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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.

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)


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

Ever noticed that when you’re stressed, your stomach just doesn’t feel the same? Loose stools, bloating, and constipation. It’s not always just IBS. Stress harms your gut microbiome, affecting your normal bowel function.
Your gut microbiome is a community of trillions of microorganisms living in your gut. It contains bacteria, viruses, fungi, and much more. They aren’t harmful. They’re responsible for gut function, protecting your gut lining, regulating blood sugar levels, and even altering your mood.
Stress isn’t just in your head. It’s a whole-body experience. The gut is one of the most stress-sensitive organs in your body. That’s why you notice the symptoms so acutely. But how does it actually affect your gut bacteria? Let’s take a closer look.
Not sure if you’ve got an imbalanced gut microbiome? The Functional Gut Clinic offers personalised gut testing to help you understand your microbiome.
Stress occurs whenever your body triggers the fight-or-flight response. It could be a tiger hiding in the bushes, or, more likely, an upcoming deadline or relationship problem.
Some stress is good. It focuses your mind on the problem at hand. It does this by spiking cortisol levels, activating the sympathetic nervous system, and redirecting blood to the appropriate areas (and away from digestion).
The problem comes with repeated stress. High cortisol levels and low blood flow can combine and dysregulate the gut microbiome. Known as gut dysbiosis, it can trigger a cascade of inflammation, leaky gut, and less support from the gut bacteria.
Your gut microbiome is determined by the surrounding environment. Just as a polar bear can’t survive in the desert, your gut bacteria require a specific ecosystem.
Prolonged stress reduces digestive secretions (think dry mouth), slows gut motility, and alters the overall pH (or acidity) of your gut. Together, these changes influence which species thrive and which struggle.
Usually, this means beneficial species diminish, lower overall microbial diversity, and open the door to opportunistic bacteria. That’s why you suddenly notice bloating, discomfort, and irregular bowel habits whenever things get heated at work.
Heard of cortisol and adrenaline? They’re the stress hormones. Whenever you experience any form of stress, these hormones are released to prepare you to react (to fight or flight). Chronic stress elevates these levels persistently, directly weakening the gut’s protective lining.
Stress hormones weaken the gut barrier: When cortisol and adrenaline stay elevated for too long, they can loosen the tight junctions that hold the gut lining together.
Things start leaking through: As the barrier becomes less effective, substances that normally stay inside the gut can slip into the bloodstream.
Inflammation follows: Bacterial by-products like lipopolysaccharides (LPS) can trigger low-grade inflammation, which over time may contribute to digestive discomfort, fatigue, and broader health issues.
So far, we’ve talked about the effect of your brain on your gut. But this is a conversation, not a monologue. Just as stress disrupts gut health, the state of your gut microbiome also influences how your body responds to stress.
For example, a healthy community of gut bacteria buffers against stress. It interacts with the nervous system, influencing neurotransmitter production and inflammatory signalling. This can dampen the stress response.
It might sound a little like the bugs are taking over. But it’s how we evolved over millions of years. They’re as much a part of us as we are of them. When we’re less stressed, the beneficial gut bacteria survive better, and when they survive better, we’re less stressed. A classic feedback loop.
Think about managing stress. Meditation, breathing techniques, and a week beside the beach could help us all reduce our stress levels. But there’s more to stress reduction.
Eat a diet rich in fibre and gut-friendly foods. Supporting your gut bacteria may help lower stress levels. Fermented foods, lots of different plants, and less ultra-processed foods can work wonders.
Get enough sleep. Poor sleep harms your gut bacteria just as much as it spikes your cortisol levels. Aim for a solid eight hours every night.
Exercise regularly. Getting enough exercise can lower your cortisol levels and increase endorphins, providing a healthy outlet for stress-related energy.
Practice stress management strategies. Ideally, this should be something you enjoy. Listening to ASMR. Reading a good book. Practicing yoga. Whatever you prefer.
If stress is showing up as digestive symptoms, it may be a sign that your gut microbiome is under strain. While lifestyle changes offer some help, they don’t always address what’s happening beneath the surface.
Personalised gut microbiome testing at The Functional Gut Clinic identifies imbalances linked to stress, inflammation, and gut barrier disruption. You’ll receive a personalised treatment plan based on your results to help your gut recover.
Read the next related article: How Alcohol Affects Your Gut Microbiome
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.



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).


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.
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.

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.

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.


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.
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.

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

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.



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.

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.
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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Burning mid-chest, worse when bending or lying down

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

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

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

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

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

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

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

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