Heartburn (Pyrosis): Or something else? Differential Diagnosis

Cardiovascular System (I00-I99).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Diffuse esophageal spasm – neuromuscular dysfunction of esophageal muscles with intermittent retrosternal (located behind the sternum) pain.
  • Functional dyspepsia (irritable stomach)
  • Hypercontractile esophagus (nutcracker esophagus) – motility disorder (movement disorder) of the esophagus characterized by high pressure amplitudes in the lower esophagus.
  • Gastric ulcer (stomach ulcer)
  • Esophagitis (inflammation of the esophagus):
    • Eosinophilic esophagitis (EoE; young men with allergic diathesis; leading symptoms: Dysphagia (dysphagia), bolus obstruction (“occlusion by a bite” – usually meat bites), and chest pain [children, adolescents, adults]Note: At least six esophageal biopsies should be obtained from different heights for diagnosis.
    • Infectious esophagitis (most common form: thrush esophagitis; furthermore, viral (herpes simplex type 1 (rarely type 2): cytomegalovirus, HIV (in the context of acute HIV syndrome 2-3 weeks after infection), bacterial (tuberculosis, Mycobacterium avium, streptococci, lactobacilli) and parasitic (Pneumocystis, cryptosporidia, Leishmania)).
    • Physicochemical esophagitis; esp. acid and alkali burns and radiation therapy.
    • “Tablet esophagitis”; most common triggers are antibiotics (esp. doxycycline), bisphosphonates, non-steroidal anti-inflammatory drugs (NSAIDs) and potassium chloride.
    • Systemic diseases that may be associated with esophagitis (eg, collagenoses, Crohn’s disease, pemphigus)
  • Esophageal achalasia – dysfunction of the lower esophageal sphincter (esophageal muscles), with the inability to relax; it is a neurodegenerative disease in which nerve cells of the myenteric plexus die. In the final stage of the disease, the contractility of the esophageal muscles is irreversibly damaged, with the result that food particles are no longer transported into the stomach and lead to pulmonary dysfunction by passing into the trachea (windpipe). Up to 50% of patients suffer from pulmonary (“lung“) dysfunction as a result of chronic microaspiration (ingestion of small amounts of material, e.g., food particles, into the lungs). Typical symptoms of achalasia are: Dysphagia (dysphagia), regurgitation (regurgitation of food), cough, gastroesophageal reflux (reflux of gastric acid into the esophagus), dyspnea (shortness of breath), chest pain (chest pain), and weight loss; as secondary achalasia, it is usually the result of neoplasia (malignant neoplasm), e.g., cardiac carcinoma (cancer of the entrance of the stomach).
  • Esophageal diverticulum – protrusions of mucosa through the muscular layer of the esophagus.
  • Esophageal ulcers – ulcers in the esophageal wall.
  • Ulcus ventriculi (stomach ulcer)

Neoplasms – tumor diseases (C00-D48)

  • Gastric carcinoma (stomach cancer)
  • Esophageal carcinoma (cancer of the esophagus)

Medication

  • See “Causes” under medications