Heartburn vs acid reflux: What’s the difference?

Acid reflux and heartburn are common irritations that can occur together. The two terms are sometimes used interchangeably, but they are different.

Acid or gastroesophageal reflux occurs when the lower esophageal sphincter (LES), a muscle that connects the esophagus to the stomach, doesn’t work correctly. Normally, the muscle opens and closes when you swallow. With acid reflux, the LES relaxes at the wrong time or doesn’t close when it should, allowing acidic stomach contents to flow backward and irritate and inflame the entire esophagus up to the throat. 

It’s not uncommon to have an episode of acid reflux every once in a while, often after you’ve just eaten a heavy meal or specific foods. Reflux may even occur without symptoms. However, acid reflux can sometimes cause heartburn and regurgitation of stomach contents.

Heartburn is a symptom of acid reflux. It’s described as a painful, burning sensation in your throat or chest. It’s caused by the refluxed stomach acid that comes into contact with the lining of the esophagus.

Sometimes acid reflux progresses to gastroesophageal reflux disease, or GERD. This is a more severe and chronic form of acid reflux that can cause significant damage to the esophagus. If you have episodes of acid reflux or heartburn more than twice a week, you may have GERD. Symptoms of GERD include:

• Heartburn
• Upper stomach or noncardiac chest pain
• A bad taste in your mouth from backwash of stomach acid or food
  
• Nausea
• Sore throat
• Trouble or pain when swallowing
• Chronic cough, hoarseness or wheezing 

Certain factors can cause the lower esophageal sphincter to weaken or relax and increase your risk for developing acid reflux or GERD. These include:

• Being overweight
• Pregnancy
• Smoking or inhaling secondhand smoke
  
• Taking certain medications, such as benzodiazepines (sedatives), calcium channel blockers (medicines used to treat high blood pressure), certain asthma medicines, nonsteroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants
• Hiatal hernia, a condition where the opening in the diaphragm allows the upper part of the stomach to move into the chest
• Consuming alcohol, carbonated drinks, or foods and beverages with caffeine

Acid reflux and heartburn can often be managed with lifestyle changes:

• Achieve and maintaining a healthy weight.
• Eat several smaller meals throughout the day instead of three large meals.
• Avoid lying down after eating. Have your last meal of the day two to three hours before bedtime.
  
• Avoid foods and beverages that seem to worsen your symptoms. Common triggers include alcohol, spicy, fatty or fried foods, chocolate, peppermint and carbonated drinks.
• Elevate the head of your bed by six to eight inches when you sleep.
• Don’t smoke. Walgreens can help you quit.
• Wear loose-fitting clothing. Tight clothes may put added pressure on your stomach. 

Over-the-counter (OTC) medications can also help ease reflux. Antacids can be used for short-term relief of mild reflux and heartburn, and work by neutralizing the acid in your stomach. H2 blockers reduce how much acid your stomach produces. While they don’t work as quickly as antacids, they provide longer-lasting relief. 

If you have more frequent symptoms or if other OTC medications don’t help, there are stronger acid blockers called protein pump inhibitors (PPIs). They work by lowering acid production and help heal the esophagus. 

If you have GERD, it may be treated with prescription medications, surgery and other procedures.

Acid reflux and heartburn are common issues that often go hand in hand. While they can be uncomfortable, lifestyle changes and medications are often enough to relieve symptoms. Ask your healthcare provider or pharmacist about lifestyle change and medications that can help improve your symptoms. 

Updated by Rebeca Thomas RN, BSN, May 2025.