An Overview of Heartburn By Richard N. Fogoros, MD, a board-certified physician Updated September 28, 2016 Print Almost everyone gets heartburn at one time or another. For most, it is an occasional annoyance. For many, it happens often enough to become disruptive to a happy life. And for a few, it can actually lead to dangerous medical problems. Because heartburn is such a frequent problem, it’s a good idea to know something about it.What Is Heartburn?Heartburn is a burning sensation you feel under your breastbone that can go from the pit of your stomach all the way up to your throat. Often it is accompanied by the presence of a sour, acidic liquid, and even partially-digested food particles, reaching the back of your throat—a symptom called regurgitation.Anyone who has experienced a bad episode of heartburn pretty much knows what it is. It’s the reflux of stomach contents up into the esophagus (swallowing tube). The burning sensation is produced by the irritating effect of stomach acid on the lining of the esophagus and the throat. Article Gastroesophageal Reflux Disease (GERD) List 21 Symptoms That Point to GERD Heartburn typically occurs within an hour or so after a meal, and is more likely to happen after a big meal. It can be triggered in many people by certain foods, especially fried foods, chocolate, alcohol, or foods containing caffeine. Heartburn is often made worse by lying flat, wearing tight clothing, or bending over. People who have frequent heartburn generally learn pretty quickly to loosen their belts, stay upright, and elevate the head of their beds; and they often find that taking antacids will help to relieve their symptoms.In many cases, such simple measures are enough. However, if you have heartburn more than just occasionally, or if your episodes of heartburn are particularly severe, there are some important things you should know. 9 Things You Should Know About Heartburn1. Heartburn Is Almost Always Caused by GERDThe main cause of heartburn is a medical condition called gastroesphageal reflux disease, or GERD. GERD is caused by the abnormal functioning of the lower esophageal sphincter (LES). The LES is a muscular ring at the junction of the esophagus and stomach, and its job is to keep stomach contents out of the esophagus. When the LES relaxes inappropriately, stomach contents can reflux up into the esophagus, producing heartburn. GERD is a very common disorder, and since it can lead to some serious consequences, it needs to be treated appropriately. If you have heartburn, you almost certainly have GERD.2. Severe Heartburn Can Be DangerousPeople who have severe heartburn—specifically people whose episodes of heartburn occur several times a week or more, or that produce symptoms that are particularly alarming—generally have severe GERD. This can lead to some dangerous problems.GERD can cause a number of serious problems with the esophagus, including erosive esophagitis (inflammation and erosions in the lining of the esophagus), esophageal stricture (narrowing of the esophagus), Barrett’s esophagus (the formation of abnormal cells in the lining of the esophagus that can become cancerous), or perforation of the esophagus. Article Is Acid Reflux Really Common? Article Could Heartburn Be a Sign of High Cholesterol? GERD can also cause asthma, chronic laryngitis, and stricture of the larynx or trachea (breathing tube). Chronic regurgitation of stomach acid into the mouth can even promote dental cavities.So, as you can see, heartburn is not always a mere annoyance. It may be a sign that something much more serious and even dangerous may be going on.3. Heartburn Doesn't Involve the Heart, But...It is common for doctors (and articles on heartburn) to say something like, “Heartburn is a misnomer, since it has nothing to do with the heart.” This is a correct statement. By definition, heartburn is caused by stomach acid refluxing into the esophagus, and so it has nothing to do with the heart.However, this kind of statement can give you a false sense of security. What these authorities fail to mention is that, until you know that the burning sensation you are experiencing is caused by acid reflux, you may not have heartburn at all. You may, in fact, have a cardiac problem—namely angina due to coronary artery disease. It is not all that uncommon for angina to show up with the same kind of burning discomfort.Anyone who has the new onset of heartburn-like symptoms when they are middle age or older—especially if they have some risk factors for heart disease, such as being overweight; having hypertension, diabetes or prediabetes; living a sedentary lifestyle; having abnormal blood lipids; or being a smoker—should see a doctor for an evaluation before self-medicating for heartburn. They may not have heartburn at all, and a delay in diagnosing angina can have fatal consequences.4. Heartburn Can Affect AsthmaIt is now well-recognized that GERD is a common trigger of asthma. The reflux of stomach acid into the throat and upper airways can worsen asthma attacks by three mechanisms: by making the airways more prone to spasm, by increasing vagal tone, and by directly irritating the upper airways. For one thing, this means that anyone who has frequent asthma attacks should be tested for GERD. And for another, it means that anyone who has both asthma attacks and heartburn should receive an aggressive course of therapy for GERD. Article Heartburn Myths You Should Know the Truth About Article Prevent Exertion-Associated Gastroesophageal Reflux During Workouts Treating GERD, if it is present, can greatly decrease the number of asthma attacks. Read more about asthma and GERD.5. Other Conditions Can Be Confused With HeartburnDoctors use the term heartburn to indicate the burning discomfort beneath the breastbone that is caused by the reflux of stomach acid. But, as you now know, this particular symptom (burning discomfort) may not always indicate heartburn.In addition to cardiovascular issues like coronary artery disease, there are some other medical conditions that can also be confused with heartburn caused by GERD. These include:Peptic ulcer diseaseDisorders of the biliary tract Motility disorders of the esophagus, such as achalasia or esophageal spasm Esophageal cancerAnyone who receives aggressive therapy for heartburn and experiences only minimal improvement should be re-evaluated to make sure they are being treated for the right problem.6. There Are Four Kinds of Treatment for HeartburnThere are four general treatments commonly used to treat heartburn caused by GERD. From the mildest to strongest types of therapy they are:Lifestyle and Dietary Modifications—There are a number of lifestyle and dietary adjustments that can greatly improve heartburn. These include:Lose weight if you are overweight: Obesity greatly increases the propensity for GERD, as well as related complications.Elevate the head of your bed.Avoid any foods that trigger heartburn. These are different for everyone, but common culprits include fatty foods, chocolate, caffeine, peppermint, onions, citrus, and tomatoes. Stop smoking. Smoking relaxes the LES and makes GERD much more likely. Cut back on alcohol to no more than one drink per day. Alcohol relaxes the LES and can increase reflux.Stop eating at least three hours before bedtime.Eat smaller, more frequent meals.Eat slowly and chew your food very well.Wear looser clothing.Chew gum after a meal. Drink a warm, non-caffeinated beverage after a meal.Many people who have mild heartburn can completely eliminate their symptoms by taking such lifestyle measures.Antacids—Antacids neutralize stomach acid and can reduce the irritation caused by the reflux of stomach contents. Antacids do not prevent reflux, but because they work very quickly, they can reduce the symptoms caused by reflux. Gaviscon, Maalox, Mylanta, Rolaids, and Tums are among the more commonly used antacids.Histamine-2 receptor antagonists (H2RAs)—These drugs diminish the production of stomach acid and, over time, can help get rid of heartburn. They do not work immediately, so they do not relieve acute episodes. Rather, they are often prescribed as a specific course of therapy, usually two to four weeks in duration, to try to stop GERD altogether and, thus, eliminate heartburn. The H2RA drugs, all of which are about equally effective, are Axid (nizatidine), Pepcid (famotidine), Tagamet (cimetidine), and Zantac (ranitidine). Proton pump inhibitors (PPIs)—PPIs are the most potent inhibitors of stomach acid currently available and tend to be more effective in eliminating GERD (and heartburn) than the H2RA drugs. They are more expensive, however, and they also cause more adverse effects, so most doctors will try an H2RA drug first. Like the H2RA drugs, the PPIs are prescribed for a prolonged course of therapy (usually eight weeks) to attempt to get rid of GERD altogether. The PPIs include AcipHex (rabeprazole), Prevacid (pantoprazole), Nexium (esomeprazole), and Prilosec (omeprazole). One PPI is roughly as effective as another. Read more about PPIs for GERD.7. Heartburn Is Common During PregnancyHeartburn is extremely common during pregnancy. Up to 50 percent of pregnant women will experience heartburn, and this symptom is extremely troublesome for many of them. This heartburn is due to two factors. First, the hormonal changes that occur during pregnancy tend to relax the LES. Second, the increased abdominal volume that occurs with pregnancy places the stomach contents under extra pressure.During pregnancy, women with heartburn should make every effort to make appropriate adjustments to limit the problem, such as elevating the head of the bed, wearing loose clothing, and avoiding dietary triggers. If these measures are insufficient, antacids that do not contain sodium bicarbonate or magnesium trisilicate can be used. Sulfacate (Carafate), a medication that coats the lining of the gastrointestinal tract, is often prescribed for heartburn during pregnancy because it is safe. (However, if it were really very effective it would also be recommended for people other than pregnant women.) H2RAs or PPIs can also be used if heartburn is particularly vicious, though the safety of these drugs during pregnancy has not been fully established.Despite such ministrations by medical professionals, many pregnant women take whatever lifestyle measures they can, supplement those measures with some antacids, and resign themselves to a certain amount of heartburn for the duration. Read more on heartburn and pregnancy.8. Sometimes You Can Treat Heartburn YourselfYou don’t always need to see a doctor if you have heartburn. If you have heartburn once a week or less, and if you don’t have any alarming symptoms, there’s nothing wrong with trying to treat it yourself. (The next section describes what an “alarming symptom” is.)If you are going to treat heartburn yourself, you should make all of the lifestyle and dietary changes described above that apply to you. While you are waiting for these lifestyle adjustments to work, you can take an antacid whenever you experience one of your infrequent episodes of heartburn. You have undoubtedly noticed that both H2RA drugs and PPIs are now readily available over-the-counter. (Commercials touting them are hard to miss.) If you have mild heartburn, there’s nothing wrong with taking a two-week course of one of these.But if you find that making the appropriate lifestyle changes has not helped, or if you find yourself adding an H2RA or PPI to your regular shopping list, your attempt at self-treatment has not worked. To make sure you don’t develop one of the unfortunate complications of GERD, it’s time to see your doctor.9. Sometimes You Need to See a DoctorIt is important to see your doctor if your mild heartburn has not responded to your reasonable attempts at self-treatment, or if you have heartburn that is more than mild.If you regularly have heartburn more than once a week it is not mild, it is likely that you have chronic GERD. You also have more than mild heartburn if your symptoms are so severe that an antacid fails to relieve them. There are also some alarming symptoms or signs that indicate that your GERD has progressed to the point that it is doing more than merely causing heartburn. These include: Dysphagia (difficulty in swallowing)Odynophagia (pain with swallowing)VomitingCoughing or expectorating bloodEpisodes of dyspnea New-onset or worsening asthmaIf any of these circumstances or symptoms apply to you, it is time to see your doctor so that a definitive diagnosis can be made and an aggressive course of therapy can be instituted.How Is Heartburn Treated?When doctors diagnose heartburn and begin treating it, they are actually treating GERD. In doing so, they are attempting not only to relieve your symptoms of heartburn, but also to prevent the more serious complications of GERD.The level of aggressiveness the doctor uses in treating you will likely depend on whether your doctor believes your heartburn is mild, moderate, or even severe.As we have seen, mild heartburn is generally treated with lifestyle adjustments and antacids as needed.If the heartburn is considered moderate (that is, more frequent than once a week or so, but not accompanied by alarming symptoms) it is likely that your doctor will also prescribe an H2RA drug to be taken twice a day for two to four weeks.If your heartburn is more severe (nearly daily, or accompanied by alarming symptoms), your doctor will probably want you to have an endoscopy to document whether you may already have one of the complications of GERD. In addition, he or she is likely to skip the H2RA drug altogether and escalate directly to an eight-week course of a PPI drug.In rare cases, if GERD fails to improve with such measures, surgical treatment may be recommended.Learn more: Treating GERDKeep in mind that the goals of treating heartburn are two-fold. First, of course, the goal is to eliminate (or at least greatly reduce) the amount of heartburn you are experiencing and its severity. But second, it is important to keep the acid reflux that accompanies GERD from causing permanent damage to your esophagus, throat, or airways.A Word From VerywellHeartburn is a very common symptom; most of us will experience it from time to time. If it is mild and infrequent, we can usually manage it ourselves, or even laugh it off.But for a lot of people, heartburn is not a laughing matter. It can become very disruptive to normal living. And because heartburn is a sign of GERD, it can be accompanied by some very damaging medical problems. If you have heartburn that is anything but mild, or that cannot be successfully managed by the simple steps you can take yourself, it is important to enlist the help of your doctor in controlling your symptoms, and making sure you don’t develop any of the serious consequences of acid reflux.Sources:Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Institute Technical Review on the Management of Gastroesophageal Reflux Disease. Gastroenterology 2008; 135:1392.Katz PO, Gerson LB, Vela MF. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2013; 108:308.Mikami DJ, Murayama KM. Physiology and Pathogenesis of Gastroesophageal Reflux Disease. Surg Clin North Am 2015; 95:515.