Heartburn vs Indigestion
Heartburn is a specific clinical presentation due to acute gastritis while indigestion is the layman’s term for the actual ill feeling caused by gastritis and other conditions.
Heartburn is a burning sensation felt in the lower chest or upper abdomen due to acute gastritis. Acute gastritis presents as upper abdominal pain, tightening chest pain behind the sternum, and difficulty in breathing, which exaggerates with lying down. There is usually nocturnal burning type chest pain. It is a very common condition plaguing many millions of people. Men and women both get it equally. It is related to irregular meal patterns.
There are three main meals for a day with two small snacks after breakfast and lunch. Human body is conditioned to this regular regimen and gastric juices flow like clockwork at meal times even if nothing is in the stomach. Gastric juices help digest food. Secretion of gastric juices occurs in three phases. Cephalic phase starts when we feel hungry and when we see food. When we start eating, the gastric phase starts and when food enters the small bowel the intestinal phase starts. When there is nothing in the stomach for the acidic stomach juices to act upon, the mucosal lining becomes its target. There are many protective mechanisms in the stomach to protect it against the highly acidic secretions. There is a thick mucus layer overlying the gastric lining cells. The acidity drops along the thickness of the mucus layer from highly acidic stomach cavity to a neutral pH at the gastric lining cells. There are many buffers to deactivate any stray acids. When there is a long standing starvation or irregular/ inadequate food intake, these protective mechanisms fail. Without the protection, acid destroys the stomach lining cells and ulcer may be the end result.
Ulcers usually occur at the lesser and greater curvatures and at the pyloric area of the stomach. These ulcers are difficult to treat due to constant irritation by gastric acidity. Food may also reflux up the esophagus with chronic gastritis. With prolonged gastritis, the lining of the lower esophagus may change into a pre-cancer state. This is called Barette’s esophagus. Upper gastrointestinal endoscopy to visualize the alimentary canal up to the second part of the duodenum is the investigation of choice. A small piece of the ulcer edge may be removed to examine under the microscope, to exclude cancers. Helicobacter pylori is associated with chronic gastritis. Helicobacter pylori eradication treatment, antacids, and proton pump inhibitors are the available treatment options.
Indigestion is a condition where there is a mild discomfort in the upper abdomen due to a variety of conditions. Excessive consumption of alcohol, smoking, eating too much, eating quickly, and high fiber diet usually causes an ill feeling which includes upper abdominal pain, nausea, vomiting and a bloated feeling. Acute gastritis is one of the commonest causes of indigestion.
What is the difference between Heartburn and Indigestion?
• Heartburn is a specific clinical condition caused by acute gastritis while indigestion refers to the ill feeling caused by gastritis, as well as other conditions.
• Heartburn suggests acute gastritis while indigestion is a vague presentation which requires further examination and investigation to achieve at a probable diagnosis.