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).Bullet list
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

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.


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.

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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

  • Burning pain that radiates into your back

  • 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).

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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.

What causes heartburn?

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:

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

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.

Not sure where to start?

Take our 5-minute gut health questionnaire

Our guided self-assessment tool asks you some simple questions to find out more about your symptoms, so we can share personalised recommendations for the most suitable diagnostic tests for you.

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.

Our gut health diagnostic tests are fully regulated and accredited by professional bodies, so you can trust us to deliver the highest standards of accuracy and reliability.

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