Heartburn

Heartburn (acid reflux) is a burning feeling that rises up from your stomach or lower chest towards your neck.

Key points

  1. Heartburn is a common experience that happens when digestive acid leaks up from your stomach into your oesophagus. It is often confused with indigestion, which is stomach pain or discomfort felt after eating. 
  2. Heartburn can be caused or made worse by eating a large meal, being overweight or pregnant and smoking, some medicines, food and drink.
  3. See your doctor if you have regular heartburn as this can cause complications. You may have gastro-oesophageal reflux disease (GORD).
  4. Treatment of occasional heartburn includes lifestyle changes and taking over-the-counter medicines such as antacids. See your doctor if your symptoms haven’t improved after 4 weeks of treatment, your symptoms get more severe or you develop regular heartburn for the first time and you are aged over 50 years.
See your doctor urgently if you experience the following:
  • difficulty swallowing
  • pain on swallowing
  • chest pain or tightness
  • unexplained weight loss
  • anaemia
  • black bowel motions
  • vomit containing blood or dark granules.

These may be warning signs for more serious conditions such as gastric (stomach) ulcers or, very rarely, stomach or oesophageal cancer. Your doctor will also check that your symptoms are not caused by a problem with your heart.

What is heartburn?

The burning feeling is caused by digestive acid and other juices leaking up (refluxing) from your stomach into your oesophagus (the passage between your stomach and your throat).

The acids reflux in this way when the 'valve' at the top of your stomach (the lower oesophageal sphincter) stops working properly. The sphincter is meant to let food and fluid down, and nothing back up.

It is quite common for the sphincter to not work, especially when the pressure in your stomach is too high or when your stomach produces too much acid. However, in some cases, it’s unclear why the sphincter doesn’t work properly.

What is the relationship between indigestion and heartburn? 

Indigestion (dyspepsia) is a group of symptoms that describe stomach pain or discomfort experienced after eating. Heartburn is one of these symptoms. 

What are the symptoms of heartburn?

Typical symptoms of heartburn include:

  • a burning feeling that rises up from your upper stomach (tummy) or lower chest towards your neck
  • an acid taste in your mouth
  • upper abdominal (tummy) pain or discomfort.

Who does heartburn affect? 

Most people experience heartburn at some time, most often after a large meal. However, some people have it on a regular basis. About 1 in 3 adults has some heartburn every few days, and nearly 1 in 10 adults has heartburn at least once a day.

In many cases, it is mild and passes quickly. For others, it is so frequent and severe that it affects their quality of life.

You are at higher risk of getting heartburn if you:

  • smoke
  • are pregnant
  • drink a lot of alcohol
  • are overweight
  • are aged between 35 and 64 years.

What causes heartburn?

Occasional heartburn

The following are common causes of occasional heartburn:

Lifestyle factors – heartburn may be caused or triggered by factors such as:

  • being overweight
  • eating large meals
  • smoking
  • having too much caffeine or alcohol
  • physical activity after eating
  • bending forward or lying down
  • fatty or spicy foods
  • cola drinks or chocolate
  • stress and anxiety.

Non-steroidal anti-inflammatory (NSAID) medicines, such as ibuprofen, diclofenac and naproxen, can cause heartburn as well as causing indigestion (dyspepsia). Read more about indigestion (dyspepsia).

Pregnancy – heartburn is also common at advanced stages of pregnancy when your womb pushes up against your stomach. Read more about pregnancy.

Hiatus hernia – this is a condition where one of the organs in your abdomen (tummy) pushes up into your chest area through an opening in your diaphragm. Read more about hiatus hernia.

Frequent or regular heartburn 

If you have frequent or regular heartburn, you may have gastro-oesophageal reflux disease (GORD). Heartburn is the most common symptom of GORD (gastro-oesophageal reflux disease). You are likely to have GORD if you have heartburn on 2 or more days a week (although you may still have it with less frequent symptoms). Three out of 4 people with heartburn have GORD. See your GP or doctor if you have frequent or regular heartburn.

When should I seek medical advice?

Occasional heartburn is usually nothing to worry about. However, if you have frequent and persistent heartburn, see your doctor. Without treatment, ongoing heartburn or GORD can lead to complications.

  • Reflux oesophagitis – frequent or an extended period of heartburn can inflame your oesophagus (oesophagitis) because it gets ‘burnt’ by the acid leaking up (refluxing) from your stomach.  
  • Respiratory problems – people with heartburn occasionally develop respiratory problems (where breathing is made harder) like asthma, chronic cough, pneumonia, choking at night or a sore throat in the morning.

Read more about GORD.

You should also see your GP or doctor if:

  • your symptoms have not improved after 4 weeks of treatment with medicine
  • your symptoms get more frequent or severe
  • you develop regular heartburn for the first time and you are aged over 50 years.
See your doctor urgently if you experience the following:
  • difficulty swallowing
  • pain on swallowing
  • chest pain or tightness
  • unexplained weight loss
  • anaemia
  • black bowel motions
  • vomit containing blood or dark granules.

These may be warning signs for more serious conditions such as gastric (stomach) ulcers or, very rarely, stomach or oesophageal cancer. Your doctor will also check that your symptoms are not caused by a problem with your heart.

How is heartburn diagnosed?

To make a diagnosis of heartburn, your doctor will ask you some questions about your symptoms and examine you. If you have occasional heartburn, usually no test is needed.

Further tests may be required if you have frequent or regular heartburn to determine how severe your heartburn is or if there is any damage to your oesophagus.

These may include the following tests:

  • Endoscopy or gastroscopy – endoscopy involves having an endoscope (a flexible tube with a tiny video camera and light at one end) passed through your mouth down into your stomach to examine the lining of your digestive tract. Read more about endoscopy.
  • pH monitoring this test involves using an acid monitor (a thin tube with a sensor at one end) to measure acidity levels in your oesophagus.
  • Other tests – a chest x-ray or ECG may be done to rule out other conditions with similar symptoms.

How is heartburn treated?

Treating heartburn is important because, over time, acid reflux can damage your oesophagus. For some people with mild, infrequent or occasional symptoms, lifestyle changes and over-the-counter medicines such as antacids can help relieve pain and discomfort.

However, regular antacids use may hide GORD.  If you have frequent heartburn, talk to your doctor. They will be able to check for causes and prescribe more effective medicines.

There are 3 major categories of medicines for treating heartburn:

  • Antacids –  these medicines are used to lower the level of stomach acids. They provide fast relief but don’t help to heal existing oesophageal damage or prevent heartburn from happening again. You can buy antacids in your local pharmacy without a prescription by your doctor. Antacid brands include Mylanta, Eno, Quick-Eze and Gaviscon. Read more about antacids.
  • H2-receptor blockers – these medicines reduce the production of stomach acid. They are slower acting than antacids but provide longer-term symptom relief. For many people, this treatment allows your oesophagus to heal and relieves the symptoms entirely. Examples include ranitidine and cimetidine. These medicines may be prescribed by your doctor or the tablets can be purchased over the counter.
  • Proton pump inhibitors – these medicines block stomach acid production and help to heal your oesophagus. Proton pump inhibitors need to be prescribed by your doctor. Examples include omeprazole and lansoprazole. Proton pump inhibitors are often only needed for 4–8 weeks and shouldn’t be taken for longer than that. If you’ve been taking a proton pump inhibitor for more than 4–8 weeks and your symptoms have resolved, talk to your doctor about reviewing your medicines. Read more about proton pump inhibitors.

If you are pregnant, ask your doctor or pharmacist to find out whether these medicines are safe for you to take.

Surgery 

Surgery is an option for a few people if lifestyle changes and medicines have not helped. Surgery aims to provide a cure by tightening the oesophageal sphincter at the top of your stomach. But, as with all surgery, there are associated risks. 

Talk to your doctor to find out the best treatment options for you.

How can I care for myself with heartburn?

There are a number of lifestyle changes you can make to reduce symptoms of heartburn.

  • Watch what you eat and how much you eat. Try to identify and avoid foods, eg, fatty foods, spicy foods, chocolate, coffee, cola drinks, orange juice or alcohol, that trigger your heartburn and try not to overfill your stomach.
  • Quit smoking. Smoking affects the functioning of the oesophageal sphincter and allows acid reflux. Read more about quitting smoking.
  • Reduce alcohol and caffeine intake.
  • Stay upright after a meal – use gravity to help keep stomach acids down. Wait at least 3 hours after eating before lying down or going to bed.
  • Lose weight if you are overweight. Excess weight puts pressure on your stomach, causing acid to go back up your oesophagus.
  • Raise the head of your bed by 10cm (thus lifting your head slightly higher than your stomach) if symptoms occur often or at night.
  • Avoid or reduce the use of non-steroidal anti-inflammatories (NSAUDs).
  • Avoid tight clothing on your waist.
  • Relax and avoid stress.

Learn more

Heartburn and reflux Choosing Wisely, NZ
Acid reflux, heartburn, indigestion (GORD) HealthInfo Canterbury, NZ
Heartburn Health Direct, Australia
Heartburn and acid reflux NHS, UK
Acid reflux and oesophagitis Patient Info, UK

References

  1. Heartburn and reflux Choosing Wisely, NZ, 2016
  2. Acid reflux and oesophagitis Patient Info, UK
  3. Managing dyspepsia and heartburn in general practice - an update BPAC, NZ, 2011
  4. Management of dyspepsia and heartburn New Zealand Guidelines Group, Ministry of Health, NZ, 2004
Credits: Health Navigator Editorial Team. Reviewed By: Dr Rob Wallace, GP, Auckland Last reviewed: 04 Nov 2020