any “relief”, i.e. it does not reduce the feeling of fullness. The constant belching causes reflux of gastric acid into the oesophagus, which causes a strong burning sensation in the stomach, chest and, more rarely, in the throat, in the area of the larynx. The trigger for type C gastritis (chemically induced gastritis) is generally speaking an unhealthy lifestyle.
In addition to smoking, this includes excessive alcohol consumption, stress and the regular intake of painkillers of the NSAID group. These include Aspirin®, Ibuprofen and Naproxen. The classic combination is high alcohol and cigarette consumption, for example at the weekend when “partying”, followed by headaches the next day, which are treated with Aspirin® or ibuprofen.
If the stomach is permanently exposed to this stress, it reacts with an inflammation. The only sensible therapy in this case is to reduce cigarette and alcohol consumption, to avoid painkillers of the NSAID class and to avoid stress. Alternatively, paracetamol can be taken, as it has less effect on the stomach (but on the liver). If the burning sensation in the chest occurs in combination with a feeling of fullness and frequent burping and at the same time there is an increased consumption of alcohol, cigarettes and painkillers, gastritis – i.e. inflammation of the stomach – should always be considered.
