Gastroesophageal Reflux Disease (GERD), commonly known as acid reflux, is a digestive condition where stomach acid flows back into the esophagus, causing uncomfortable symptoms. The most recognized symptoms include a burning sensation in the chest (heartburn), the regurgitation of sour liquid or food particles, and general chest discomfort. Because the esophagus shares nerve pathways and proximity with other organs, these common symptoms are not exclusive to acid reflux. Numerous conditions affecting the upper digestive tract, heart, esophagus, and respiratory system can produce similar pain or irritation. Understanding these “mimics” is important for receiving an accurate diagnosis and effective treatment.
Upper Gastrointestinal Tract Conditions
Conditions causing inflammation or lesions within the stomach or esophagus can be mistaken for acid reflux, as they create localized pain and irritation. Peptic ulcers are open sores that form on the lining of the stomach (gastric ulcers) or the first part of the small intestine (duodenal ulcers). The burning pain associated with these ulcers is often felt in the upper abdomen or chest and may temporarily improve after eating or taking an antacid, mimicking heartburn.
Gastritis, the inflammation of the stomach lining, causes similar upper abdominal pain, bloating, and a burning sensation due to the stomach’s compromised protective barrier. Both peptic ulcers and gastritis are frequently caused by Helicobacter pylori infection or the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs). The resulting deep irritation can feel indistinguishable from the pain caused by acid reflux.
Eosinophilic Esophagitis (EoE) is an immune-mediated allergic disease where eosinophils accumulate in the esophageal lining, causing inflammation. While it can cause heartburn and chest pain, EoE is more associated with difficulty swallowing (dysphagia) or food getting stuck in the esophagus (food impaction). EoE symptoms may not respond fully to standard acid-suppressing medications, necessitating a biopsy to confirm the presence of high levels of eosinophils.
Esophageal Motility Disorders
Motility disorders involve mechanical issues related to the muscle function of the esophagus. These conditions interfere with peristalsis, the coordinated muscle contractions that normally push food toward the stomach. When these movements are disrupted, they can generate intense pain and cause food to become trapped, leading to symptoms that closely resemble severe acid reflux.
Achalasia is characterized by the failure of the lower esophageal sphincter (LES) to relax and the absence of peristalsis. The inability of the LES to open prevents food from entering the stomach, causing accumulated, undigested food to be regurgitated, which patients may mistake for acid reflux. The severe chest pain in achalasia is often due to the intense pressure and distention of the esophagus, rather than acid irritation.
Diffuse Esophageal Spasm (DES) involves painful, uncoordinated, and simultaneous contractions of the esophageal muscles. These forceful spasms cause severe, crushing chest pain often confused with both heartburn and cardiac events. The pain mechanism is intense, disorganized muscle contraction, not the chemical burn of stomach acid. Treatment focuses on relaxing the esophageal muscles or surgically addressing the LES, which is distinct from the acid suppression used for GERD.
Cardiac and Chest Pain Sources
Symptoms originating from the heart and surrounding chest structures are the most concerning mimics of acid reflux due to the close anatomical location. Angina, chest pain caused by reduced blood flow to the heart muscle (myocardial ischemia), is frequently described as a pressure, squeezing, or tightness in the chest, similar to severe heartburn. This potentially life-threatening condition must be ruled out immediately when chest pain occurs.
A heart attack (myocardial infarction) can present with chest discomfort mistaken for indigestion or heartburn, especially in women. The pain is often accompanied by symptoms that differentiate it from reflux, such as shortness of breath, dizziness, cold sweats, or pain radiating to the jaw, neck, back, or arms. If chest pain includes any of these signs, seeking immediate emergency medical attention is necessary.
Musculoskeletal issues, such as costochondritis, can also cause chest pain that mimics reflux. Costochondritis is inflammation of the cartilage connecting the ribs to the breastbone. This condition produces sharp, localized pain worsened by movement or pressing on the tender area, unlike the deep, burning sensation typical of acid reflux.
Airway and Respiratory Symptom Mimics
Acid reflux can sometimes cause “extra-esophageal” symptoms, such as chronic cough or hoarseness, often referred to as Laryngopharyngeal Reflux (LPR) or “silent reflux.” Conditions external to the digestive tract can also cause these symptoms, leading to frequent misdiagnosis, as they typically affect the upper airway and respiratory system.
Chronic Sinusitis and Post-Nasal Drip cause mucus to continually drip down the back of the throat, triggering a persistent, irritating cough and the need for frequent throat clearing. This constant irritation of the larynx and pharynx mimics the effects of acid reaching the upper airways. While both LPR and post-nasal drip cause these symptoms, allergies often produce thinner, more watery mucus, which can sometimes help distinguish the source of the irritation.
Asthma, especially cough-variant asthma, often presents with a chronic cough mistakenly attributed to acid reflux. The cough in this form of asthma is a primary symptom, typically without the classic wheezing or shortness of breath. Since the symptoms of respiratory diseases and LPR overlap considerably, specialized testing is often required to determine if the chronic cough is caused by airway inflammation or irritation from gastric contents.