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Chest or Back Pain

by Norton J. Greenberger, MD

Pain in the middle of the chest or upper back can result from disorders of the esophagus (see Overview of the Esophagus) or from disorders of the heart or aorta (see Chest Pain). Symptoms may be similar. Gastroesophageal reflux disease (GERD—see Gastroesophageal Reflux (GERD)), caused by stomach acid splashing up into the esophagus, can cause a burning sensation or a tightness under the breastbone (sternum), which may resemble the pain of heart disease. Spasms of the esophagus and other esophageal muscle disorders can cause a severe squeezing sensation also resembling the pain of heart disease.

Some symptoms are more suggestive of esophageal disorders. Severe pain that occurs suddenly after vomiting or after a procedure involving the esophagus suggests a rupture of the esophagus. Heartburn is a burning pain caused by GERD that rises into the chest and sometimes the neck and throat, usually after meals or when lying down. Heartburn is among the most common digestive symptoms in the United States. Difficulty swallowing (see Difficulty Swallowing) and discomfort that occurs only with swallowing also suggest an esophageal disorder. Chest discomfort that occurs routinely with exertion and goes away after a brief rest suggests a heart problem. However, because symptoms frequently overlap, and because heart disease is particularly dangerous, doctors often do a chest x-ray, an electrocardiogram (ECG), and sometimes a cardiac stress test before doing tests to look for esophageal disease.

Treatment is usually given only when the cause is known, although people with very typical symptoms of GERD may be given a trial of acid-blocking drugs.