It is a sensation of discomfort due to indigestion. It is usually witnessed
as a retrosternal acute burning sensation.
A. Heartburn in immunocompetent individuals
Heartburn is a cardinal symptom of
GERD (gastro-esophageal reflux disease) &
is relatively specific; because of the safety of most antireflux medications,
an empirical approach is appropriate for many patients with
However, the presence of certain symptoms or signs in a patient with
reflux-like symptoms should lead to an early endoscopy:
- dysphagia or
- weight loss
- gastrointestinal bleeding
- frequent vomiting
These symptoms imply either the development of a
(e.g., stricture, Barrett's esophagus, or
adenocarcinoma) or another disorder
masquerading as GERD (e.g.,
squamous cell cancer or a gastric/duodenal lesion
such as cancer or
B. Heartburn in immunocompromised patients
Heartburn in immunocompromised patients often indicates an esophageal
- idiopathic esophageal ulcers
Because most patients with the acquired immunodeficiency syndrome and
esophagitis will have candidiasis, an empirical 1- to 2-week course of antifungal
therapy may be justified. Those who fail this approach, however, should
almost always have an endoscopy and biopsy because each of the common causes
requires specific therapy.
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