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Gastric Pain vs. Heartburn: Differentiating Between Acid Reflux and Gastritis Symptoms

senior male patient with his hand on his heart

Gastric pain and heartburn are common symptoms that can cause discomfort and affect daily activities. While they may share similarities, they stem from different underlying conditions. Understanding the differences between gastric pain and heartburn is essential for accurate diagnosis and appropriate management. In Singapore, where gastrointestinal conditions are prevalent, recognizing the distinct characteristics of these symptoms is crucial for effective healthcare delivery.

Understanding Gastric Pain and Heartburn

Gastric pain, also known as epigastric pain, refers to discomfort or burning sensation in the upper abdomen, typically located just below the sternum (breastbone). It may vary in intensity and duration and can be accompanied by other symptoms such as bloating, nausea, or vomiting. Gastric pain can be caused by various factors, including gastritis, peptic ulcers, or functional gastrointestinal disorders.

Heartburn, on the other hand, is a burning sensation or discomfort felt in the chest, behind the breastbone. It often occurs after eating or when lying down and is commonly associated with regurgitation of stomach acid into the esophagus. Heartburn is a hallmark symptom of  gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back into the esophagus, causing irritation and inflammation of the esophageal lining.

Differentiating Symptoms of Gastric Pain and Heartburn

While both gastric pain and heartburn may involve discomfort in the upper abdomen or chest, several key differences can help distinguish between the two:

  • Location of Discomfort: Gastric pain typically occurs in the upper abdomen, just below the sternum, whereas heartburn is felt behind the breastbone or in the chest. Gastric pain may also radiate to the back or shoulders in some cases.
  • Character of Pain: Gastric pain is often described as a dull, aching sensation or a gnawing feeling in the upper abdomen. It may worsen after eating or when the stomach is empty. In contrast, heartburn is characterized by a burning sensation or discomfort in the chest, usually accompanied by a sour or acidic taste in the mouth.
  • Triggers and Timing: Gastric pain may be triggered by eating certain foods, consuming alcohol or caffeine, or taking medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). It may occur throughout the day or be more pronounced during mealtimes. Heartburn, on the other hand, typically occurs after eating, especially large or fatty meals, or when lying down, bending over, or exercising. It can occasionally be caused by certain food items also.
  • Associated Symptoms: Gastric pain may be accompanied by symptoms such as bloating, belching, nausea, or vomiting. In some cases, it may be associated with alarm signs such as unintentional weight loss, difficulty swallowing, or persistent vomiting, which may indicate more serious underlying conditions. Heartburn is often accompanied by regurgitation of stomach acid into the throat, sour or bitter taste in the mouth, and throat irritation.

Causes and Risk Factors

Gastric pain and heartburn can be caused by a variety of factors, including:

  • Gastritis: Inflammation of the stomach lining, often caused by infection with Helicobacter pylori bacteria, excessive alcohol consumption, prolonged use of NSAIDs, or stress.
  • Peptic Ulcers: Open sores that develop in the lining of the stomach or duodenum, commonly caused by H. pylori infection or long-term use of NSAIDs.
  • GERD: A chronic condition characterized by the reflux of stomach acid into the esophagus, leading to heartburn, regurgitation, and other symptoms.
  • Functional Gastrointestinal Disorders: Conditions such as functional dyspepsia or irritable bowel syndrome (IBS) characterized by chronic or recurrent abdominal pain or discomfort without an identifiable cause.

Diagnostic Evaluation

The diagnosis of gastric pain or heartburn typically involves a comprehensive evaluation by a healthcare provider, which may include:

  • Medical History: A detailed history of symptoms, including their onset, duration, severity, triggers, and associated factors.
  • Physical Examination: Assessment of vital signs, abdominal tenderness, and other signs suggestive of gastrointestinal pathology.
  • Diagnostic Tests: Laboratory tests, such as blood tests to check for H. pylori infection or signs of inflammation, and imaging studies, such as upper endoscopy or abdominal ultrasound, to visualize the gastrointestinal tract and assess for structural abnormalities.
  • Symptom Assessment Tools: Questionnaires or symptom assessment tools may be used to quantify the severity and impact of symptoms on daily life.

Treatment and Management

The treatment approach for gastric pain and heartburn depends on the underlying cause and severity of symptoms. Common treatment modalities may include:

  • Lifestyle Modifications: Avoiding trigger foods, reducing alcohol and caffeine consumption, quitting smoking, maintaining a healthy weight, and practicing stress-reduction techniques.
  • Medications: Over-the-counter antacids, H2-receptor antagonists (e.g.ranitidine) or proton pump inhibitors (e.g., omeprazole) may be prescribed to alleviate symptoms and promote healing of the gastrointestinal mucosa.
  • Antibiotic Therapy: In cases of H. pylori infection, a course of antibiotics combined with acid-suppressing medications (triple therapy) may be recommended to eradicate the bacteria and reduce the risk of recurrent gastritis or peptic ulcers.
  • Endoscopic Interventions: In some cases, endoscopy may be indicated to visualize the gastrointestinal tract, obtain tissue samples for biopsy, or perform therapeutic procedures such as hemostasis for bleeding ulcers or dilation of strictures.


Gastric pain and heartburn are common symptoms that can arise from various gastrointestinal conditions, including gastritis, peptic ulcers, and GERD. While they may share similarities in terms of location and discomfort, they stem from different underlying mechanisms and have distinct clinical features. Recognizing the differences between gastric pain and heartburn is essential for accurate diagnosis and appropriate management. 

In Singapore, where gastrointestinal conditions are prevalent, healthcare providers play a crucial role in assessing patients with these symptoms, conducting thorough evaluations, and implementing tailored treatment strategies to alleviate symptoms and improve quality of life. By educating patients about the differences between gastric pain and heartburn and empowering them to seek timely medical attention, healthcare professionals can contribute to better outcomes and enhanced patient well-being.

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