Heartburn: Why it happens and what to do

Heartburn is a common problem created by acid reflux, a condition where some of the stomach contents are forced back up into the esophagus. It creates a burning pain in the lower chest.

Persistent acid reflux that happens more than twice a week is called gastroesophageal reflux disease (GERD). Heartburn is felt when stomach acid flows back up into the esophagus, the pipe that carries food from the mouth to the stomach. Heartburn is a symptom of GERD.
According to estimates from the American College of Gastroenterology, at least 15 million Americans experience heartburn every day. Learn more about stomach fluid, the sphincter between the esophagus and stomach, and how reflux can be harmful.

Fast facts on heartburn:

• Causes include diet, obesity, and lack of exercise.
• The primary symptom is a burning sensation in the throat or chest from stomach acid.
• In many cases, heartburn has little bearing on overall health.
• There are many treatments, including PPI medications (proton-pump inhibitors).

Causes

There are many causes of heartburn, including obesity and smoking.

Occasional heartburn is normal and is rarely a significant cause for concern.
Recurrent acid reflux results in the diagnosis of gastroesophageal reflux disease (GERD or GORD) and can have serious consequences for health and indicate other underlying health issues.
Gastroesophageal reflux disease is seen in people of all ages, and the cause is often attributable to a lifestyle factors, such as obesity, smoking, and low levels of exercise.
See here for more detail about the causes of gastroesophageal reflux disease (GERD).

Symptoms

Symptoms include a burning sensation in the middle of the chest.

The symptoms of heartburn are fairly obvious to most sufferers. The most common is a feeling of warmth or heat, sometimes burning, in the chest and throat, caused by the stomach acid.
Other symptoms include:

• burning sensation in the middle of the chest.
• rising pain, possibly reaching the jaw.
• burning and indigestion-like pain.
• foul, acrid taste in the mouth.

If a person experiences symptoms of acid reflux frequently, they should consult their doctor, who may refer them to a gastroenterologist - a specialist in gut medicine - for further investigation. Learn more about GERD.

Remedies

The main treatment for repeated heartburn caused by gastroesophageal reflux disease is to reduce the production of stomach acid.
Lifestyle remedies can help prevent or reduce heartburn.
Suggestions collected from physicians by researchers include:

• following a healthful diet, with a limited fat intake
• avoid eating before lying down and sit up straight while eating
• avoiding heavy lifting and straining
• monitoring and avoiding triggers, such as alcohol, caffeine, spicy food, full cream milk, gassy foods, such as soft drinks, and acidic food, such as tomato, lemon, or orange juices
• reducing weight, if appropriate
• avoiding smoking
• keeping fit through exercise
• eating small meals, more often
• having a review of existing medications

Not all of these have been supported by research. If they are, they could mean that fewer people need to use medication.

During pregnancy

Heartburn and indigestion are common in pregnancy, due to hormonal changes and the baby pressing against the stomach.
There are diet and lifestyle changes that can often help to relieve the symptoms.
The American Pregnancy Association suggests:

• eating five to six small meals throughout the day
• not lying down within an hour of eating
• avoiding fatty and spicy foods

Before eating, it may help to eat some yogurt or drink some milk, possibly with a spoonful of honey in it.

Treatment

Apart from lifestyle alterations, heartburn can be reduced by using drugs such as:

• antacids
• proton-pump inhibitors (PPIs)
• histamine-2 blockers

However, these can have adverse effects.

Prevention

Changes to lifestyle or behavior can prevent or improve heartburn symptoms.