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

Learn more about heartburn

What Does Your Gut Microbiome Have to Do With Your Health

Why Your Gut Microbiome Matters for Your Health

November 28, 20254 min read

Trillions of bacteria and other microbes live inside your gut, collectively known as your “gut microbiome.” Far from being harmful, these microorganisms are vital to your health, supporting everything from your immune system and heart to brain function and mood.

Your diet determines your gut microbiota. It can either support it, by feeding the healthy bacteria, or disrupt it, damaging your intestinal microbes and causing broader problems.

Below, we’re covering the gut microbiome: what it is, why it’s important, and how it affects your health. We’ll also look at what you can do to support your gut microbiome clinic.

What Is the Gut Microbiome?

Your gut microbiome is all the non-human cells living in your gut. There are trillions of bacteria and other microbes living within your gut, helping you digest fibre and releasing compounds that influence how your body functions — even your mood.

Most of these microbes are found in a pocket of your large intestine known as the caecum — it’s the dividing point between the large and small intestine (where your appendix is).

Different people have slightly different gut microbiota. But there can be thousands of different species. In one study called the PREDICT program, identical twins had around 34% of their gut microbes in common; usually, it’s around 30% in unrelated people.

So, it’s extremely unique to each person.

Why Is the Gut Microbiome Important?

Most of us are raised to think of bacteria as being bad. But that’s not the case. In fact, we evolved alongside bacteria, forming symbiotic relationships that support our health.

The “good” bacteria in our gut:

  • helps digest food by breaking down complex carbohydrates, fibres, and proteins that the body can’t process alone.

  • produces vital nutrients, including vitamins B12 and K, as well as short-chain fatty acids (SCFAs) like butyrate that nourish the gut lining.

  • regulates the immune system, training it to respond appropriately and preventing excessive inflammation.

  • protects against pathogens by competing with harmful bacteria and strengthening the gut barrier.

  • influences metabolism by affecting how the body stores fat, regulates blood sugar, and balances energy.

  • supports brain function through the gut–brain axis, influencing mood, stress levels, and cognition.

Your gut microbiome isn’t only beneficial microorganisms. It’s a delicate balance of over 100 different species (out of over 1,000 possible species). The most dominant organisms are:

  • Firmicutes, including Lactobacillus

  • Bacteroidetes, including Prevotella

  • Actinobacteria, including Bifidobacterium

These bacteria initially come from your mother’s birth canal — exposure happens at birth. Then, as you grow, the colony begins to diversify. It’s believed that a higher microbiome diversity is good for your health.

The Effect of the Gut Microbiome on Your Health

So, a diverse gut microbiome is good for you. It supports many aspects of your body, from digestion and nutrient availability to immune regulation and metabolism.

But what happens if your microbiome isn’t quite right?

Well, the evidence indicates that “dysbiosis” — an imbalance in your gut bacteria — can lead to obesity, heart disease, diabetes, and even cancer.

In the gut itself, dysbiosis is linked to conditions like irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). So, if you notice symptoms such as bloating, cramps, or abdominal pain, the underlying cause might be your gut microbiome.

Indeed, people who take probiotics (containing Bifidobacterium and Lactobacilli) can relieve IBS symptoms. Because your gut bacteria rely on what you eat, your diet is the single biggest factor shaping your microbiome.

Your Diet and the Gut Microbiota

Most animals have a preferred diet. The presence of certain foods in an environment can determine if an animal thrives or dies. The same is true for bacteria.

Feeding your gut microbiota a variety of different and nutritious foods helps them to thrive and survive. Opting for large amounts of ultra-processed foods may not be as supportive.

To support your gut microbiome, you can:

  • Eat fermented foods like kimchi, sauerkraut, or yoghurt – they contain friendly live bacteria

  • Add a wide variety of healthy foods to your diet (particularly different colours)

  • Reduce your intake of ultra-processed foods

  • Give yourself a gap between meals to let digestion happen

  • Up your intake of plant-based foods

You might also want to consider taking a specific probiotic supplement. They contain healthy bacteria, crucial for replacing any lost good bacteria. You may notice some disruption after taking antibiotics, so it’s a useful remedy to get your gut microbiota back on track.

Get Your Gut Microbiome Checked

Suspect your gut microbiome may not have the right balance? The Function Gut Clinic offers the UK’s first fully integrated, full-spectrum microbiome clinic.

We offer a range of tests:

  • Stool microbiome analysis

  • Hydrogen sulphide breath testing

  • SIBO breath testing (hydrogen and methane)

  • Gastric acid output testing

  • Gut motility and transit studies

  • Gut permeability assessments

Together, these tests inspect your gut microbiome, identifying any issues and providing a roadmap to better digestive health. You’ll receive a full action plan and ongoing care and support.

Book your microbiome test today and take control of your digestive health.

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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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Are you experiencing any other symptoms

Symptoms are often closely connected. Find out more below.

Reflux

Burning mid-chest, worse when bending or lying down

Constipation

Difficulty going to the toilet, unusual stools, often with stomach ache or intestinal cramps, bloating, nausea or appetite loss

Bloating

Feeling uncomfortably full and tight, excess belching/breaking wind, abdominal pain or gurgling

Regurgitation

Bringing food or drink back up, difficulty swallowing, feeling that food or drink is stuck in your throat, horrible taste in your mouth

Swallowing Issues

Dysphagia - difficulty swallowing, feeling that food or drink is stuck in your throat, horrible taste in your mouth

Diarrhoea

Loose or explosive stools, can’t get to a toilet in time

Abdominal Pain

Cramps; sharp or dull pain, Bloating, Excessive belching, Nausea or vomiting

Faecal Incontinence

Stools leak unexpectedly, Can’t get to a toilet in time

IBS

Abdominal pain or cramping, bloating, changes in bowel habits and urgency, gas