Heartburn

Heartburn is a burning feeling that rises from the stomach or lower chest up towards the neck. It can occur at any time but usually it happens after eating.

Heartburn may occur while simply bending or lying down, and it can disturb sleep in a few people. Many pregnant women get heartburn, which goes away after the baby is born. Frequent heartburn may be a symptom of reflux disease and requires medical attention.

Key points

    1. Heartburn is caused by stomach contents backing up into the oesophagus. It is often confused with indigestion, which is stomach pain or discomfort felt after eating. 
    2. Overeating or drinking too much coffee or alcohol are common causes of occasional heartburn.
    3. Frequent heartburn is often a symptom of reflux disease (GORD)
    4. Antacids are an effective treatment for occasional heartburn, but frequent heartburn requires medical attention.
    5. Treating frequent heartburn is important because, over time, acid reflux can damage your oesophagus.

Causes

The burning feeling is caused by acid and other juices leaking up (refluxing) from the stomach into the oesophagus (the passage between your stomach and your throat). The acids reflux in this way when the 'valve' at the top of the stomach (the lower oesophageal sphincter) stops working properly. The valve is meant to let food and fluid down, and nothing back up.

Occasional heartburn

  • Lifestyle factors. Heartburn may be triggered by factors such as being overweight, eating large and fatty meals, smoking, too much caffeine or alcohol, or physical activity after eating.
  • Non-steroidal anti-inflammatory drugs (eg, ibuprofen, diclofenac, naproxen) can aggravate heartburn as well as causing dyspepsia (a combination of symptoms that includes generalised upper abdominal pain, discomfort and bloating).
  • Pregnancy. Heartburn is also common at advanced stages of pregnancy when the womb pushes up against the stomach.

Frequent heartburn 

Heartburn is the most common symptom of reflux disease, which is also known as GORD (gastro-oesophageal reflux disease). Reflux disease is likely to be present when heartburn occurs on two or more days a week (although reflux disease may still be present with less frequent symptoms). Three out of four people with heartburn have reflux disease.

Who does heartburn affect? 

Most people experience heartburn at some time, often after a large meal. However, some people have it on a regular basis:

  • about 1 adult in 3 has some heartburn every few days
  • nearly 1 adult in 10 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.

Regular heartburn is more common in:

  • smokers
  • pregnant women
  • heavy drinkers
  • those who are overweight
  • those aged between 35 and 64 years.

What is the relationship between indigestion and heartburn? 

Indigestion and heartburn both describe symptoms. They are not diseases in themselves.

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

Symptoms

Typical symptoms of heartburn include:

  • burning in your oesophagus
  • sometimes acid taste in your mouth
  • upper abdominal pain or discomfort.

When to seek medical advice

Occasional heartburn as a result of over-indulgence is usually nothing to worry about. However,  if you suffer from frequent and persistent heartburn, visit your doctor. This could be a symptom of reflux disease. Without treatment, ongoing heartburn can lead to complications, including:

  • Reflux oesophagitis. In people who have heartburn frequently or for an extended period of time, the oesophagus can become inflamed (oesophagitis) because it is ‘burnt’ by the acid leaking up (refluxing) from the stomach. More...
  • Respiratory problems. People with heartburn may occasionally develop respiratory problems (where breathing is made harder) like asthma, pneumonia, choking at night and a sore throat in the morning.

It is important to talk to your doctor if you have ongoing heartburn. They will be able to prescribe medications to help heal any acid damage and prevent further damage occurring.

See your doctor urgently if you have:

  • 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 it is not heart pain causing your symptoms.

If you develop regular heartburn for the first time and are aged over 50 years, if medication has not improved your symptoms after four weeks or if your symptoms get more frequent or severe, it is important to see a doctor.

Diagnosis

To make a diagnosis of heartburn, your doctor with take your medical history and conduct a physical examination. Further tests may be required to determine how severe your heartburn is or if there is any damage to your oesophagus.

These tests may include:

Endoscopy - which 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. More...

pH monitoring - which involves using an acid monitor (a thin tube with a sensor at one end) to measure acidity levels in your oesophagus.

Treatment

Treating heartburn is important because, over time, acid reflux can damage your oesophagus. For some people with mild, infrequent symptoms, taking antacids can help to relieve the pain and discomfort. However, regular antacid use may conceal reflux disease.  If you have frequent heartburn, talk to your doctor. They will be able to prescribe more effective medications for heartburn.

There are three major categories of medications for treating heartburn:

  • Antacids. These medications neutralise stomach acids. They providing fast relief but do not help to heal existing oesophageal damage or prevent heartburn from happening again. Antacid brands include Mylanta, Eno, Quick-Eze and Gaviscon.
  • H2-receptor blockers. These medications reduce the production of stomach acid. They are slower acting than antacids but provide longer-term symptom relief. For many people, this treatment allows the oesophagus to heal and relieves the symptoms entirely. Includes ranitidine and cimetidine.
  • Proton-pump inhibitors. These medications block stomach acid production and help to heal the oesophagus. Includes omeprazole and lansoprazole.

Surgery 

Surgery is an option for a few patients if lifestyle changes and medications have not helped. Surgery aims to provide a cure by strengthening the valve (known as the oesophageal sphincter) at the top of the stomach. But, as with all surgery, there are associated risks.

Self care

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

  • watch what you eat and how much you eat. Avoid foods that trigger your heartburn and try not to overfill your stomach.
  • if you smoke, quit - smoking affects the functioning of the oesophageal sphincter
  • reduce alcohol and caffeine intake.
  • remain 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.
  • if you are overweight, try losing weight. Excess weight puts pressure on the stomach, causing acid to back up the oesophagus.
  • if symptoms occur often or at night, raise the head of your bed by 10cm (thus lifting your head slightly higher than your stomach)
  • avoid or reduce the use of non-steroidal anti-inflammatory drugs.

Learn more

Heartburn and gastro-oesophageal reflux disease NHS Choices, UK
Heartburn
 Heartburn Australia

References

Managing dyspepsia and heartburn in general practice - an update. Best Practice Journal, Feb 2011
Management of dyspepsia and heartburn. New Zealand Guidelines Group, Ministry of Health NZ, 2004

Credits: Editorial team, latest update July 2015.