What is heartburn?

Heartburn is a burning feeling that rises from the stomach or lower chest up towards the neck. It can occur at any time but usually it happens after eating. Heartburn may occur while simply bending or lying down, and it can disturb sleep in a few people. Many pregnant women get heartburn, which goes away after the baby is born.

What causes heartburn?

The burning feeling is caused by acid and other juices that digest food leaking up from the stomach into the oesophagus (the passage between your stomach and your throat). The acid manages to escape (reflux) when the 'valve' at the top of the stomach (the lower oesophageal sphincter) stops working properly. The valve is meant to let food and fluid down, and nothing back up.

Lifestyle

Lifestyle factors, such as being overweight, eating large and fatty meals, smoking and alcohol, can worsen heartburn symptoms; so trying to reduce these may help. However, other treatment is often required.

Non-steroidal anti-inflammatory drugs (eg, ibuprofen, diclofenac, naproxen) can aggravate heartburn as well as causing dyspepsia (a combination of symptoms that includes generalised upper abdominal pain, discomfort and bloating).

Could it be something more serious?

See your doctor urgently if you have:

• difficulty swallowing
• pain on swallowing
• chest pain or tightness
• unexplained weight loss
• anaemia
• black bowel motions
• vomit containing blood or dark granules. 

These may be warning signs for more serious conditions such as gastric (stomach) ulcers or, very rarely, stomach or oesophageal cancer. Your doctor will also check that it is not heart pain causing your symptoms.

Also, if you develop regular heartburn for the first time and are aged over 50 years, if medication has not improved your symptoms after four weeks or if your symptoms get more frequent or severe, it is important to see a doctor.

However, for most people with heartburn, the problem is likely to be reflux disease.

Reflux disease

Heartburn is the most common symptom of reflux disease, which is also known as GORD (gastro-oesophageal reflux disease). Reflux disease is likely to be present when heartburn occurs on two or more days a week (although reflux disease may still be present with less frequent symptoms). Three out of four people with heartburn have reflux disease.

Damage caused by stomach acid

In people who have heartburn often or for a long period of time, the oesophagus can become inflamed (reflux oesophagitis) because it is ‘burnt’ by the acid leaking up from the stomach. It is important that you report long term or regular heartburn to your doctor who can prescribe medications to help heal any acid damage and control the symptoms.

Other possible complications

People with heartburn may occasionally develop other complications, such as respiratory problems (where breathing is made harder) like asthma, pneumonia, choking at night and a sore throat in the morning.

What can be done?

For some people with mild, infrequent symptoms, taking antacids helps to relieve the pain and discomfort. However, regular antacid use may conceal reflux disease and there are more effective medications your doctor can prescribe for heartburn.

More information on over-the-counter treatments for heartburn and indigestion.

Two types of medication - drugs called proton pump inhibitors and H2 blockers - can very effectively reduce the amount of acid in your stomach. For the vast majority, this treatment allows the oesophagus to heal and relieves the symptoms entirely.

In some people, specific lifestyle changes may also help. If symptoms occur often or at night, raising the head of the bed by 10cm (thus lifting your head slightly higher than your stomach) can reduce night-time reflux.

Eating smaller meals, avoiding fatty foods and avoiding eating in the few hours before going to bed all can help reduce symptoms, as can stopping smoking and reducing alcohol intake. If you are overweight, losing weight could also help improve your symptoms.

Surgery is an option for a few patients if other attempts at controlling reflux have failed. Surgery aims to provide a cure by strengthening the valve at the top of the stomach. But, as with all surgery, there are associated risks.

Endoscopy

If you have other specific symptoms, your doctor may need to make further investigations and may refer you to a specialist for an endoscopy. An endoscope is a flexible tube attached to a tiny video camera that is used to examine the inside of the digestive tract.

Endoscopy is not painful although some people find it uncomfortable and you may have a slightly sore throat afterwards. If you prefer, you can be sedated for the procedure.

Have you had any of the following symptoms?

• heartburn
• bringing up acid or small amounts of food after meals
• food sticking (difficulty swallowing food)
• chest pains or discomfort

If so, reflux may be the cause of one or more of these. It would be worthwhile discussing this with your doctor, particularly if you are over 50 years of age. If you have chest pain, you must see a doctor urgently.

Original material provided by everybody. Updated November 2011.