Diverticulitis is a condition where small, bulging pouches, called diverticula, develop in the wall of the large intestine and become inflamed or infected. The typical pain associated with diverticulitis is located in the lower left side of the abdomen, where the sigmoid colon resides. Although the source of the pain is in the lower abdomen, digestive inflammation can cause pain sensations that are felt elsewhere in the body, including the chest. This discrepancy in pain location can be alarming, often leading individuals to worry about life-threatening conditions. Understanding how pain signals travel and how other common digestive issues present can help distinguish the source of the discomfort.
Mechanisms of Referred Pain from Abdominal Inflammation
The phenomenon of feeling pain at a site distant from the actual source of injury is known as referred pain. This occurs because the internal organs (viscera) and the skin share common pathways of sensory nerves that travel up the spinal cord to the brain.
When nerve fibers from an inflamed organ, like the colon affected by diverticulitis, enter the spinal cord, they converge with somatic nerve fibers that innervate the chest or back. The brain can misinterpret the intense signal from the inflamed area, perceiving the pain as originating from the more sensitive superficial tissue.
The colon and other abdominal organs are primarily innervated by nerve roots ranging from the thoracic (Th10) down to the lumbar spine (L1). Severe inflammation or distention, which happens in complicated diverticulitis, can irritate these nerves, causing the pain to be felt higher up the torso, sometimes registering in the lower anterior chest area.
Referred pain from diverticulitis is considered a rare presentation. However, documented cases exist where inflammation in the sigmoid colon was the source of lower chest discomfort. This unusual pain pattern emphasizes that the location of the pain does not always directly indicate the location of the affected organ.
Other Gastrointestinal Sources of Chest Pain
While diverticulitis can cause referred chest pain, other upper gastrointestinal (GI) conditions are far more common culprits for chest discomfort that mimics heart problems. The esophagus runs alongside the heart and shares many sensory nerve pathways, making it difficult for the brain to differentiate between esophageal pain and cardiac pain.
The most frequent causes of non-cardiac chest pain include:
- Gastroesophageal Reflux Disease (GERD): Often called heartburn, this involves the backflow of stomach acid into the esophagus, creating a burning sensation that can radiate to the chest and back. GERD pain commonly occurs after eating, when lying down, or when bending over, and is usually relieved by antacids.
- Esophageal spasms: These are abnormal, intense contractions of the muscles lining the esophagus. Spasms can cause a sudden, crushing, or squeezing chest pain often confused with a heart attack.
- Excessive gas buildup: Gas in the stomach or colon can press against the diaphragm, the muscle separating the chest and abdominal cavities, leading to discomfort perceived in the chest.
- Peptic ulcers: Sores in the stomach or small intestine lining can cause a gnawing or burning pain that may extend upward to the chest area.
- Hiatal hernia: This occurs when part of the stomach pushes up through the diaphragm, which can result in chest discomfort.
These upper-GI issues are much more likely to be the source of unexplained chest pain than pain referred from lower-GI diverticulitis.
When Chest Pain Requires Emergency Medical Attention
Distinguishing between digestive pain and a life-threatening cardiac event can be challenging, even for medical professionals. Because of this overlap, any severe or unexplained chest pain must be treated with immediate caution and evaluated by emergency medical services. There are specific “red flag” symptoms that strongly suggest the chest pain is related to a heart problem rather than a benign digestive issue.
- Pain that radiates significantly to other parts of the body, such as the left arm, jaw, neck, or back, is a primary warning sign.
- Chest discomfort accompanied by symptoms like shortness of breath, sudden dizziness, cold sweats, or intense nausea should also prompt an immediate emergency call.
- Pain that feels like crushing pressure or tightness and does not subside quickly after rest or with antacids is highly concerning.
- Chest pain that consistently worsens with physical exertion and improves with rest is a classic indicator of reduced blood flow to the heart, a condition known as angina.
Although digestive issues can cause pain, it is impossible for a person to accurately self-diagnose the source of severe chest pain. Seeking immediate medical attention ensures that life-threatening cardiac conditions are ruled out first.