Heartburn: What to Do for Relief
Also known as: Pyrosis, Acid reflux
Heartburn: A Common Burning Feeling in the Chest
Heartburn, also called pyrosis, is a burning sensation that rises from the stomach toward the throat along the esophagus. It’s one of the most common digestive symptoms in the United States. According to the American College of Gastroenterology, up to 20% of the U.S. population has gastroesophageal reflux disease (GERD), defined as reflux symptoms two or more times a week. GERD is the backward flow of acidic stomach contents into the esophagus, whose lining isn’t built to handle that acidity.
Causes and Risk Factors
Heartburn is mainly caused by a malfunction of the lower esophageal sphincter, the muscle that normally keeps stomach contents from flowing back up. Several factors contribute to this:
- Obesity and being overweight, which increase abdominal pressure
- Pregnancy
- Excessive alcohol, coffee, tobacco, and spicy food intake
- Certain medications (anti-inflammatories, aspirin, some blood pressure medicines)
- Large meals eaten late at night, or lying down right after eating
Symptoms
Heartburn’s clinical signs are distinctive and often allow for a quick diagnosis:
- Burning behind the breastbone: a hot feeling starting in the pit of the stomach and rising behind the sternum toward the throat
- Acid regurgitation: sour or bitter liquid rising into the mouth
- Frequent belching
- Chest pain, sometimes mistaken for heart-related pain
- Chronic cough and hoarseness, from irritation of the larynx
- Difficulty swallowing (dysphagia) in more advanced or complicated cases
Diagnosis
Heartburn is usually diagnosed clinically, based on the doctor’s questions about symptoms, frequency, and triggers. If there’s uncertainty or symptoms persist despite treatment, additional tests may be ordered: an upper endoscopy to examine the esophagus and stomach, or 24-hour esophageal pH monitoring to measure acid levels in the esophagus.
Treatments
Heartburn management relies on several complementary approaches:
- Proton pump inhibitors (PPIs): omeprazole, pantoprazole, esomeprazole, the standard medication, which significantly reduces stomach acid production
- H2 blockers (famotidine): an alternative to PPIs, effective for mild to moderate cases
- Antacids (calcium carbonate, aluminum hydroxide): fast-acting but short-lived, useful for occasional flare-ups
- Lifestyle and dietary changes: essential alongside any medication for lasting relief
Prevention
Several lifestyle habits can significantly reduce how often and how badly heartburn occurs:
- Avoid lying down for 2 to 3 hours after eating
- Raise the head of the bed by about 6 to 8 inches if you have nighttime symptoms
- Limit acid-triggering foods: coffee, alcohol, spicy food, chocolate, and citrus
- Reduce or quit smoking
- Maintain a healthy body weight
When Should You See a Doctor?
See a doctor promptly if you have intense chest pain that could suggest a cardiac emergency, difficulty swallowing, vomiting blood, unexplained weight loss, or if your symptoms persist despite proper treatment for more than 2 weeks.
Sources
- American College of Gastroenterology, patient education on acid reflux and GERD
- MedlinePlus, U.S. National Library of Medicine health information
- MedlinePlus: Gastroesophageal reflux disease, dietary and lifestyle changes (dinner 2 to 3 hours before sleep, raising the head of the bed) and warning signs
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), symptoms, causes, and risk factors of GER and GERD
- NIDDK: Treatment for GER & GERD, raising the head of the bed 6 to 8 inches, and PPIs being better than H2 blockers
- StatPearls: Gastroesophageal Reflux Disease (NCBI Bookshelf), risk-factor medications, belching among symptoms, ambulatory pH monitoring, and PPIs as the most effective therapy
- MedlinePlus: Omeprazole, over-the-counter omeprazole should be used for 14 days and a doctor called if symptoms do not improve after that