Heartburn is a burning sensation in the chest that occurs when stomach contents flow back into the oesophagus, the tube that carries food from the mouth to the stomach.
It is common and often occurs after eating. Symptoms can become worse when a person lies down or bends over. Some people may also notice a sour or bitter taste in the mouth or the sensation of food or liquid coming back up.
Despite its name, heartburn does not usually involve the heart. It is a digestive symptom linked to gastroesophageal reflux, or GER, which occurs when stomach contents move back into the oesophagus.
What causes heartburn?
A ring of muscle at the lower end of the oesophagus, known as the lower oesophageal sphincter, normally relaxes when food enters the stomach and then tightens to prevent stomach contents from flowing back.
When this muscle relaxes when it should not or does not close properly, stomach contents can move into the oesophagus. The resulting irritation can cause the burning sensation known as heartburn.
Heartburn is therefore not simply a result of the stomach producing too much acid. The main problem is the movement of stomach contents back into the oesophagus.
Common triggers
Certain foods and drinks can trigger or worsen heartburn, although triggers vary from person to person.
Common examples include fatty or fried foods, spicy foods, chocolate, coffee and other caffeinated drinks, alcohol, citrus products, tomato products and large meals. Eating close to bedtime can also make symptoms worse, particularly when lying down soon afterward.
Being overweight or pregnant can increase the likelihood of reflux. Smoking and some medicines can also contribute to GERD symptoms. A hiatal hernia, in which part of the stomach moves upward through the diaphragm, can also increase the risk.
Heartburn and GERD are not the same
Heartburn is a symptom. Gastroesophageal reflux disease, commonly known as GERD, is a longer-lasting condition in which reflux repeatedly causes troublesome symptoms or complications.
Occasional reflux is common. GERD is more persistent and may require medical treatment. Repeated exposure to stomach contents can cause inflammation of the oesophagus and, in some people, complications such as narrowing of the oesophagus or Barrett’s oesophagus, a change in the lining associated with an increased risk of oesophageal cancer.
How heartburn can be managed
People who experience occasional heartburn may be able to reduce symptoms by identifying and avoiding their personal triggers.
Eating smaller meals, avoiding food for about two to three hours before lying down, stopping smoking and maintaining a healthy weight can help reduce reflux symptoms in appropriate cases.
Over-the-counter medicines can also provide relief. Antacids can help with mild heartburn, while other medicines, including H2 blockers and proton pump inhibitors, reduce stomach acid. People who need these medicines frequently or whose symptoms do not improve should speak with a health professional rather than relying on self-treatment indefinitely.
There is no need for everyone with heartburn to follow a restrictive diet. Because triggers differ, identifying the foods and habits that actually worsen an individual’s symptoms is more useful than automatically avoiding large groups of foods.
When to see a doctor
Heartburn that occurs frequently, continues despite lifestyle changes or nonprescription treatment, or interferes with daily activities should be assessed by a health professional.
Medical attention is also important when symptoms include difficulty or pain when swallowing, persistent vomiting, unexplained weight loss, loss of appetite or signs of bleeding such as vomiting blood or passing black, tarry stools.
Doctors can often diagnose GERD from a person’s symptoms and medical history. When necessary, they may use tests such as an upper gastrointestinal endoscopy or oesophageal pH monitoring to investigate persistent symptoms, complications or other possible causes.
Chest pain should not automatically be assumed to be heartburn
Although heartburn can cause burning chest pain, chest pain can also have other causes, including potentially serious heart conditions.
Severe or unexplained chest pain, particularly when accompanied by pressure, difficulty breathing or pain spreading to the arm or jaw, requires urgent medical assessment. Heartburn and a heart attack can sometimes feel similar, and symptoms alone may not always distinguish between them.
Occasional heartburn is common, but recurring symptoms should not simply be ignored. Understanding the difference between occasional reflux and persistent GERD can help people seek appropriate care when symptoms continue.
