Heartburn's Hidden Effects

Heartburn sufferers don't have to be reminded that the sharp, burning sensation just below their ribs is, in fact... a symptom known as heartburn. They often live with and have become accustomed to the pain. However, heartburn, caused by the movement of stomach acid up into the esophagus, can contribute significantly to a variety of seemingly unrelated ailments. Research now shows that severe acid reflux can be associated with asthma, hoarseness, chronic cough, laryngitis, and other conditions including non-cardiac chest pain.^1-3 In some instances, these ailments surface even when heartburn's usual symptoms are absent. This can lead doctors to misdiagnosis and patients to misunderstand these conditions because people with asthma or ear, nose, and throat (ENT) complaints often do not have symptoms of heartburn or acid reflux.^{1, 2}

The exact mechanisms through which heartburn causes non-cardiac chest pain,⁴ asthma,^{2, 3} hoarseness,⁴ and laryngitis^{4, 5} are unclear; however, heartburn is, at least in one report, the third most common cause of chronic cough, after asthma and postnasal drip.⁴ Overall, heartburn is linked to these other lung and ENT conditions by the evidence of small amounts of acid in the upper esophagus and airway. In asthma, for example, acid entering the voice box (larynx) can cause wheezing.² Acid that repeatedly reaches the back of the throat and the larynx can cause damaging laryngitis and hoarseness.^{5, 6} Chest pain from a severe heartburn episode can be mistaken for angina or a heart attack. In fact, the pain, which may radiate to the neck and/or shoulder, is often so difficult to distinguish from cardiovascular pain that sophisticated equipment is generally necessary to determine whether or not one is having a heart attack (For more information, see our "Heartburn or Heart Attack?" section). ENT complaints such as hoarseness, laryngitis and chronic cough may result from repeated acid reflux during sleep.⁴

There are different medications to treat heartburn, and these various medications work in different ways. Consult your health care professional to discuss the treatment that is appropriate for your type of heartburn. Antacids neutralize existing stomach acid and provide relatively rapid but short-term relief of heartburn symptoms. H2 blockers partially block production of acid in the stomach. The effect of H2 blockers generally lasts up to 12 hours. Proton pump inhibitors (PPIs), available with a prescription or over the counter, provide 24-hour treatment of frequent heartburn symptoms with each pill when taken as directed. PPIs, powerful inhibitors of stomach acid production, virtually shut down the acid pumps in the cells of the stomach where stomach acid is produced, leaving enough acid for normal digestion of food.

A PPI may decrease chronic heartburn-related symptoms of asthma, hoarseness, chronic cough and laryngitis. However, those patients who do not exhibit usual reflux symptoms may need to receive the interdisciplinary medical care of both a gastroenterologist and an ENT specialist.

Suggested Reading:

Richter JE. Extraesophageal presentations of gastroesophageal reflux disease: an overview. Am J Gastroenterol. 2000;95:S1-3.
Richter JE. Beyond heartburn: extraesophageal manifestations of gastroesophageal reflux disease. Am J Manag Care. 2001;7:S6-9.
Paterson WG. Extraesophageal manifestations of reflux disease: myths and reality. Chest Surg Clin N Am. 2001;11:523-38.
Fennerty MB. Extraesophageal gastroesophageal reflux disease. Presentations and approach to treatment. Gastroenterol Clin North Am. 1999;28:861-73,vi.
Wiener GJ, Koufman JA, Wu WC, Cooper JB, Richter JE, Castell DO. Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring. Am J Gastroenterol. 1989;84:1503-8.
McNally PR, Maydonovitch CL, Prosek RA, Collette RP, Wong RK. Evaluation of gastroesophageal reflux as a cause of idiopathic hoarseness. Dig Dis Sci. 1989;34:1900-4.