Heartburn Patient Information Fact Sheet

What is heartburn?
Heartburn is a type of indigestion. It occurs when acid in your stomach flows back up your esophagus, which runs from your stomach to the back of your throat. This acid irritates the lining of your esophagus causing the pain known as heartburn.

What are the symptoms of heartburn?
Symptoms may include a burning sensation in the center of your chest that travels up toward your throat, a taste of acid at the back of your throat, and small bits of food re-entering your mouth. The symptoms usually start after meals and get worse when you bend over or lie flat. Heartburn may get worse at night when you are lying down and may improve after belching or drinking milk. You may find it painful to swallow some types of food and drink, particularly hot drinks and spicy foods.

Why do people get heartburn?
There is a muscle at the bottom of your esophagus that acts as a valve and keeps food and acid in the stomach. If there is a lot of pressure on your stomach (eg, if you are pregnant, wear tight clothes or a belt, if you bend over, or if you are overweight) acid may be forced up through this valve into your esophagus. The medical term for this is gastroesophageal reflux disorder, or GERD. If your stomach becomes too full this can also push acid up through the valve into your esophagus. When acid touches the lining of your esophagus, it will burn and cause you pain. This is because the lining of the esophagus is not as tough as the lining of the stomach. Spicy foods and hot drinks can make this pain worse.

Smoking can cause the valve to work less effectively and increase the amount of acid produced in the stomach. Once the acid is in your esophagus it may cause damage to the lining, which over a period of time can make swallowing difficult.

Will I need any tests?
A diagnosis can usually be made from your symptoms alone. If your doctor is not sure of the exact diagnosis, or your symptoms do not get better with treatment, you may be referred to a specialist (likely a gastroenterologist) for tests. There are two main tests:

Barium swallow—this is where you swallow a white liquid that can be seen on an x-ray as it passes through your digestive system. This will show any acid reflux and help to rule out other medical problems such as stomach ulcers.

Endoscopy—this is a procedure in which a fiber-optic tube that relays images to a video monitor is passed through the mouth down into the stomach. This allows the doctor to examine your esophagus and stomach. The doctor may take a sample (biopsy) from the lining of your esophagus or stomach for laboratory tests.

How is heartburn treated?
The most important treatment is for you to change your lifestyle (see Self-Help) below). In addition there are several different types of medicine that can help heartburn:

Medicines that neutralize any excess acid are known as antacids and contain aluminum hydroxide, calcium carbonate, magnesium salts or sodium bicarbonate; most will contain a combination of two or more of these ingredients. Many antacids will also contain alginates (see below) or a medicine called simethicone, which helps gas bubbles in the stomach to join together and be expelled.

Medicines that reduce the amount of acid produced by the stomach fall into two classes: H2-antagonists and proton pump inhibitors. H2-antagonists include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac). Proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex). Medicines that tighten the stomach valve and make the stomach empty more quickly and help to reduce any acid reflux such as metoclopramide (Reglan).

Surgery is only needed if the valve mechanism is damaged and treatment has not stopped the symptoms.

Self-help measures

  • If you smoke, try to stop. Cutting down is not enough.
  • If you are overweight, try to reach your ideal body weight. Heartburn often stops when your weight is back to normal.
  • Avoid very large meals and drink alcohol in moderation.
  • Avoid spicy foods, hot drinks and fruit juice.
  • Drink low-fat milky drinks.
  • Avoid aspirin and drugs such as ibuprofen if possible, as they may aggravate heartburn.
  • Sit upright for about an hour after eating. Try to eat a few hours before going to bed.
  • Raise your bed-head by four to six inches (use bricks, books, or blocks) or sleep with three pillows.
  • Avoid tight clothing or belts around your stomach.
  • Squat or kneel to avoid bending and stooping.

Further information
National Digestive Diseases Information Clearinghouse (NDDIC): http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.aspx

Last Reviewed: May 2013