Heartburn

Struggling with heartburn? Here’s what you need to know to find relief.

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What is heartburn?

Heartburn is a burning pain in your chest. This pain is caused by stomach acid rising from your stomach into your oesophagus (the pipe that takes food from your mouth to your stomach).

This can cause:

- Burning pain in the middle of your chest

- Pain which is worse when you bend over or lie down

- Burning pain that radiates into your back

By learning more about the causes of, tests for, and treatment for heartburn, you can understand it better and make informed decisions to get back on track.

Why does heartburn happen?

There are several possible causes of heartburn, and it’s important to find out what’s causing yours.

Here are the main causes of heartburn:

Gastroesophageal reflux disease (GORD)
Hiatus hernia, when part of your stomach moves up into your chest
Surgery you’ve had in the past (especially bariatric surgery)
Certain foods and drinks, such as alcohol, coffee, chocolate, and fatty or spicy foods
Being overweight
Smoking
Pregnancy
Stress or anxiety
Medication, such as anti-inflammatory painkillers
Overgrowth of bacteria in your small intestine (this is called SIBO)

Diagnosing heartburn

Diagnostic testing allows us to pinpoint the exact cause so we can recommend the right solution.

Oesophageal manometry, 24-hour pH, malabsorption breath tests, SIBO & gastric emptying

At the Functional Gut Clinic, we use the following highly accurate and trusted diagnostic tools, to identify the underlying cause of your heartburn:

Oesophageal manometry – which measures the function of your oesophagus (food pipe)

24-hour pH impedance monitoring – which looks at whether you have any reflux

Carbohydrate malabsorption breath test – which finds out if you have certain food intolerances (lactose or fructose)

Small intestinal bacterial overgrowth (SIBO) breath test – which finds out if you have an overgrowth of bacteria in your small intestine (called SIBO)

Gastric emptying test – which measures how quickly food leaves your stomach

Find out more and book your test

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Most Common Triggers of GERD and How to Avoid Them

Common Triggers of GERD & How to Avoid Them

Education| Reflux

March 31, 2025•5 min read

Gastro-oesophageal reflux disease (GORD), or acid reflux, is a condition where the stomach contents reflux into the oesophagus (food pipe). Common symptoms include heartburn, chest pain, hoarseness, coughing, difficulty swallowing, and regurgitation.

GORD is linked to several underlying causes. These range from a hiatus hernia, where part of the stomach lies in the chest, to pregnancy, where the pressure in the abdomen pushes the food contents back up into the oesophagus.

Several GORD triggers increase the risk of an acid attack. These triggers either affect the muscles that prevent the backflow of stomach contents into the oesophagus or increase the production of stomach acid. Let’s take a closer look.

Common Reflux Triggers

Not sure if you have acid reflux? Consider if these triggers cause your symptoms to worsen:

Spicy, Fatty, or Acidic Foods

What you eat is almost certainly a major factor in causing acid reflux. After all, the more acid that’s present in your stomach, the more severe the symptoms will be.

Most of these foods are either acidic or trigger the release of acid from the stomach. For example, high-fat foods, such as pizza or chips, increase the risk of acid reflux via the following mechanisms:

Delayed Gastric Emptying. Fatty foods linger in the stomach for longer as they’re harder to digest. Prolonged gastric retention increases the risk of backflow.
Lower Oesophageal Sphincter (LOS) Relaxation. The LOS sits between the stomach and oesophagus, acting as a valve to prevent the stomach contents from moving backwards. Both fatty and spicy foods can relax the LOS.
Stimulating Acid Production. Spicy foods, especially those containing chilli or pepper, can stimulate the stomach lining to produce more acid. This increase in acid can contribute to the discomfort and symptoms associated with acid reflux.
Irritation of the Oesophagus. Both types of foods can also directly irritate the oesophageal lining if the tissue is already sensitive or damaged from existing reflux, exacerbating symptoms and discomfort.

Acidic foods, on the other hand, simply lower the pH of your stomach. Foods to avoid include:

Coffee
Citrus fruits
Tomatoes
Peppermint
Caffeine
Chocolate
Garlic
Onions

Smoking

Smoking is another major trigger for GORD. It acts via several mechanisms, including reducing saliva production, which neutralises stomach acid, increases acid production, and impairs LOS function.

However, smoking can also exacerbate the complications of prolonged reflux. Acid reflux damages the oesophagus, potentially leading to oesophageal cancer. Smoking is carcinogenic and can further increase the risk of cancer.

Drinking Alcohol

Alcohol is a known muscle relaxant. It causes your LOS to relax and allows acid to reflux into the oesophagus. It also irritates the stomach lining, triggering the production of more acid. The solution? We recommend the following tips:

Limit your alcohol consumption to a few drinks.
Opt for white wine instead of red wine.
Dilute your alcoholic drink with water or soda water.
Monitor your alcohol consumption.
Bring along a pack of antacids to counteract heartburn.

Eating Large Meals or Too Close to Bedtime

Perhaps the biggest mistake people with GORD make is overeating. It’s often behind GORD flare-ups and is one of the easiest GORD triggers to avoid.

Your LOS usually stays closed due to the upward pressure against it – it works like a valve. However, if the pressure in your stomach gets high enough, it can force the LOS to open, allowing the stomach contents to move into the oesophagus.

Eating larger meals will rapidly increase your stomach pressure. Instead of eating three big meals a day, it’s sensible to restrict your diet to six small meals – or three meals and three snacks. This prevents your stomach from becoming too full.

Eating too close to your bedtime or too quickly is also a problem. This is likely to trigger acid production and the LOS opening just before going to be, which is likely to lead to a flare-up. Try to take smaller bites, chew your food thoroughly before swallowing, and take your time.

Lying Down After Eating

The only reason GORD flare-ups don’t occur all the time is due to gravity. It prevents the stomach contents from entering the oesophagus. When you lie down, the stomach contents are free to flow down towards the mouth. Plus, the stomach contents press harder against the LOS, once more forcing it open.

We recommend:

Wait at least three hours after meals before lying down.
Raise the head of your bed by 6-8 inches using blocks or a wedge pillow.
Sleep on your left side to minimise acid reflux.
Wear loose clothing to reduce pressure on your stomach.

Wearing Tight Clothes

What you wear is a common reflux trigger. Remember, the more pressure in your abdomen, the greater the chance of the LOS opening. Wearing extremely tight clothing around the abdomen squeezes the stomach, forcing food and acid into the oesophagus.

Getting Too Stressed

You might not think of emotions as a GORD trigger. However, stress can stimulate stomach acid production, reduce LOS function, and alter your lifestyle habits. It’s not clear how stress causes greater stomach acid release or impairs LOS function, but it might be connected to cortisol levels.

That being said, practicing mindfulness, getting enough exercise, and taking time to destress can help relieve your symptoms. Reducing stress also makes it easier to choose healthier options instead of fatty foods, which can trigger GORD.

Testing for Acid Reflux

Dealing with the common triggers for GORD is only part of the solution. If you suspect you’ve got acid reflux, you need to get tested to confirm the diagnosis.

Here at The Functional Gut Clinic, we guide patients through the testing process and offer two kinds of testing:

24-hour Reflux Testing monitors the presence of acid in your stomach and is used to diagnose GORD.
Oesophageal Manometry measures pressure changes in the oesophagus, detecting if there’s a problem with the LOS or muscles used to swallow.

Our team can help advise you on the best option for your symptoms. We’ll also talk you through your results after the test to ensure you receive the right treatment.

It's important to remember that chronic acid reflux can also impact oral health, leading to dental erosion and other issues.

The Functional Gut Clinic

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Heartburn is a burning pain in your chest.

Heartburn is often experienced after eating and can last anywhere from a few minutes to several hours. The stomach releases more acid after eating certain foods, including spicy dishes, fatty foods, citrus fruits, tomato-based products, garlic, and caffeinated drinks. The more acid that is produced, the greater the risk of heartburn.

Other factors include obesity, smoking, stress, pregnancy, and eating too close to bedtime.

What are the symptoms of heartburn?

Heartburn primarily causes an uncomfortable or burning sensation in the middle of your chest. You may also experience:

A burning sensation in your throat
A strong acidic or sour taste in your mouth
Difficulty swallowing (dysphagia)
A feeling of pressure or pain behind your breastbone
Repeated coughing
Hoarse voice

In addition to these symptoms, the pain from the acid can get worse when lying down or bending over. This is because the acid flows out of the stomach and into the oesophagus. Whenever you lie down, you increase the risk of heartburn-related symptoms.

Constant heartburn is a sign of a severe underlying condition. Most people experience heartburn in episodic attacks – usually after consuming certain foods. If the heartburn is persistent, it’s crucial to speak to a medical professional. You can also consider organising a test via The Functional Gut Clinic (see below).

What causes heartburn?

Heartburn occurs when the contents of the stomach enter the oesophagus (the food pipe connecting your stomach to your throat). Usually, the stomach contents are prevented from going back into the oesophagus by a juncture called the lower oesophageal sphincter. However, in some people, this sphincter doesn’t function properly.

Heartburn is a symptom of gastroesophageal reflux disease (GORD). GORD simply refers to the backflow of acid from the stomach into the oesophagus. GORD is the condition; heartburn is the symptom.

Several factors increase the risk of heartburn. The causes of heartburn and GORD either increase acid production within the stomach or affect the functioning of the lower oesophageal sphincter. These include:

Hiatal hernia. A hiatus hernia involves a part of your upper stomach penetrating through the diaphragm (the layer of muscle separating your chest from your stomach). This usually occurs due to a weakness or tear.
Pregnancy. If you become pregnant, the increased pressure during the third trimester (and sometimes earlier) forces the stomach contents backwards, causing heartburn.
Surgery. Previous surgery, especially bariatric surgery, increases the risk of not only heartburn but also a hiatus hernia.
Smoking. Smoking is closely linked to heartburn and GORD. People who quit smoking notice a significant reduction in heartburn symptoms.

Overweight or obesity. Being overweight or obese is a major risk factor for GORD. This is likely due to the increased pressure in the stomach alongside a diet high in fatty, processed foods.
Medications. Certain medications, such as anti-inflammatory painkillers (e.g., ibuprofen or aspirin), sedatives, and blood pressure medications, can increase your risk of heartburn.
Stress or anxiety. An increase in stress or anxiety can increase acid production in some people, leading to heartburn. It’s often accompanied by another factor.
Small intestine bacterial overgrowth (SIBO). Excessive bacterial growth in the small intestine leads to increased abdominal pressure and subsequent acid reflux, which can cause heartburn. Managing SIBO often reduces these symptoms.

Foods to avoid

Acid production is a normal part of the stomach’s function. The acid helps digest food. Certain foods require more acid to digest, triggering an increased production in the stomach.

For most people, this isn’t an issue as the acid flows into the small intestine. However, if you struggle with heartburn and GORD, then it’s sensible to limit or avoid certain foods. These include:

Citrus fruits (like oranges and grapefruits)
Tomatoes and tomato-based products
Spicy foods
Garlic and onions
Chocolate
Mint
Fatty or fried foods
Caffeinated beverages (such as coffee and tea)
Carbonated drinks
Alcohol

It’s not just the food. Eating an excessively large meal, wearing tight clothes, and lying down soon after eating can increase the risk of heartburn. If you’re experiencing persistent heartburn, it’s often linked to diet rather than another factor.

Is heartburn the same as GORD?

No. Heartburn specifically refers to the burning sensation in the chest. GORD is the underlying condition involving the backflow of acid. Heartburn is a symptom of GORD. Acid reflux is sometimes used as shorthand for GORD – however, not every attack of acid reflux is an example of GORD.

Acid reflux refers to any episode of acid backflowing into the oesophagus. If the episodes occur two or more times a week, it is diagnostic for GORD. Most people experience acid reflux episodes occasionally. This can increase in frequency as acid reflux progresses to GORD. You should speak to a doctor if you notice this change.

Does acid reflux always cause heartburn?

Heartburn is always caused by the backflow of acid into the oesophagus. Several other conditions can create a similar sensation. For example:

Oesophageal ulcers. Ulcers occur due to erosion of the oesophageal lining. Often associated with acid reflux or overusing anti-inflammatory medications.
Oesophagitis. Severe inflammation of the oesophagus is closely linked to GORD. However, it can also be caused by medications and infections. An allergic condition known as eosinophilic oesophagitis can also cause heartburn.
Functional heartburn. Unlike the other conditions, this isn’t a problem with your oesophagus or stomach. It’s caused by a disorder of the gut-brain connection. It involves the same heartburn symptoms but without any signs of acid reflux or inflammation. It’s connected to overactive nerves.

How long does heartburn last?

Heartburn is not a permanent condition. It lasts as long as the acid is present to irritate the oesophagus and throat. Most people experience heartburn and GORD for between a few minutes to several hours. The timespan often depends on the underlying cause. For example, if your heartburn is due to your diet, it might go away within a few minutes. In contrast, if you have a hiatus hernia, the heartburn might persist for much longer, even after standing up.

Constant heartburn is a rare symptom. It’s a concerning sign, as the acid can continue to damage your oesophagus. If you’re constantly feeling heartburn (or using lots of antacids), then it’s critical to speak to a doctor.

Is heartburn serious?

Most cases of heartburn aren’t serious. It’s common to experience heartburn after a large meal or eating certain foods. However, if the heartburn becomes repeated or constant, it can cause long-term damage. Usually, the damage caused by acid reflux heals like any injury. If it happens regularly, then the oesophagus lining can become permanently injured.

Potential long-term complications include:

Oesophageal strictures. The lining of the oesophagus becomes replaced with scar tissue due to repeated inflammation. This scar tissue causes a narrowing of the oesophagus (stricture), which prevents food from getting through.
Intestinal metaplasia. The tissue lining of the oesophagus undergoes a change to look more like the lining of your intestines, protecting it from damage. It is called Barrett’s oesophagus and is a precancerous condition.
Oesophageal cancer. Cancer is a rare complication of GORD and heartburn. It occurs due to persistent inflammation and cellular changes. The longer your heartburn persists, the greater the risk of cancer.

Heartburn and GORD can also indicate problems in your stomach. For example, excess acid production can lead to gastritis (stomach inflammation) and stomach ulcers. It may also aggravate preexisting conditions such as asthma.

How do we diagnose the causes of heartburn?

The following tests may be used to diagnose what is causing your heartburn:

Oesophageal manometry – which measures the function of your oesophagus (food pipe)
24-hour pH impedance monitoring – which looks at whether you have any reflux
Carbohydrate malabsorption breath test – which finds out if you have certain food intolerances (lactose or fructose)
Small intestinal bacterial overgrowth (SIBO) breath test – which finds out if you have an overgrowth of bacteria in your small intestine (called SIBO)
Gastric emptying test – which measures how quickly food leaves your stomach
The following tests may be used to diagnose what is causing your heartburn:
Oesophageal manometry – which measures the function of your oesophagus (food pipe)
24-hour pH impedance monitoring – which looks at whether you have any reflux
Carbohydrate malabsorption breath test – which finds out if you have certain food intolerances (lactose or fructose)
Small intestinal bacterial overgrowth (SIBO) breath test – which finds out if you have an overgrowth of bacteria in your small intestine (called SIBO)
Gastric emptying test – which measures how quickly food leaves your stomach

Heartburn treatment

Lifestyle changes

Most people who experience occasional heartburn symptoms can benefit from lifestyle changes. This involves limiting exposure to potential triggers. You might want to try:

Avoiding trigger foods, such as fatty foods or caffeinated beverages
Eating smaller meals
Avoiding tight clothing
Avoiding lying down immediately after eating
Quitting smoking and alcohol consumption.

Often, people find that small changes to their diet can stop or reduce episodes of heartburn. If the heartburn continues, it’s usually a sign that something else is going on. It’s crucial to get to the bottom of your symptoms; otherwise, they will persist.

Medication

As heartburn is caused by acid, neutralising this acid relieves symptoms. The primary treatment for heartburn is an over-the-counter (OTC) antacid, such as Gaviscon or Alka-Seltzer. These medications provide immediate relief from your symptoms – perfect for tackling a sudden acid reflux attack. If you experience constant heartburn, it’s sensible to carry antacids with you. However, excessive use of antacids can cause other problems.

Your doctor may prescribe medications that prevent acid production. This includes:

Proton Pump Inhibitors (PPIs). These medications reduce stomach acid production by blocking the enzyme in the stomach lining that produces acid. Common examples include omeprazole, esomeprazole, and pantoprazole. PPIs are used to treat GORD by allowing the oesophagus to heal and preventing further damage.
H2 Receptor Antagonists. These drugs work by blocking H2 receptors on stomach cells that signal the production of acid. This results in decreased stomach acid output. Examples include ranitidine, famotidine, and cimetidine. They are effective in relieving GORD symptoms and are generally used for milder cases.

Surgery

In the majority of cases, lifestyle changes and medication are enough to prevent heartburn symptoms. If GORD doesn’t respond to medication, surgery might be a potential option. This can repair a hiatus hernia, strengthening the lower oesophageal sphincter and permanently preventing the backflow of acid.

Procedures include:

Nissen fundoplication. This procedure tightens the junction between the stomach and the oesophagus.
Transoral incisionless fundoplication. A similar procedure performed non-surgically using an endoscope.
LINX device. A tiny ring of magnets is placed around the junction between the stomach and oesophagus to prevent reflux. It’s a type of minimally invasive surgery.

When should you seek medical care for heartburn?

Heartburn is extremely uncomfortable. However, most cases are relatively mild and treatable with antacids. Speak to a medical professional if:

You experience heartburn more than once a week
You have other associated symptoms
You have difficulty swallowing
Your heartburn persists despite treatment
You’re over the age of 60
You have a tight or squeezing chest pain
You cough up blood

Remember, occasional heartburn is relatively normal. But if you have constant heartburn, it’s crucial to get tested. The Functional Gut Clinic is highly experienced in diagnosing acid reflux. We’ll organise your test and provide advice on what to do next.

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