Heartburn is a burning sensation in the lower chest. Heartburn can be caused by different conditions, but most often it is related to gastroesophageal reflux disease (GERD).
Treatment may depend on the cause of your heartburn. In most cases, heartburn can be treated with medications, lifestyle changes, or surgery.
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Heartburn is caused by stomach acid that moves up into the esophagus. A muscle at the top of the stomach allows food to enter the stomach. This muscle also closes to prevent food and acid from moving back up into the esophagus. Certain conditions can keep this muscle from closing completely, which allows acid to flow out. This causes heartburn.
Factors that increase your chance of heartburn include: ObesitySmokingExercising or strenuous activity immediately after eatingLying down, bending over, or straining after eatingPregancyPrior surgery for heartburn such as vagotomyDiabetesSclerodermaCertain nervous system disordersIn-dwelling nasogastric tube
Foods and beverages associated with heartburn include: Alcohol use, especially in excessCaffeinated productsCitrus fruitsChocolateFried foodsSpicy foodsFoods made with tomatoes, such as pizza, chili, or spaghetti sauce
Medications and supplements associated wtih heartburn include: AnticholinergicsCalcium channel blockersTheophylline, bronchial inhalers, and other asthma medicationsNitratesSildenafilBisphosphonates
Heartburn symptoms usually occur after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.
Common heartburn symptoms may include: Burning feeling that starts in the lower chest and moves up the throatFeeling that food is coming back upSour or bitter taste in the throat
Other symptoms and complications of reflux include: Sore throatHoarsenessChronic coughFeeling of a lump in the throatAsthmaWaking up with a sensation of chokingDifficulty swallowing
If reflux persists, the acid can damage the esophagus. Symptoms of esophageal damage include: Bleeding and ulcers in the esophagusVomiting bloodBlack or tarry stoolsInflammation and scarring of the esophagusBarrett's esophagus— precancerous condition that can lead to esophageal cancer
Dental problems, which may occur because of the effect of stomach acid on tooth enamel
It is common to experience heartburn occasionally. If you have heartburn at least two times a week, make an appointment to see your doctor. Call your doctor if you have any symptoms of heartburn complications.
Heartburn and chest pain due to a
can feel similar. Get medical help right away if you have:
Squeezing or chest pressurePain in the left shoulder, left arm, or jawTrouble breathingSweating, clammy skinNauseaWeaknessLightheadednessPain that starts during activity or stress
If you are not sure of the cause of any pain in your chest, call for emergency help right away.
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may be able to make a diagnosis based on your symptoms. Your doctor may also take images of your esophagus or stomach with an
upper GI series
. A sample of your esophagus may be taken and sent for examination. This is often done during an
Other tests may include: 24-hour pH (acid) monitoringManometry to test muscle strength in the lower esophagus
Talk to your doctor about the best treatment plan for you. Treatment will depend on what is causing your heartburn. Treatment may focus on preventing heartburn from occuring or repairing damage causing the heartburn.
To help decrease the indicidence of heartburn: Keep a food diary of what you eat and what the reaction is. Make gradual changes to your diet and record the results.Avoid foods that trigger heartburn symptoms.Eat smaller portions.Allow at least 2-3 hours between meals and lying down, and exercise.Lose weight
Avoid belts and clothing that are too tight. This may increase pressure on the abdomen.Elevate head of bed 6-8 inches.
Medication may help relieve symptoms and repair any damage to the esophagus. Many prescription heartburn medications are available over-the-counter. Your doctor may recommend the following. Proton-pump inhibitors block acid production in the stomachH-2 blockers decrease the amount of acid secreted by the stomachAntacids neutralize stomach acid
If symptoms are severe and you cannot tolerate medication, surgery may be an option.
The most common surgery for heartburn is
. The doctor wraps the stomach around the esophagus. This creates pressure on the muscle at the opening to the stomach.
An advantage of endoscopic techniques is that they do not involve incisions in the skin. Instead, the doctor inserts a lighted device called an endoscope through the mouth and down the esophagus. The doctor can perform one of a variety of procedures with this scope to decreases the backward flow of stomach acid into the esophagus.
If surgery or endoscopy is successful, you may no longer need heartburn medication.
There are no current guidelines to prevent heartburn.
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Last reviewed March 2014 by Daus Mahnke, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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