The retrosternal pain is a pain that is localized in the chest, more precisely in its central part posterior to the sternum. Sometimes, however, the pain can radiate up to the neck and back , manifesting itself as a sensation of deep, sharp pain or even as a burning sensation.
Typically, retrosternal pain is central but can also be right or left when pushing towards one or the other side of the sternum.
Given the location, it is very easy to get scared when pain occurs in any part of the chest. In fact, the first thought that comes to mind is that that discomfort is connected to a heart disease, especially a myocardial infarction.
The concern may be entirely legitimate as retrosternal pain is one of the manifestations that is most frequently associated with episodes of heart attack or angina pectoris , but it is also true that in most cases during cardiac episodes other symptoms are added and above all that the causes of pain are consequent to many other pathological states.
Also, as we will see in our detailed guide, the main causes ofpain in the sternum and chest are due to digestive disorders and more generally involve the digestive system and not the heart as the anatomical proximity to the pain might suggest.
If on the one hand we want to reassure you that very often the retrosternal pain does not indicate a state of medical emergency, on the other hand we recommend that you speak promptly with your doctor and be directed to more specific tests.
This is because even digestive disorders in the long run can seriously compromise the general state of health, therefore they must be treated before they become a chronic condition.
When to seek medical advice
If you feel a sporadic, slight pain, resulting from a meal rich in acidic foods such as citrus fruits (lemons, oranges, grapefruit …) and tomatoes or fatty and fried foods, there is no need to be alarmed. You can stop the burning episode with bicarbonate or infusions, to contact the general practitioner who will evaluate the situation and will be able to propose suggestions for a diet that facilitates digestion.
When the retrosternal pain , on the other hand, becomes continuous and occurs frequently, it is necessary to undergo more in-depth medical examinations on the recommendation of a specialist in gastroenterology.
If, on the other hand, the pain is very intense and acute, it is associated with other symptomssuch as sweating, shortness of breath, irradiated pain in the arm, nausea and dizziness, chest pain , it is necessary to seek prompt medical intervention.
Retrosternal pain: the causes
As we mentioned in the previous paragraph, most of the conditions associated with retrosternal pain can be attributed to a malfunction of the gastric system or to malformations, congenital or otherwise, which cause a long rise in gastric juices. the esophageal tube such as to cause burning and irritation.
The following are the main causes:
Gastroesophageal Reflux Disease
It is a rather common condition and consists in the passage of food material from the stomach to the esophagus, therefore in the opposite direction to the physiological transit.
There are factors that predispose to the development of this disease:
- Obesity which often leads to increased pressure in the stomach;
- Foods: one of the major predisposing factors is the intake of foods that lead to an increase in gastric secretion, such as chocolate, coffee, alcohol, tea, mint and spices;
- Increased production of bile ;
- Hiatal hernia .
The glands present in the stomach wall have a very important function as they have the task of producing acid substances that allow food to be digested.
However, when there is an increase in the production of these substances (the causes of which are listed above) their passage in the direction of the esophagus. The mucosa of the esophagus, however, does not have the same degree of resistance to acid substances as the stomach, therefore it becomes inflamed, and if the situation is repeated constantly, an esophagitis develops.
Esophagitis can then present itself in different degrees of severity:
- heartburn when the esophageal mucosa shows only a transient inflammation;
- esophagitis proper when contact with acids causes lesions;
- gastroesophageal reflux disease when the disorder is chronic and damages the mucosa causing ulcers, scars and erosions;
- Barrett’s esophagus which is the most dangerous evolution of the disease. Barrett’s esophagus is a predisposing factor for the formation of an adenocarcinoma. Therefore it is a condition to keep under close eye with constant analysis and targeted therapy.
Hiatal hernia
We have seen that the formation of a hiatal hernia can be the cause of gastroesophageal reflux but is in turn a cause of retrosternal pain .
It is a sliding of the upper part of the stomach (bottom) towards the esophagus which then protrudes into the chest. This factor brings the two mucous membranes (gastric and esophageal) closer and facilitates reflux, which will then give that continuous burning sensation and heaviness and which worsens at night, therefore when lying down, also affecting the quality of sleep.
Gastritis
It is an inflammation of the gastric mucosa caused by a Helicobacter Pylori infection or due to the intake of non-steroidal anti-inflammatory drugs but it is also frequent in subjects who consume large quantities of alcohol and in smokers.
Gastritis causes pain in the upper chest and is sometimes associated with nausea. If not properly treated (mainly with proton pump inhibitors), gastritis can degenerate into more severe pathological pictures such as chronic atrophic gastritis, gastric ulcer and stomach cancer.
There are also milder manifestations, and generally more common, which cause the sensation of pain or heartburn, let’s see them below.
- Indigestion and diet : this is the most common cause of increased gastric juices, and therefore of pain and retrosternal burning . The causes are many, ranging from the intake of very large meals or inflammatory foods such as acidic, fatty, fried foods, chocolate, coffee and spices. The most predisposed subjects are those who suffer from anxiety , those who smoke and drink alcohol;
- Pregnancy: the retrosternal pain occurs mainly in conjunction with the last trimester of gestation and the main cause and to be linked to heartburn. This is because during pregnancy the growth of the uterus compresses the intestine and the stomach, and similarly for what happens in the hiatal hernia, the gastric juices come into contact with the mucous membrane of the esophagus more easily. At the end of gestation this disorder usually disappears.
At this point it is necessary to include cardio-vascular disorders , such as myocardial infarction and dissection of the aorta,
among the possible causes of retrosternal pain . These are rarer conditions than the previous ones, but despite this, the situation should certainly not be underestimated.
If the pains are acute and are accompanied by other symptoms such as shortness of breath, nausea, pains that extend to the arm and dizziness, you should promptly seek medical attention.
Which elements is the diagnosis based on?
The diagnosis of retrosternal pain is generally made following a specialist visit in gastroenterology on the recommendation of the treating physician. The factors that are taken into greater consideration are those relating to the symptoms felt by the patient, therefore: when the problem occurs, how long it lasts and if it is accompanied by other symptoms / conditions.
They are then evaluated by palpation of the chest and abdomen if there are swellings, masses or skin manifestations of interest.
On the basis of the data collected, we proceed by carrying out specialist tests such as blood tests and specific tests to view the state of health of the stomach and esophagus.
Generally one of the most common tests in case of continuous retrosternal pain is that of gastroscopy . It is an invasive examination through which, through a tube inserted through the nostril or through the mouth, it passes through the esophagus up to the stomach to explore the environment.
The visit is carried out by administering a mild general and local sedation to attenuate the gag reflex. The inserted tube has a built-in camera that transmits the images on a monitor visible to the doctor (who can thus see the presence of alterations or a hiatal hernia) and instruments that allow you to perform a small biopsy sample.
The tissue sample will then be analyzed to understand the cause of the mucosal inflammation: whether of bacterial or autoimmune origin.
What therapies we have available
The therapy is related to the cause that triggers the pain localized in the retrosternal area .
If the cause is due to the excessive production of gastric juices, a condition that can lead to gastroesophageal reflux disease , anti-inflammatory drugs and proton pump inhibitors are generally administered, then the action of a drug that calms the inflammatory process is combined with one that inhibits the production of gastric juices.
If it causes itit is due to the presence of a hiatal hernia or if this arises following reflux disease, a surgical intervention may also be considered.
In any case, it is recommended that you speak to your doctor promptly if you experience pain or burning in the back of the sternum . A timely diagnosis allows to establish an effective therapy, avoiding the negative evolution of pathologies which, if caught in time, can be appropriately controlled.
Consequently, he is wary in every way from resorting to do-it-yourself therapies or naturalistic remedies found on the internet or recommended by friends.
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