Heartburn

Heartburn is a burning or hot feeling behind the breastbone. It often starts after eating and may move upward toward the throat. Despite its name, heartburn usually comes from the digestive system rather than the heart.

A common cause is acid reflux. This happens when stomach contents flow backward into the esophagus, the tube carrying food from your mouth to your stomach. The esophagus does not have the same protective lining as the stomach, so reflux can irritate it.

Occasional heartburn is common and may settle with simple changes or non-prescription medicine. Repeated symptoms can be a sign of gastroesophageal reflux disease, often shortened to GERD. However, heartburn has several possible causes, and chest discomfort should not automatically be assumed to be reflux.

Heartburn often feels like a burning sensation in the middle of the chest. It may begin in the upper abdomen and rise toward the throat. The discomfort can become worse after a large meal, when bending over, or when lying down.

You may also notice:

• A sour, bitter, or acidic taste
• Fluid or partly digested food rising into the throat
• Burping, bloating, or nausea
• Symptoms that disturb sleep
• Throat irritation, hoarseness, or coughing

The return of stomach contents into the mouth is called regurgitation. It can happen with or without burning.

Heartburn can sometimes resemble pain caused by a heart or lung problem. How the discomfort feels is not always enough to tell the causes apart.

The most common cause is acid reflux. A ring of muscle at the lower end of the esophagus normally helps keep stomach contents in place. If it relaxes at the wrong time or does not close well, reflux can occur.

Large or high-fat meals can increase symptoms in some people. Eating close to bedtime, lying down after eating, alcohol, smoking, and certain foods or drinks may also contribute. Triggers differ between people, so you do not need to avoid every food commonly linked with heartburn.

Pregnancy can cause heartburn because hormonal changes relax digestive muscles and the growing uterus puts pressure on the stomach. Carrying extra weight around the abdomen can also increase pressure.

A hiatus hernia may contribute. This means part of the stomach moves upward through an opening in the diaphragm, the muscle beneath the lungs.

Some medicines can irritate the esophagus or make reflux more likely. Examples include certain pain relievers and medicines used for other long-term conditions. Do not stop a prescribed medicine on your own; ask a doctor or pharmacist whether it could be contributing.

Less common causes include inflammation or narrowing of the esophagus, an ulcer, an esophageal movement disorder, or an allergic condition called eosinophilic esophagitis. Heart and lung conditions can also cause discomfort that is mistaken for heartburn.

Call emergency services for new, severe, or unexplained chest pain, especially if it feels like pressure, squeezing, or heaviness. This is particularly important if the discomfort spreads to your arm, jaw, back, or shoulder, or occurs with breathlessness, sweating, faintness, weakness, or nausea. Do not wait to see whether an antacid helps.

Emergency assessment is also appropriate if you vomit blood, vomit material resembling coffee grounds, or pass black, tar-like stool. These can be signs of bleeding in the digestive tract.

Seek same-day medical advice if swallowing becomes difficult or painful, food feels stuck, or you are vomiting repeatedly. Prompt assessment is also important if you cannot keep fluids down.

Book a routine appointment if heartburn keeps returning, affects sleep or daily activities, or continues despite appropriate non-prescription treatment. You should also arrange an appointment if you have unexplained weight loss, ongoing nausea, a persistent cough or hoarse voice, or regularly need medicine to control symptoms.

A doctor will usually ask when the burning occurs, what it feels like, and whether food, activity, or body position affects it. They may ask about swallowing problems, regurgitation, weight changes, medicines, pregnancy, smoking, alcohol, and your personal and family medical history.

Many people with typical symptoms do not need tests straight away. A doctor may suggest lifestyle changes or a trial of treatment and review how you respond.

An upper endoscopy may be recommended if symptoms persist or there are concerns such as trouble swallowing, bleeding, or weight loss. During this test, a thin flexible camera is passed through the mouth to examine the esophagus and stomach. Small tissue samples may be taken.

Other tests can measure how often acid enters the esophagus or how well its muscles work. If your symptoms could be heart-related, assessment may include an electrocardiogram, or ECG, and other urgent tests.

Treatment depends on how often symptoms occur and what appears to trigger them. Keeping a brief record of meals, symptoms, medicines, and bedtime may help you identify personal patterns.

Helpful measures can include:

• Eating smaller meals and avoiding lying down soon afterward
• Limiting only the foods or drinks that clearly trigger symptoms
• Raising the head of the bed if symptoms occur at night
• Working toward a comfortable weight if abdominal pressure contributes
• Avoiding smoking

Stacking ordinary pillows may bend your body and be less helpful than raising the upper end of the bed or using a supportive wedge.

Antacids can neutralize stomach acid and may give short-term relief. Alginate products form a barrier above stomach contents. H2 blockers and proton pump inhibitors like omeprazole or lansoprazole, or PPIs, reduce acid production and last longer. Follow the product label and ask a pharmacist if you take other medicines, have kidney or liver problems, are pregnant, or are unsure which product is suitable.

Regular or prolonged self-treatment can hide a problem that needs assessment. If medicine is not helping, symptoms quickly return, or you need it frequently, arrange a medical review.

Occasional heartburn may improve within minutes to hours, especially when its meal or position trigger has passed. Symptoms caused by pregnancy, medicine, a hiatus hernia, or ongoing reflux may continue or return until the contributing factor is addressed.

Repeated reflux can sometimes inflame the esophagus. Effective treatment usually controls symptoms and allows irritation to heal, but symptoms may come back after treatment stops. Follow-up is useful if your pattern changes or your usual treatment becomes less effective.

Is heartburn the same as acid reflux?

No. Acid reflux is the backward movement of stomach contents. Heartburn is one symptom reflux can cause. Reflux may also cause regurgitation or throat symptoms without burning.

Can stress cause heartburn?

Stress may worsen symptoms or make discomfort feel more noticeable. It can also change eating, sleep, alcohol use, and other habits. However, stress should not be assumed to explain new or severe chest pain.

Should I avoid coffee, tomatoes, or spicy food?

Only if they clearly trigger your symptoms. Triggers are personal, and broad food restrictions are often unnecessary. A short symptom record can help identify a consistent link.

Can heartburn happen without eating?

Yes. It may occur at night, during pregnancy, after taking certain medicines, or when bending and exercising. Chest pain during exertion needs medical assessment because it may not be heartburn.

Does milk treat heartburn?

Milk may briefly soothe burning, but it is not a reliable treatment. Higher-fat milk may worsen reflux in some people.