Heartburn

Definition

It is a sensation of discomfort due to indigestion. It is usually witnessed as a retrosternal acute burning sensation.


A. Heartburn in immunocompetent individuals

GERD

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 GERD.

However, the presence of certain symptoms or signs in a patient with reflux-like symptoms should lead to an early endoscopy:

  1. dysphagia or odynophagia
  2. weight loss
  3. gastrointestinal bleeding
  4. frequent vomiting

These symptoms imply either the development of a GERD-related complication (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 peptic ulcer).


B. Heartburn in immunocompromised patients

Heartburn in immunocompromised patients often indicates an esophageal infection.

  • Candida
  • cytomegalovirus
  • herpesvirus
  • 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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