Diagnosis of Heartburn
The diagnosis of heartburn is primarily based on a person’s symptoms. However, it may also involve further tests if the symptoms are frequent, severe, or resistant to treatment. Since many other conditions can mimic the discomfort of acid reflux. An accurate diagnosis of heartburn is essential to ensure the right treatment and to exclude more serious causes such as cardiac issues or gastrointestinal disorders. Early recognition and proper evaluation also help prevent complications like oesophagitis, ulcers, or even pre-cancerous changes to the oesophagus.
Doctors usually ask patients to describe their symptoms in detail. They focus on feelings like burning behind the breastbone. A sour or bitter taste in the mouth, and when these symptoms happen—such as after eating, lying down, or at night. Also, the length, how often, and how strong the symptoms are matter a lot. If symptoms come back two or more times each week. This often points to gastro-oesophageal reflux disease (GORD), which is the long-term form of heartburn.
In most cases, when patients have common symptoms and no warning signs—like trouble swallowing, weight loss, or bleeding—doctors can often make a diagnosis just by talking with them. First, patients try changing their habits and using acid-reducing medicines, either over-the-counter or prescribed. If symptoms get much better, this confirms the diagnosis.
Diagnosis of Heartburn
However, when symptoms are atypical, persistent, or suggestive of complications, further investigation becomes necessary. A key diagnostic tool in such cases is upper gastrointestinal endoscopy (also known as oesophagogastroduodenoscopy or OGD). This procedure involves inserting a thin. Flexible tube with a camera through the mouth to examine the lining of the oesophagus, stomach, and upper part of the small intestine. It allows for direct visualisation of any inflammation (oesophagitis), ulcers, strictures, or abnormal growths. Biopsies may be taken to check for Barrett’s oesophagus, a pre-cancerous condition linked to chronic acid exposure.
24-hour pH monitoring is another test used in the diagnosis of heartburn. Particularly in cases where endoscopy is normal but symptoms persist. This test measures acid levels in the oesophagus over a 24-hour period using a probe either inserted through the nose or placed during endoscopy. It helps establish the frequency and duration of reflux episodes and correlates them with symptoms. Which is especially useful in patients with silent reflux or those whose symptoms do not respond to medication.
Oesophageal Manometry
Oesophageal manometry is sometimes performed in conjunction with pH monitoring. This test evaluates the strength and coordination of oesophageal muscle contractions and the function of the lower oesophageal sphincter (LES). It is particularly useful in diagnosing motility disorders, such as achalasia or diffuse oesophageal spasm, which can present with chest pain or swallowing difficulty and mimic heartburn.
In some cases, a barium swallow X-ray may be used to examine the structure of the upper gastrointestinal tract. After drinking a chalky liquid that coats the lining of the oesophagus and stomach, the patient undergoes a series of X-rays. This test can reveal anatomical abnormalities such as a hiatus hernia, strictures, or evidence of reflux. However, it is less sensitive than endoscopy and has largely been replaced by more modern techniques in many centres.
Diagnosis of Heartburn
Cardiac evaluation is crucial in patients presenting with chest discomfort, especially if they are over 40, have a history of heart disease, or display symptoms during exertion. Since the pain from heartburn can mimic angina or even a heart attack, doctors often order an electrocardiogram (ECG), blood tests (including troponin), or even a cardiac stress test to exclude life-threatening cardiac events. It is important to rule out cardiac causes before concluding that reflux is responsible for chest pain.
If people don’t get better with regular treatment or their symptoms return soon after stopping medicine, doctors may suggest testing for Helicobacter pylori infection. This helps find a possible cause and guide the next steps in treatment. This bacterium can cause stomach ulcers and gastritis, both of which may cause upper abdominal discomfort that overlaps with heartburn symptoms. Testing methods include urea breath tests, stool antigen tests, and biopsies during endoscopy. Eradication of the infection can provide long-term symptom relief in affected individuals.
In Pregnant Women
The diagnosis of heartburn in pregnant women usually does not require formal testing unless symptoms are severe or atypical. Most cases can be managed conservatively with dietary adjustments and safe antacids. Testing is generally avoided unless there is suspicion of a more serious issue.
In children and infants, diagnosis is based on clinical presentation as well. While regurgitation is common in babies and usually self-limiting, persistent vomiting, feeding difficulties, poor growth, or respiratory symptoms may suggest reflux disease and warrant further evaluation by a paediatrician.
The decision to pursue diagnostic testing depends on several “red flag” indicators, including:
Difficulty swallowing (dysphagia)
Painful swallowing (odynophagia)
Unexplained weight loss
Vomiting blood or passing black stools (indicating gastrointestinal bleeding)
Symptoms persisting despite 4–8 weeks of treatment
Family history of gastrointestinal cancers
In such cases, referral for specialist assessment and diagnostic imaging is not only appropriate but potentially life-saving.
Diagnosis of Heartburn
In summary, the diagnosis of heartburn is usually straightforward when symptoms are typical and responsive to treatment. However, in cases that are complex, persistent, or concerning, further tests such as endoscopy, pH monitoring, or manometry are essential to confirm the cause and guide management. Accurate diagnosis not only ensures effective relief but also safeguards against missed or misdiagnosed conditions that could pose serious health risks.
