Can stomach problems cause chest tightness? What should I do?

We all know that stomach problems usually present with symptoms such as stomach pain, nausea, vomiting, etc. But some people say that stomach problems can also cause chest tightness. Is this true? Today let’s talk about whether stomach problems can cause chest tightness?

Many patients with chest pain or tightness are misdiagnosed as having coronary heart disease

Mr. Wu, 47 years old, went to the hospital for treatment due to chest pain, chest tightness and shortness of breath. He had visited a doctor and was suspected of having coronary heart disease. However, dynamic electrocardiogram and cardiac ultrasound showed no obvious abnormalities. Coronary angiography ruled out coronary heart disease. At the vascular surgery department and gastroesophageal reflux center of a certain hospital, the doctor performed a gastroscopy and 24-hour esophageal pH monitoring on Mr. Wu and confirmed that he was suffering from gastroesophageal reflux disease. His symptoms were relieved after taking oral acid-suppressing drugs.

Why does this phenomenon of misdiagnosis and mistreatment often occur? The reason for this has to start with the nature of chest pain.

The difference between chest pain caused by gastroesophageal reflux and angina pectoris

Pain anywhere from the head and neck to the lowest rib is called chest pain. Chest pain may be related to the organs, ribs, or chest muscles in the chest cavity, but it may also be radiating pain caused by abdominal disease. However, when many people have chest pain, the first thing they think of is heart disease. They then go to the cardiovascular department frequently for treatment. After an electrocardiogram (ECG) shows nothing wrong, they are still worried. So they do a dynamic echocardiogram, which is still fine, but they are still worried. They then do a cardiac color ultrasound or even coronary angiography, and they are determined not to give up until they reach the Yellow River.

"In fact, chest pain caused by gastroesophageal reflux disease is not uncommon in clinical practice, but it has not attracted the attention of doctors. This pain manifests in different forms, sometimes radiating to the back, and sometimes similar to angina attacks." There are four reasons why the two are often confused:

1. Similar pain locations: Visceral pain can be felt on the corresponding body surface, or may involve other parts, manifesting as pain in distant parts. The heart and esophagus are both innervated by the autonomic nervous system, and pain is mainly transmitted through the sympathetic nerves. The pain fibers of the two and the pain fibers of the chest somatic tissues sometimes cross in the central nervous system. Because superficial pain is more common than visceral pain, the central nervous system often misinterprets pain information from the viscera as coming from superficial body tissues, which manifests as referred pain in the chest.

2. When suffering from gastroesophageal reflux disease, gastric acid can stimulate the vagus nerve endings in the lower esophagus, causing coronary artery spasm and contraction through the visceral-vagus nerve reflex, leading to myocardial ischemia and hypoxia. Therefore, transient ST-T changes (ST wave and T wave waveform changes) or arrhythmias may appear on the electrocardiogram. The clinical diagnosis of gastroesophageal reflux disease is often based on typical reflux symptoms (i.e., heartburn, retrosternal pain, heartburn, progressive dysphagia, etc.).

3. Similar triggering factors: Gastroesophageal reflux disease can occur after a full meal, during sleep, or by emotional excitement, which is very similar to the causes of angina pectoris, especially spontaneous angina pectoris.

4. Similar reaction to nitroglycerin: chest pain can cause coronary artery spasm and contraction, leading to myocardial ischemia and hypoxia, which is especially prone to occur in patients with existing coronary heart disease. The use of nitroglycerin can alleviate temporary symptoms in some patients because nitrates also have a relaxant effect on esophageal smooth muscle, relieving esophageal spasm while dilating coronary arteries, increasing coronary blood flow, and reducing venous return, thereby relieving angina pectoris. Due to the improvement of symptoms and the lack of comprehensive understanding of the disease by clinicians, misdiagnosis is easy to occur. However, the chest pain of gastroesophageal reflux disease responds slowly to nitroglycerin, and the symptom improvement is not as obvious as that of angina pectoris.