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Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper abdomen just beneath the lower breastbone (sternum). This discomfort may spread in waves upward into your throat, and you may have a sour taste in your mouth. Heartburn is sometimes called indigestion, acid regurgitation, sour stomach, or pyrosis. It is not caused by problems with your heart, although sometimes heart problems can feel like heartburn. See a picture of heartburn.
Heartburn may cause problems with swallowing, burping, nausea, or bloating. These symptoms can sometimes last up to 2 hours or longer. In some people, heartburn symptoms may cause sleep problems, a chronic cough, asthma, wheezing, or choking episodes.
Heartburn usually is worse after eating or made worse by lying down or bending over. It gets better if you sit or stand up.
Almost everyone will have troubles with heartburn now and then.
Heartburn occurs more frequently in adults than in children. Many women have heartburn every day when they are pregnant. This is because the growing uterus puts increasing upward pressure on the stomach.
Symptoms of heartburn and symptoms of a heart attack may feel the same. Sometimes your heartburn symptoms may mean a more serious problem and need to be checked by your doctor.
Dyspepsia is a medical term that is used to describe a vague feeling of fullness, gnawing, or burning in the chest or upper belly, especially after eating. A person may describe this feeling as "gas." Other symptoms may occur at the same time, such as belching, rumbling noises in the abdomen, increased flatus, poor appetite, and a change in bowel habits. Causes of dyspepsia can vary from minor to serious.
Causes of heartburn
Heartburn occurs when food and stomach juices back up (reflux) into the esophagus, which is the tube that leads from the throat to the stomach. This process is called gastroesophageal reflux. Common causes of reflux include:
- Incomplete closing of the valve (the lower esophageal sphincter, or LES) between the esophagus and the stomach.
- Foods and drinks, such as chocolate, peppermint, fried foods, fatty foods, sugars, coffee, carbonated drinks, and alcohol. After heartburn occurs, the backflow of stomach juices can cause the esophagus to become sensitive to other foods, such as citrus fruits, tomatoes, spicy foods, garlic, and onions. Eating these foods may cause more heartburn.
- Pressure on the stomach caused by obesity, frequent bending over and lifting, tight clothes, straining with bowel movements, vigorous exercise, and pregnancy.
- Smoking and use of other tobacco products.
- Prescription and non-prescription medicines, such as aspirin, ibuprofen, prednisone, iron, potassium, antihistamines, and sleeping pills.
- A hiatal hernia, which occurs when a small portion of the stomach pushes upward through the diaphragm, which is the muscle that separates the lungs from the abdomen.
- Stress, which can increase the amount of acid your stomach makes and cause your stomach to empty more slowly.
Severity of heartburn
Mild heartburn occurs about once a month. Moderate heartburn occurs about once a week.
Severe heartburn occurs every day and can cause problems such as trouble swallowing, bleeding, or weight loss. Heartburn with other symptoms, such as hoarseness, a feeling that food is stuck in your throat, tightness in your throat, a hoarse voice, wheezing, asthma, dental problems, or bad breath, may be caused by a more serious problem, such as gastroesophageal reflux disease (GERD). A persistent inflammation of the lining of the esophagus occurs in GERD and can lead to other health problems. Heartburn may also be related to an infection with Helicobacter pylori (H. pylori) bacteria.
Persistent heartburn symptoms can be a sign of a more serious medical condition, such as severe inflammation of the esophagus or cancer of the stomach or esophagus.
Heartburn is more serious when it occurs with abdominal pain or bleeding.
- Abdominal pain, especially pain located directly below the breastbone, may be a sign of more serious problems, such as heart disease, peptic ulcer disease, gallbladder disease, a tear in the esophagus, or inflammation of the stomach (gastritis). For more information, see the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
- Vomiting of blood may mean bleeding in the digestive tract, often from the esophagus or stomach. If you have bleeding in the esophagus, stomach, or part of the small intestine attached to the stomach (duodenum), stools may be dark red or black and tarry. Large amounts of bleeding can lead to shock, a life-threatening condition. For more information, see the topic Nausea and Vomiting, Age 12 and Older.
Heartburn in children
Almost all babies spit up, especially newborns. Spitting up decreases when the muscles of the esophagus, which is the muscular tube that connects the throat to the stomach, become more coordinated. This process can take as little as 6 months or as long as 1 year. Spitting up is not the same thing as vomiting. Vomiting is forceful and repeated. Spitting up may seem forceful but usually occurs shortly after feeding, is effortless, and causes no discomfort.
Children who vomit frequently after eating during the first 2 years of life have increased chances of having heartburn and reflux problems, such as GERD, later in life. Children with reflux problems also have increased chances of other problems, such as sinusitis, laryngitis, asthma, pneumonia, and dental problems. For more information, see the topic Nausea and Vomiting, Age 11 and Younger.
The treatment of heartburn depends on how severe your heartburn is and what other symptoms you have. Home treatment measures and medicines that you can buy without a prescription usually will relieve mild to moderate heartburn. It is important to see your doctor if heartburn occurs frequently and home treatment does not relieve your symptoms.
Check your symptoms to decide if and when you should see a doctor.
Health Tools help you make wise health decisions or take action to improve your health.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Symptoms of a heart attack may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Light-headedness or sudden weakness.
- A fast or irregular heartbeat.
For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.
Many prescription and non-prescription medicines can cause heartburn. A few examples are:
- Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
- Steroids, such as prednisone.
- Some heart medicines.
Caffeine and alcohol also can cause heartburn.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Home treatment, such as lifestyle changes and non-prescription medicines, may be all that is needed to treat mild to moderate heartburn. But if your symptoms do not get better with home treatment, or if your symptoms occur frequently, see your doctor to find out whether other medical conditions may be causing your symptoms.
Keep a record of your heartburn symptoms before and after making lifestyle changes or using non-prescription medicines so you can discuss any improvement with your doctor. See an example of a heartburn symptom record .
Medicines to treat heartburn
If you are pregnant and have heartburn symptoms, be sure to talk to your doctor before you take any heartburn medicines. Some medicines may not be safe to take while you are pregnant. For more information, see the topic Pregnancy-Related Problems.
Many people take non-prescription antacids for mild or occasional heartburn. If you use antacids more than just once in a while, talk with your doctor.
- Antacids such as Tums neutralize some of the stomach acid for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
- Some antacids, such as Gaviscon, have a foaming agent (alginate) that acts as a barrier between stomach acid and the esophagus.
- Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks and you should not take it if you can't take aspirin. It may make your tongue or stools black. The black colour is usually not serious. Brushing your teeth and tongue after taking Pepto-Bismol may keep your tongue from turning black. Ask your doctor if your child younger than age 12 should take this medicine.
Antacids work faster than acid reducers (H2 blockers), but their effect does not last more than 1 to 2 hours. H2 blockers can provide relief for up to 12 hours.
Antacids do have side effects. They may cause diarrhea or constipation. Also, antacids can interfere with how your body absorbs other medicines.
Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.
If you have any health risks, talk with your doctor before you start taking an antacid. If you have kidney disease, it is especially important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.
Stomach acid reducers
Histamine receptor (or H2) blockers, decrease the amount of acid that the stomach makes, which may reduce irritation to the stomach lining and decrease heartburn. Some examples of non-prescription acid reducers are Pepcid AC, Zantac 75, and Axid AR. Talk with your doctor if you take an H2 blocker for more than 2 weeks.
Proton pump inhibitors
Proton pump inhibitors (PPIs), such as omeprazole (for example, Losec), reduce stomach acid and effectively treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn has not gotten better with other home treatment measures, antacids, or H2 blockers. You may need to use a PPI for up to 5 days before you have relief of your heartburn. PPIs are not available without a prescription.
Acid reducers can sometimes change the way other medicines work. If you are taking prescription medicines, be sure to talk with your doctor before you take a non-prescription acid reducer.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Heartburn is not relieved by home treatment and medicine.
- Swallowing problems are not improving.
- You continue to lose weight for no reason.
- Your symptoms become more severe or frequent.
You can make changes to your habits and lifestyle to prevent your symptoms of heartburn. Here are some things to try:
- Change how you eat.
- It's best to eat several small meals instead of two or three large meals.
- After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
- Chocolate, mint, and alcohol can make heartburn worse. They relax the valve between the esophagus and the stomach.
- Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make heartburn symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
- Do not smoke or chew tobacco.
- If you get heartburn at night, raise the head of your bed 15 cm (6 in.) to 20 cm (8 in.) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
- Do not wear tight clothing around your middle. Lose weight if you need to. Losing just 2 to 5 kilograms can help. For more information, see the topic Weight Management.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What are your main symptoms? Report any symptoms, such as abdominal pain, a change in bowel habits, or vomiting.
- How long have you had heartburn?
- Have you had this problem before? If so, do you know what caused the problem at that time? How was it treated? How did you respond to that treatment?
- Have you had any signs of bleeding from your digestive system?
- Have you had any difficulty swallowing when you eat or drink?
- How much tobacco do you use? How much alcohol do you drink? How much caffeine do you drink?
- Has your weight increased or decreased more than 2 kg (5 lb) recently?
- Have there been any changes in your diet? Are you eating certain foods more often?
- Have there been changes in your daily schedule, such as when you eat and when you go to bed?
- Are you taking any non-prescription or prescription medicines? Bring a list of all the medicines you are taking to your appointment.
- What home treatment measures have you tried? Did they help? Be sure to include lifestyle changes you have made.
- What non-prescription medicines have you taken or used to treat your heartburn? Did they help?
- Do you have any health risks?
It will be easier to make lifestyle changes if your family understands the reasons for the changes. Take a friend or family member to the appointment with you, and discuss diet and sleeping habits with your doctor.
Remember to take your heartburn symptom record to your doctor visit. Be sure to note any lifestyle changes you have made or non-prescription medicines you use.
Current as of: February 26, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
H. Michael O'Connor MD - Emergency Medicine