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Heartburn

Medically Reviewed by Poonam Sachdev on September 28, 2021

What Is Heartburn?

Heartburn is an irritation of the esophagus -- the tube that connects your throat and stomach. It's caused by stomach acid. This leads to a burning discomfort in your upper belly or below your breastbone.

Despite its name, heartburn has nothing to do with the heart. But some of the symptoms are similar to those of a heart attack or heart disease.

Heartburn Symptoms

Heartburn feels just like its name: a burning sensation behind your sternum, or breastbone, in the middle of your chest. You might also feel it in your throat. You may also:

  • Feel pain in your chest when you bend over or lie down
  • Have a hot, acidic, bitter, or salty taste in the back of your throat
  • Find it hard to swallow

How long does heartburn last?

It can vary. For some folks, it can last just a few minutes. Sometimes it can last for several hours.

Heartburn happens about once a week for up to 20% of Americans and is common in pregnant women.

Heartburn Causes and Risk Factors

Heartburn symptoms can start up because of a problem with a muscular valve called the lower esophageal sphincter (LES). It's located where the esophagus meets the stomach -- below the rib cage and slightly left of center.

Normally, with the help of gravity, the LES keeps stomach acid right where it should be -- in your stomach. When it's working right, the LES opens to allow food into your stomach or to let you belch, then closes again. But if the LES opens too often or doesn't close tightly enough, stomach acid can seep into the esophagus and cause a burning sensation.

If your LES doesn't tighten as it should, there are often two things that contribute to the problem. One is overeating, which puts too much food in your stomach. Another is too much pressure on your stomach, often due to obesity, pregnancy, or constipation.

Certain foods can relax your LES or increase stomach acid, including:

  • Tomatoes
  • Citrus fruits
  • Garlic and onions
  • Chocolate
  • Coffee or caffeinated products
  • Alcohol
  • Peppermint

Meals high in fats and oils (animal or vegetable) often lead to heartburn, as do certain medications. Stress and lack of sleep can raise how much acid your stomach makes and can cause heartburn.

If you're pregnant, the hormone progesterone can relax your LES and lead to heartburn. Smoking also relaxes the LES and increases stomach acid.

Heartburn Diagnosis

If your heartburn goes on for a long time, it may be a sign of a more serious condition known as gastroesophageal reflux disease (GERD). Your doctor may be able to tell if GERD is the cause of your heartburn from your symptoms. But to tell how serious it is, they may do several tests, including:

  • X-ray: You’ll drink a solution called a barium suspension that coats the lining of your upper GI (gastrointestinal) tract -- your esophagus, stomach, and upper small intestine. This coating lets doctors see defects that could mean a problem in your digestive system.
  • Endoscopy: A small camera on a flexible tube is put down your throat to give a view of your upper GI tract.
  • Ambulatory acid probe test (esophageal pH monitoring): Sometimes, your doctor may recommend a 24-hour esophageal pH probe study, especially if you have unusual symptoms, such as throat or chest or abdominal pain, coughing, or asthma-like symptoms. An acid monitor is put into your esophagus and connected to a small computer that you can wear on a belt or shoulder strap. It measures when stomach acid backs up into your esophagus and for how long. A newer technique called Bravo measures up to 48-hour acid; it is done using wireless pH sensors, which eliminates the need for a tube insertion.
  • Esophageal motility testing (esophageal manometry): A catheter is put into your esophagus and measures pressure and movement.
  • Electrocardiogram (ECG): To see if your heart is the cause of your symptoms, you might have an ECG, a recording of the heart's electrical activity.

Heartburn Treatment

Usually, you can treat heartburn with over-the-counter medicines, including:

  • Antacids: These medications lessen the acid in your stomach to ease heartburn pain. They can also sometimes help with stomach pains, indigestion, and gas.
  • Acid blockers and proton pump inhibitors: These drugs lessen the amount of acid your stomach makes. They can also calm symptoms of acid indigestion.

If OTC medicines don’t work for you, your doctor may give you a prescription version of these types of medicines.

Heartburn Complications

Occasional heartburn isn't dangerous. But GERD can sometimes lead to serious problems, such as:

  • A long-term cough
  • Laryngitis
  • Inflammation or ulcers of the esophagus
  • Problems swallowing because of a narrow esophagus
  • Barrett's esophagus, a condition that can make it more likely to get esophageal cancer

Heartburn Prevention

Follow these tips to help prevent heartburn:

  • Keep a healthy weight.
  • Avoid foods and beverages that make symptoms worse.
  • Wear clothes that are loose around the waist.
  • Eat smaller meals, and try not to overeat.
  • Don't smoke.
  • Avoid constipation.
  • Get enough sleep and minimize stress.
  • Wait 3 hours after eating before you lie down.
  • Elevate the head of your bed 6 to 8 inches.
WebMD Medical Reference

Sources

SOURCES:

American Journal of Gastroenterology: “Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease,” “Guidelines for the management of dyspepsia.”

Pettit, M. Pharmacy World and Science, December 2005. 

Feldman, M. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., Saunders, 2010.

National Digestive Diseases Information Clearinghouse: "Digestive Diseases Statistics for the United States."

Gabbe, S. Obstetrics: Normal and Problem Pregnancies, 5th ed., Churchill Livingstone, 2007.

Cleveland Clinic: "Heartburn Symptoms," “Heartburn,” “Heartburn: Care and Treatment.”

Mayo Clinic: “Heartburn.”

University of California, San Francisco: “Heartburn Diagnosis.”

National Heartburn Alliance.

DeVault, K. and Castell, D. American Journal of Gastroenterology, 2005; vol 100: pp 190-200.

Talley, N. and Vakil, N. American Journal of Gastroenterology, October 2005; vol 100: pp 2324-2337.

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