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

The Microbiome and Your Immune System: How Gut Health Shapes Immunity

The Microbiome & Your Immune System

May 25, 20264 min read

Your body’s defences aren’t just about white blood cells and vitamins. A large part of your immune system operates in the gut, where it’s shaped by the bacteria that live there. This community, also known as the microbiome, helps regulate immune responses, supporting your ability to fight infections while keeping inflammation in check.

These bacteria aren’t passive. They’re in constant communication with your immune system, sending and receiving signals that influence how it behaves. When that balance is disrupted, it can contribute to issues like allergies, chronic inflammation, and even autoimmune conditions. That’s why gut microbiome testing is so important.

What Is the Gut Microbiome?

The gut microbiome comprises trillions of bacteria, viruses, and other microbes living in the digestive tract. We often think of all bacteria as bad. But that’s not the case. In fact, some bacteria serve vital functions, such as working with your immune system.

Gut microbes have a role in everything from digestion and metabolism to signalling and immunity. They produce many of the nutrients and molecules the body needs to fight off infections.

How the Gut Microbiome Supports the Immune System

The Gut as an Immune Hub

Your gut is the centre of your immune system. Around 70% of all immune cells are located in and around the gut, particularly in structures known as gut-associated lymphoid tissue (GALT).

That makes sense. If pathogens want to enter the body, they can either do so through the skin or the digestive tract. While the skin is a thickened barrier, the gut must still absorb nutrients, creating an entry point.

The immune system is constantly battling microbes. It uses it as a “training ground” for immune responses, helping it respond appropriately rather than overreacting or missing real threats.

Communication Between Gut and Immune Cells

Gut bacteria don’t just sit there. They actively communicate with the immune system.

Compounds like short-chain fatty acids (SCFAs) and other metabolites are constantly produced, influencing how immune cells behave. These signals fine-tune immune activity, guiding when to mount a response and when to tolerate harmless substances.

Otherwise, your body could tip into chronic inflammation like a frontline defence that shoots at everything it sees.

The Gut-Immunity Link Explained Simply

Barrier Protection

People say the best defence is a good offense. But for the body, every fight wastes resources. Better to protect the physical barriers that prevent pathogens from entering the body.

The gut lining is that barrier. A healthy microbiome strengthens the tight junctions binding the cells together, preventing “leakage” into the circulation.

Immune Regulation (Not Just Activation)

Like all defensive operations, your immune system needs messages from the frontline. This prevents accidents where your immune system starts to attack the body itself (known as autoimmunity) or remains in a constant state of high alert (chronic inflammation).

Rather than just activating immune cells, your microbiome releases molecules that help regulate responses, supporting a balanced system. That means it’s ready when an actual attack happens.

What Happens When the Microbiome Is Disrupted?

If your gut microbiome becomes dysregulated, it’s known as dysbiosis. This occurs when bacterial numbers are low or harmful bacteria become too dominant over the beneficial ones.

You may notice:

  • Increased susceptibility to infections

  • Chronic inflammation

  • Digestive issues

  • Worsening allergies or sensitivities

  • Skin issues like acne

The gut microbiome is also linked to the autoimmune conditions, in which the immune system mistakenly attacks the body’s own tissues. For example, low levels of Bacteroides, Bifidobacterium, and butyrate-producing bacteria have been associated with increased inflammation and changes in immune regulation, including the activation of autoreactive immune cells.

These changes may contribute to the development or progression of conditions such as inflammatory bowel disease (IBD), rheumatoid arthritis, type 1 diabetes, and multiple sclerosis.

How to Support Gut Health and Immunity

Diet as the Foundation

Eating a wide variety of fibre-rich foods is the best thing you can do to support your beneficial gut bacteria. Fermented foods are another good option, as they contain beneficial bacteria. They’re a great option if you’ve just taken a course of antibiotics.

Lifestyle Factors That Matter

A lack of sleep, stress, and a sedentary lifestyle work against your gut microbiome. Support your immune system by putting healthy habits in place. Just exercising 2-3 times per week and introducing something to reduce stress can make a big difference.

Avoiding Common Disruptors

It’s not just what to do, it’s what not to do.

Overuse of antibiotics, highly processed diets, and chronic stress, all harm your microbiome. They provide the opportunity for harmful bacteria to thrive.

Take a Microbiome Test

If you’re dealing with recurring infections, ongoing digestive issues, or symptoms that don’t quite add up, it may be worth looking deeper at your gut.

The Functional Gut Clinic offers personalised microbiome testing to assess the current state of your gut health.

From there, you’ll receive clear, tailored guidance on what to change. This might be diet, lifestyle, targeted support, or a bit of each. It takes the guesswork out and gives you a practical plan based on what’s actually happening in your body.

You might like to read the next interesting article: At-Home vs Clinical Microbiome Tests: What's the Difference and Which Should You Choose?

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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