Heartburn and gastroesophageal reflux disease (GERD), are both medical conditions caused by a malfunction of the lower esophageal sphincter (LES), a muscular valve that keeps partially digested food and gastric juice inside the stomach. Gastric juice flowing backward up the esophagus causes unpleasant burning sensations and chest pain that are associated with both heartburn and GERD. Heartburn and GERD are sometimes confused with one another because frequent heartburn is a primary symptom of GERD and the former condition is often used to diagnose the latter. While heartburn is usually no cause for concern, GERD can be quite debilitating and can cause other long-term health problems.
The LES is designed to remain in a closed position, opening only to permit food to flow from the esophagus into the stomach. Occasionally, however, the LES opens at random and allows partially digested food and stomach acid to reflux, or travel backward from the stomach into the esophagus. Although they can lead to heartburn symptoms, these random openings of the LES are usually completely normal, and a healthy esophagus will eventually push the acid back down where it belongs using a sequence of wavelike muscle contractions called peristalsis. When the LES is particularly weak, however, these random openings may occur with greater frequency, which can lead to the esophageal lining becoming damaged by acid reflux. If a patient experiences heartburn symptoms more than twice every week, then it is likely that the patient has GERD.
One difference between heartburn and GERD is the severity of the symptoms. Normal heartburn that might occur after eating acidic or fatty foods usually presents with pain in the chest and a sensation of burning in the chest and throat. There may also be a foul, sour taste inside the mouth that can be linked to stomach acid reflux. GERD sufferers often experience these heartburn symptoms in addition to symptoms linked to long-term damage to the esophageal lining, including sore throat, coughing, difficulty swallowing, and the sensation that swallowed food has become stuck in the throat. While heartburn symptoms usually cause discomfort, GERD symptoms can be debilitating and disruptive.
Another difference between heartburn and GERD is that heartburn alone usually does not lead to further medical complications. The near-constant backwash of acid into the esophagus that is associated with GERD can cause the esophagus to become inflamed, a condition called esophagitis. Chronic esophagitis can then lead to other serious conditions, such as breathing trouble, esophageal bleeding or ulceration, or a condition known as Barrett's esophagus that heightens the risk of developing esophageal cancer.
Treatments for heartburn and GERD may also differ. Usually, normal heartburn symptoms will go away if the heartburn sufferer takes an over-the-counter antacid. These antacids temporarily relieve heartburn symptoms in GERD sufferers, but they can't treat the damaged esophageal tissue. More effective drugs called proton pump inhibitors limit the stomach's acid production, thus giving the esophageal lining some time to begin healing. Severe cases of GERD may require surgical procedures.