Heartburn is a painful burning sensation in your chest or throat after eating. It happens when digestive acid in the stomach flows back up into your esophagus – the tube that connects your stomach and throat. The discomfort can feel as though someone has lit a bonfire in your chest, and it’s burning its way up to your neck. It could be triggered by the foods you eat, particularly spicy, acidic, or fatty foods.
Albeit its name, heartburn has nothing to do with heart pain. Some of the symptoms, however, mimic those of a heart attack.
Occasional heartburn is no cause for alarm. The symptoms can be managed with lifestyle changes and over-the-counter medications.
However, if your heartburn is frequent and severe, you may have gastroesophageal reflux disease (GERD). In this case, talk to your doctor because it can have dire health consequences.
How does heartburn occur?
The esophagus is a tube that connects the mouth to the stomach. The lower esophageal sphincter (LES) is a ring-like band of muscle that acts as a gate at the junction where the esophagus meets the stomach, below the rib cage, and slightly left of center. When you swallow, the LES muscle relaxes to allow food to flow down into the stomach. Once in the stomach, the LES muscle tightens again to prevent food from refluxing back into the esophagus. Usually, with the assistance of gravity, the LES keeps stomach acid right where it should be – in your stomach.
However, in people with heartburn, the LES muscle often weakens and leaves the esophagus susceptible to stomach acid. When the LES opens too frequently or doesn’t close tightly enough, stomach acid can rise back up into the esophagus and cause a burning sensation when the stomach acid comes into contact with the lining of the esophagus. The acid reflux may be worse when you’re bent over or lying down.
Causes and risk factors
There are several potential contributors to heartburn.
Pregnancy, obesity, or hiatal hernia can exert pressure on your stomach.
If you’re pregnant, the progesterone hormone can relax your LES and increase pressure within the abdominal cavity, thereby predisposing you to acid reflux.
Likewise, being overweight can increase your risk of heartburn because the excess fat exerts pressure on your stomach.
A hiatal hernia occurs when a portion of the stomach protrudes into the chest through an opening in the diaphragm, thereby compromising the LES function.
Certain eating habits
Meals high in oils and fats may trigger heartburn. Avoid certain foods, such as:
- Fried or fatty foods
- Spicy foods
- Chocolate or caffeine
- Tomatoes and tomato-based products, e.g., ketchup
Furthermore, eating a large portion of food or eating shortly before bedtime can also trigger heartburn.
Over-the-counter pain medications that may precipitate heartburn include:
Lifestyle factors that can trigger heartburn include:
- Stress and insomnia
- Wearing tight clothes or belts
Heartburn can cause pain that feels sharp, burning, or like a tightening sensation in the stomach that moves up into the middle of your chest. The pain can remain in the lower chest, or it can radiate up to the back of your sternum, breastbone, or neck. You may also have a sour, bitter, or acrid taste in the back of your throat. It can last from several minutes to hours, and often feels worse after you eat. If the acid reflux is near the throat, it may cause coughing episodes or hoarseness.
The symptoms are often worse after eating a big or greasy meal. It may also feel worse when you are lying down at night or when bending over. You may be awakened from your sleep, especially if you have eaten within two hours of going to bed.
Chronic heartburn can cause prolonged irritation and inflammation of the esophagus, eventually culminating in complications.
In particular, heartburn that frequently occurs (more than twice a week) and interferes with your routine can lead to a chronic disorder known as gastroesophageal reflux disease (GERD). GERD can seriously damage your esophagus or lead to precancerous changes in the esophagus known as Barrett’s esophagus. GERD can also cause the narrowing of the esophagus (esophageal stricture).
Reflux over prolonged periods can also be severe enough that acid wears away the enamel on teeth and cause it to decay.
When to see a doctor
Heartburn is usually a mild annoyance that does not require medical attention. But if you have other symptoms, you should contact your doctor. This includes:
- Heartburn that occurs more than twice a week
- Difficulty swallowing
- Choking sensation
- Symptoms persist despite use of over-the-counter antacids
- Persistent nausea or vomiting
- Unexpected weight loss, poor appetite, difficulty eating
- Black, tarry-looking bowel movements
- Bloody vomit
- Trouble breathing
- Hoarseness or wheezing
Also, as heartburn can mimic the symptoms of a heart attack, you should call 911 immediately if you experience:
- Severe chest pain or pressure
- Pain in the neck, shoulder, arm, or jaw
- Dizziness, nausea, or vomiting
- Shortness of breath
Heartburn diagnosis begins with an extensive medical history and physical examination. It may be helpful to document what you eat and drink, and when you experience heartburn.
In some cases, further diagnostic testing may be necessary.
An X-ray can allow the doctor to view the condition of your esophagus and stomach. Aside from looking for inflammation or irregularities, this test can determine if the esophageal muscles are functioning correctly in a rhythmic fashion.
You may be requested to swallow a liquid that coats your digestive tract. Then X-ray images are taken, which will allow your doctor to view the outline of your digestive system.
Endoscopy can be used to check for abnormalities in your stomach and esophagus. It can be used to look for problems such as inflammation or ulcer inside your esophagus.
In this test, your doctor uses a thin, flexible scope with a small fibreoptic camera to look at the lining of your esophagus and stomach. Biopsies can also be obtained to look for cancerous or pre-cancerous cells.
Ambulatory acid probe tests can be used to identify the acidity of your esophagus. An acid monitor is inserted in your esophagus connects to a small computer that you wear around your waist or on a strap over your shoulder.
Treating heartburn is important because chronic acid reflux can damage the esophagus.
The three classes of over-the-counter (OTC) heartburn medications are antacids, H2-receptor antagonists, and proton pump inhibitors. PPIs and H2 blockers both reduce the secretion of stomach acid, which can help prevent and reduce heartburn symptoms. On the other hand, antacids neutralize stomach acid.
Antacids help neutralize stomach acids in people with occasional, mild heartburn. They provide quick relief and are fast-acting. To reduce side effects such as diarrhea and constipation, look for brands that contain calcium carbonate, magnesium, and aluminum hydroxide.
H-2-receptor antagonists (H2RAs)
H-2-receptor antagonists (H2RAs) can reduce stomach acid by blocking the action of histamine receptors, which would otherwise stimulate stomach cells to produce acid.
Though H2RAs don’t work as rapidly as antacids, they may provide more extended relief. Your doctor may also advise you to take H2RAs in combination with antacids.
Proton pump inhibitors (PPIs)
Proton pump inhibitors (PPIs) are used to prevent frequent heartburn that occurs more than twice a week. They work by blocking stomach acid production. PPIs are comparatively more effective and longer-lasting than H2RAs.
The most common side effects include diarrhea, stomachache, headache, nausea, and vomiting. The risk increase if you take it for a year or more.
Lifestyle modification and home remedies
You can prevent or reduce heartburn with home remedies. However, not all of the following solutions will work for everyone.
Maintain a healthy weight
Excess pounds can press against your abdomen, causing acid up into your esophagus. Hence, you should lose weight if you are currently overweight.
Keep fit and maintain a healthy weight through diet and exercise. However, wait at least two hours after a meal before exercising – if you work out any sooner, you may trigger heartburn.
Avoid tight-fitting clothing because it could exert unnecessary pressure on your lower esophageal sphincter (LES) and abdomen, leading to heartburn symptoms. Wear loose-fitting clothing instead.
Healthy eating habits
Avoid foods that trigger heartburn
Avoid food triggers, such as:
- Fatty foods
- Spicy food
- Full cream milk
- Gassy foods (e.g., soft drinks)
- Acidic food (e.g., tomato, lemon)
Avoid lying down after a meal
Don’t lie down flat on your back for at least two hours after a meal.
Avoid late meals or heavy meals
Avoid eating meals two hours before bedtime to reduce stomach acid and stomach content. Also, try eating a smaller meal in the evening because large meals can put pressure on your stomach.
Elevate the head of your bed
When you lay flat on the bed, your stomach and throat are at the same level, allowing stomach acids to flow up your esophagus.
Instead, you should elevate your body from the waist up. Raise the head of your bed so that your head and chest are higher than your lower body. Alternatively, you can insert a foam wedge between your mattress and box spring to elevate your upper body. If you have an adjustable bed, adjust it to a proper angle for relief.
CAUTION: Do not use piles of pillows. They may cause you to put more pressure on your stomach and make your heartburn worse.
Sleep on your left side
Sleep on your left side to facilitate the removal of stomach acid. This position may help to reduce nighttime heartburn symptoms.
Stand up straight
An upright posture minimizes stress on your LES muscle, therefore reducing the risk of acid reflux. You should also avoid straining and heavy lifting.
Avoid smoking and alcohol
Both smoking and drinking alcohol relax the LES muscle, causing acid to flow back up to the esophagus. They may also increase stomach acid production.
Review existing medications
Regular use of certain medications may contribute to heartburn. Examples include:
- Anti-inflammatory and pain medicines (except acetaminophen)
- Osteoporosis drugs
- Heart and blood pressure drugs
- Hormone medications
- Asthma medications
- Depression medications
Consult your doctor if you think you are experiencing heartburn as a side effect from your medicines.
Chewing gum can stimulate saliva production, which buffers stomach acidity. Furthermore, chewing gum can facilitate swallowing, which clear stomach acid from your esophagus.
Foods to try
Several foods may help to relieve symptoms of heartburn.
Licorice root is a folk remedy that’s traditionally used to treat heartburn. It is believed to help increase the mucous coating of your esophageal lining, which may protect your esophagus from erosion caused by stomach acid.
Ideally, you can opt for deglycyrrhizinated licorice (DGL) because it’s been processed to remove its glycyrrhizin, a compound that can cause adverse side effects.
DRINK apple cider vinegar
Apple cider vinegar is another potential home remedy for heartburn. It is thought to neutralize stomach acid. If you try this remedy, remember to dilute the apple cider vinegar with water and drink it after the meal.
Ginger is a folk remedy for heartburn. Consider adding diced or grated ginger root to your stir-fry recipes and soups. Alternatively, you can brew yourself a cup of ginger tea.
DRINK baking soda with water
Baking soda may mitigate episodes of heartburn by neutralizing stomach acid. To do this, dissolve a teaspoon of baking soda in a glass of water and drink it slowly.
EAT grains and potatoes
Research has found that eating grains and potatoes can reduce the risk of GERD by 42% (1).
Foods to AVOID
Many foods may trigger heartburn by relaxing the lower esophageal sphincter (LES), which allows food to escape into the esophagus. The types of foods that trigger heartburn differ for each individual.
Keep a food diary to track the foods or drinks that may trigger your heartburn. Try removing some of the foods on this list to see if your symptoms improve.
AVOID high-fat foods
High-fat foods may cause heartburn by relaxing the lower esophageal sphincter, causing stomach acid to escape from the stomach into the esophagus. This includes otherwise nutritious fatty foods like cheese, avocados, and nuts.
High doses of mint, such as peppermint and spearmint, may irritate the lining of the esophagus. Hence, if you experience heartburn after consuming mint, then its best to avoid it.
AVOID citrus juices
Drinking citrus juices such as orange juice or grapefruit juice may cause acid reflux and trigger heartburn symptoms.
Chocolate is another common trigger for heartburn. It may relax the lower esophageal sphincter, allowing stomach acid to escape into the esophagus.
AVOID spicy foods
Spicy foods are notorious for triggering heartburn. They contain a compound called capsaicin, which slows the rate of digestion, causing food to remain in the stomach longer. Also, spicy foods may irritate an already inflamed esophagus, further worsening heartburn symptoms. Therefore, you should reduce your intake of spicy foods if you have heartburn.
Onions may relax the lower esophageal sphincter, which may cause heartburn symptoms. In one study, participants who eat a burger with onions have significantly worse heartburn symptoms than those who eat a burger without onions (2). Also, onions are a rich source of fermentable fiber, which in turn causes belching and aggravate acid reflux symptoms.
Moderate to excessive alcohol intake may trigger heartburn symptoms in several ways:
- By relaxing the lower esophageal sphincter
- By increasing stomach acid production
- By directly damaging the lining of the esophagus
Coffee may relax the lower esophageal sphincter. Hence, you should avoid or reduce the intake of coffee if it gives you heartburn.
AVOID sodas and carbonated beverages
Sodas and carbonated drinks are also common heartburn culprits. These beverages relax the lower esophageal sphincter and increase the acidity of stomach acid. Cut back or avoid sodas or other carbonated drinks if they give you heartburn.
AVOID whole milk
While milk may temporarily buffer stomach acids, the fat content of whole milk may stimulate the stomach cells to produce more acid. If drinking whole milk gives you heartburn, it’s best to avoid it or reduce your intake.
Instead, try fat-free skim milk and don’t overdo it. Drink no more than 8 ounces of skim milk at a time – as a snack in between milk.
The Bottom Line
Heartburn is a symptom of gastroesophageal reflux disorder (GERD). When heartburn strikes, many over-the-counter treatments and home remedies may provide relief. You should also avoid foods that could potentially trigger heartburn. If you experience heartburn more than two or three times a week, talk to your doctor.