In most cases, upper chest pain right after eating is non-cardiac (not related to the heart) but related to problems in the upper part of the gastrointestinal tract, i.e., the esophagus and stomach.
The most common cause of upper chest pain after eating
Acid reflux, and its chronic form – gastroesophageal reflux disease or GERD (two or more reflux episodes a week) – is probably the most common cause of non-cardiac upper chest pain after eating.
In fact, according to this study, the prevalence of GERD is around 20% in North America, Europe, and around 10% in Asia and Australia.
Why does GERD cause upper chest pain?
The cause of GERD is the reduced tone of the sphincter at the lower end of the esophagus.
When the lower esophageal sphincter is relaxed digestive juices from the stomach can flow back (reflux) into the esophagus. These highly acidic juices irritate the lining of the esophagus, causing a burning sensation around the center of the chest, called heartburn.
Heartburn is the typical symptom of GERD. Other symptoms are:
- Regurgitation.
- The difficulty of swallowing.
- Sometimes, gastric contents may reflux into thelarynx, causing cough, hoarseness, spasm of bronchi, and asthma.
- Sometimes stomach acids flow all the way up to the mouth, causing a sour taste.
How does GERD chest pain feel like?
It is difficult to distinguish between potentially serious cardiac chest pain and pain associated with GERD because of the same nerve supply of the heart and esophagus.
Differentiating features are:
- GERD also causes left-sided chest pain, but unlike heart-related chest pain, GERD pain does not radiate to the neck, jaws, left shoulder, and arm.
- When lying down, coughing, or taking a deep breath, GERD chest pain usually gets worse, cardiac does not.
Other causes of eating-related upper chest pain
While acid reflux and GERD are probably the most common triggers of upper chest pain after having a meal, several other health conditions can also cause this symptom:
- gastritis
- ulcer
- esophageal spasms
- hypersensitivity of the esophagus
- hiatal hernia
- gas pain
- esophageal perforation
- heart attack
- angina
- anxiety and stress
Gastritis
Gastritis is the inflammation of the lining of the stomach. Common risk factors of gastritis are:
- H. pylori infection
- alcohol consumption
- smoking
- NSAIDs or steroids
Besides upper chest pain, gastritis often causes nausea, vomiting, or upper abdominal pain.
Peptic ulcer disease
Peptic ulcer disease can cause upper chest pain and epigastric pain after eating. You may feel abdominal fullness, nausea, and vomiting after eating.
More severe symptoms, that require medical attention:
- blood in vomitus or stool
- tender abdomen
- weight loss
- recurrent episodes of vomiting
Peptic ulcer disease is either associated with H. pylori or NSAIDs intake. It is treated with antibiotics, antacids, and proton pump inhibitors after proper evaluation of the cause.
Drinking milk or lying flat might relieve mild chest pain after eating due to stomach ulcers.
Spicy foods often irritate existing ulcers (, albeit they don’t cause ulcers).
Upper middle chest pain & esophageal spasms
Muscle spasm of the esophagus causes squeezing, intense, and sudden upper chest pain with the feeling of food stuck in the throat.
Sometimes, it occurs after swallowing extremely hot or cold liquids and beverages. Food regurgitates back into the throat after swallowing.
Esophageal spasms may last for a few minutes to hours, causing a burning sensation in the center of the upper chest after swallowing liquids or solids.
Sometimes, it becomes difficult to distinguish between esophageal spasms and a heart attack due to the squeezing nature of upper chest pain, so it’s better to consult a doctor to avoid serious complications.
Hypersensitivity of the esophagus
A hypersensitive esophagus causes upper chest pain and heartburn after eating. Its stimulus may be mechanical, chemical, or emotional.
- Mechanically, the esophagus can be stimulated by swallowed bolus, air, or refluxed stomach content.
- Gastric acid, bile, and inflammatory mediators can cause chemical stimulation.
- Emotional stimulation may be due to stress, anxiety, or panic attack causing chest pain.
Sometimes the chest pain can be so severe, that you may feel like you have underlying heart disease. If pain is severe and mimicking a heart attack, proper evaluation and consultation are necessary.
Hiatal hernia
In a hiatal hernia, part of the stomach pushes up into the chest cavity, protruding through the diaphragm.
Common symptoms are:
- Chest pain occurs after eating due to undue pressure of the hiatal hernia on the stomach.
- A hiatal hernia often triggers acid reflux, therefore heartburn is also a common symptom.
- Difficulty in swallowing or breathing, and heartburn are common symptoms.
Sometimes hiatal hernia doesn’t cause any symptoms.
Gas pain
Gas is usually swallowed along with food or produced during digestion.
It is normal to have some gas after eating. However, too much gas can cause chest discomfort.
Gas pain can be prevented or relieved by:
- eating slowly and chewing the food well
- avoiding artificial sweeteners, soda, and smoking
- light physical exercise might also help
- find out which foods cause gas for you and avoid them
Gas pain caused by food should go away in a few hours.
Esophageal perforation – severe upper chest pain
Perforation of the esophagus is caused by forceful vomiting, retching, or ingestion of bones into the esophagus.
Symptoms are:
- severe upper chest pain
- difficulty in swallowing food
- rapid heart rate
- low blood pressure
- bubbles under the skin.
This condition usually needs surgical treatment depending on the size and location of the perforation.
Esophageal perforation might be a serious medical emergency.
Upper left chest pain due to heart attack
Intense, substernal, squeezing chest pain, radiating to neck, left shoulder, jaw, and down to left arm are characteristic symptoms of a heart attack (myocardial infarction).
Heavy, fatty meals are the most common triggers. Those who have an existing heart condition are at increased risk.
Heart and respiratory rates areusually high, and pulse may be irregular. Cough, production of frothy sputum, and wheezing may also occur. Shortness of breath occurs on exertion.
If you notice these signs and symptoms, immediately consult a cardiologist. ECG and cardiac markers confirm the diagnosis of myocardial infarction.
Sometimes it is very hard to distinguish a heart attack from GERD. Consultation is necessary to avoid serious consequences.
Upper left-sided chest pain due to angina
Angina pectoris is temporary chest pain due to decreased blood supply to the heart muscles.
Because of reduced blood flow, adequate oxygen is not provided to heart muscles, which causes pain and discomfort. It is not a heart attack, but it indicates an increased risk of a heart attack.
Symptoms of angina include:
- chest tightness and discomfort
- sweating
- nausea
- dizziness
- fatigue
- radiation of pain to neck, jaw, left shoulder, and arm
If you feel these symptoms, visit the nearest hospital as soon as possible and get yourself properly evaluated and checked.
Upper chest pain due to anxiety and stress
Upper chest pain associated with anxiety feels like sharp, shooting, persistent pain with chest tension and tightness. Some patients with anxiety issues have these symptoms after eating meals with or without panic attacks.
If you don’t have a previous history of chest pain associated with anxiety, you should consult your physician as soon as possible.
Relaxation techniques and taking good care of your physical health are usually helpful.
Radiating pain to the upper right chest after fatty foods
Pain caused by gallbladder issues usually radiates to the back (upper) and behind the breast bone mimicking a heart attack, even though the pain is usually felt on the right side.
Even though the gallbladder is in the abdomen, below the chest, it can cause pain all the way up to the right shoulder and right side of the neck. This is because an inflamed gallbladder can irritate a nerve (right phrenic nerve) that passes through the chest, right shoulder, and neck.
Most people with gallbladder problems feel severe right shoulder and upper chest pain.
Location of the pain
Different health conditions tend to trigger pain in different parts of the upper chest:
Upper left chest pain after eating
Cardiac problems, like a heart attack or angina, often cause pain on the left side of the chest. However, center or even right side chest pain is also possible because of cardiac reasons.
Gas, ulcers, heartburn might also trigger left side chest pain. Pain caused by pancreatitis might also radiate into the left part of the chest.
Eating & pain in the center of the upper chest
Eating-related pain in the center of the upper chest might be cardiac, but more often it is the esophagus that hurts.
Irritation caused by heartburn is the most common cause, but other esophageal disorders (e.g. spasms or hypersensitivity) or hiatal hernia are also possible triggers.
Upper right chest pain after having a meal
Right side pain, especially after eating fatty foods, is often associated with gallstones and the inflammation of the gallbladder.
Upper right chest pain might also be an atypical symptom of heart issues, but acid reflux, gas, ulcers might also be the cause.
As a rule of thumb, when experiencing sharp, severe chest pain, it is always a good idea to consult a health professional.
Common trigger foods of upper chest pain
Probably fatty, oily, fried foods and alcohol are the most common triggers of upper chest pain.
Such foods aggravate the symptoms of GERD,can cause heart issues. Fat can also exacerbate gallbladder problems.
GERD and acid reflux have various trigger foods, the most common ones are:
- coffee, tea, energy drinks
- citrus fruits
- tomato, onion
- sugary foods
- carbonated beverages
Spicy foods might irritate ulcers (, however, they don’t cause ulcers).
Very hot or very cold food and drink might cause esophageal issues, like spasms.
Eating too much or too fast might also be the culprit.
Final thoughts
Several health conditions and foods can trigger upper chest pain after eating.
It is important to properly diagnose the underlying medical issue, as cardiac problems or esophageal perforation might require immediate medical attention.
If pain is radiating to the jaw, left shoulder, and left arm, cardiac evaluation, and ECG should be done as soon as possible to avoid severe complications of heart diseases.
If you think a gastroesophageal disease is causing the symptoms, consult your gastroenterologist for proper evaluation and treatment.
Unhealthy foods and drinks – like alcohol or fatty meals – might aggravate the symptoms.
Sometimes the trigger foods are less obvious: depending on the underlying problem, hot beverages, soft drinks, tea, coffee, or spicy foods might all cause upper chest pain.
This article has been written by:
Department of Medicine and Surgery,
Nishtar Medical University and Hospital
