Heartburn

Last Updated March 2021 | This article was created by familydoctor.org editorial staff and reviewed by Beth Oller, MD

What is heartburn?

Despite its name, heartburn doesn’t affect the heart. Heartburn is a burning feeling in the lower chest, along with a sour or bitter taste in the throat and mouth. It usually occurs after eating a big meal or while lying down. The feeling can last for a few minutes or a few hours.

Symptoms of heartburn

Heartburn symptoms vary. They may be slight or extreme. The severity of heartburn may depend on what—and how much—you have eaten. The main symptom of heartburn is a burning feeling in your throat and chest. This happens when the acidic liquid from your food or drink comes back up into your esophagus. You may have difficulty swallowing or choke on this acid. It may even make you hoarse or cough.

What causes heartburn?

When you eat, food passes from your mouth down a tube called the esophagus. The esophagus is about 10 inches long in most people. To enter the stomach, the food must pass through an opening between the esophagus and stomach. This opening acts like a gate to allow food to pass into the stomach. Usually, this opening closes as soon as food passes through. But if it doesn’t close all the way, acid from your stomach can get through the opening and into your esophagus. This is called reflux. Stomach acid can irritate the esophagus and cause heartburn.

Hiatal hernia also can cause heartburn. Hiatal hernia is a condition in which part of the stomach is pushed up through the diaphragm (the muscle wall between the stomach and chest) and into the chest. Sometimes this causes heartburn.

How is heartburn diagnosed?

Heartburn symptoms are easy to recognize. If you think you may have heartburn, talk with your doctor. They will likely be able to diagnose you based on your symptoms.

Can heartburn be prevented or avoided?

You might be able to avoid heartburn by making some lifestyle changes.

  • Place 6- to 9-inch blocks under the legs at the head of your bed to raise it.
  • Try to eat at least 2 to 3 hours before lying down. If you take naps, try sleeping in a chair.
  • Quit smoking if you smoke.
  • Lose weight if you’re overweight.
  • Don’t overeat.
  • Eat high-protein, low-fat meals.
  • Avoid tight clothes and tight belts.
  • Avoid foods and beverages that give you heartburn.

Things that can make heartburn worse

Many things can make heartburn worse. Heartburn is most common after overeating, when bending over or when lying down. Pregnancy, stress, and certain foods can also make heartburn worse.

Things that can make heartburn worse:

  • Cigarette smoking
  • Certain drinks, including coffee (both regular and decaffeinated), other drinks that contain caffeine, alcohol, and carbonated drinks
  • Citrus fruits
  • Tomato products
  • Chocolate, mints, or peppermints
  • Fatty foods or spicy foods (such as pizza, chili, and curry)
  • Lying down too soon after eating
  • Being overweight or obese
  • Certain medicines (such as sedatives and some medicines for high blood pressure)

Heartburn treatment

If taking over-the-counter antacid medicines and lifestyle changes don’t help your symptoms, talk with your doctor. They may want you to take prescription medicine. Or they may schedule you for some tests. Tests might include:

  • pH test. This test checks for acid in the esophagus.
  • Endoscopy. This procedure checks for other conditions. During it, your doctor looks into your stomach through a long, thin tube that is inserted down your esophagus. You are sedated for this procedure, so you don’t feel it. Your doctor may also check for Helicobacter pylori, bacteria that can cause ulcers.

What about medicines for heartburn?

Several kinds of medicine can be used to treat heartburn. Antacids neutralize the acid that your stomach makes. For most people, antacids that you can get over the counter (without a prescription) give fast, short-term relief. You may need to try different medicines to find one that works best for you. However, if you use antacids too much, they can cause diarrhea or constipation. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide. One causes constipation while the other causes diarrhea. So they counteract each other.

Some brands of antacids include Maalox and Mylanta. Follow the directions on the package. H2 blockers (some brand names: Pepcid, Tagamet) reduce the amount of acid your stomach makes. Several are available without a prescription. Other medicines, such as omeprazole (brand name: Prilosec) and lansoprazole (brand name: Prevacid), also reduce how much acid the stomach makes. Metoclopramide (brand name: Reglan) reduces acid reflux. To find out what medicine is right for you, talk with your doctor.

Can heartburn be serious?

If you have heartburn only now and then, it’s probably not serious. However, if you have heartburn frequently, it can lead to esophagitis (an inflamed lining of the esophagus). If esophagitis becomes severe, your esophagus might narrow. This can cause bleeding or trouble swallowing. If you get more than occasional heartburn, it may be a symptom of something more serious. It could mean that you have:

  • Gastroesophageal reflux disease (GERD)
  • An inflamed stomach lining (gastritis)
  • Hiatal hernia
  • Peptic ulcer

Living with heartburn

Sometimes pain in the chest may be mistaken for heartburn when it’s really a sign of heart disease. If you have any of the symptoms below, call your doctor.

  • You have trouble swallowing or pain when swallowing
  • You’re vomiting blood
  • Your stools are bloody or black
  • You’re short of breath
  • You’re dizzy or lightheaded
  • You have pain going into your neck and shoulder
  • You break out in a sweat when you have pain in your chest
  • You have pain when you exercise
  • You have heartburn often (more than 3 times a week) for more than 2 weeks

Questions to ask your doctor

  • What type of over-the-counter medicine would work best for my heartburn?
  • What is causing my heartburn and what can I do about it?
  • Are there lifestyle changes I can make that will prevent heartburn?
  • Is heartburn a sign of another condition?
  • My favorite foods are causing heartburn. Besides avoiding these foods entirely, what can I do to prevent heartburn?

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