What is heartburn and how is it treated?

A burning sensation that occurs in the chest, heartburn is a digestive problem that many people experience from time to time. Although it can be very uncomfortable, occasional heartburn is typically not a serious health concern, and it can often be addressed with over-the-counter treatments and self-care.

Heartburn occurs when stomach acid flows out of the stomach and enters the esophagus, the long tube that carries food from your mouth to your stomach. Ordinarily, a ring-like muscle called a sphincter prevents this from occurring, with the help of your diaphragm. However, if the sphincter relaxes abnormally, the acid from your stomach can escape and cause the irritation commonly known as heartburn.

Many factors can cause heartburn, including:

1. Dietary habits and lifestyle: Elements of your lifestyle can increase your risk of developing heartburn. For example, lying down after you eat can cause acid to escape the stomach and trigger symptoms. A large, heavy meal that temporarily stretches your stomach may also cause heartburn. Smoking cigarettes and breathing in secondhand smoke has been shown to weaken the sphincter muscle and increase the risk for heartburn.

2. Certain foods and drinks: In many cases, heartburn is related to diet. Some foods that cause heartburn by relaxing the sphincter include:

• Alcohol
  
• Caffeinated beverages, like coffee and tea
• Chocolate
• Citrus fruits
• Fatty foods
• Fried foods
• Spicy foods
• Peppermint
• Tomatoes and tomato-based products

These foods don’t trigger heartburn in all people, and you may find that you can eat some foods on this list, but not others.

3. Abdominal pressure: When pressure increases in the abdomen, the sphincter muscle becomes compressed and may allow acid to leak out. Because of hormonal and anatomical changes in body shape that put pressure on the abdomen, many women experience heartburn with pregnancy. Excess body fat can also increase abdominal pressure, making heartburn common in people who are overweight or obese.Other causes of increased abdominal pressure that can lead to heartburn include:

• Digestive gas
  
• Hiatal hernia
• Tight clothing

4. Medications: Heartburn is a side effect of some medications. Birth control pills and certain blood pressure medications are common culprits.

Most people describe heartburn as a burning sensation located in the center of the chest. It may worsen when you lie down or bend over, and it may radiate to the throat and/or neck. When caused by food, heartburn usually starts soon after eating.

Chronic heartburn is referred to as gastroesophageal reflux disease (GERD). People who have GERD may experience additional symptoms like burping, nausea, regurgitating food and digestive juices, and a bitter taste in the mouth.

Severe heartburn can feel similar to the pain associated with a heart attack. People experiencing a heart attack may have additional symptoms, including:

• Crushing sensation or feeling of intense pressure in the chest
  
• Cold sweats
• Shortness of breath
• Fatigue
• Dizziness or lightheadedness
• Pain that spreads to the neck, jaw and/or back
• Nausea and/or vomiting

Because it can be difficult to differentiate the symptoms of heartburn from those of a heart attack, seek emergency medical attention if you experience severe chest pain.

In many cases, heartburn will resolve on its own. However, heartburn treatments can help you feel better faster. There are many ways to alleviate heartburn, including:

1. Diet and lifestyle changes: Making the following changes to your diet and lifestyle can help reduce and prevent heartburn pain.

• Avoid trigger foods: Consider keeping a food journal to track what you eat and when you experience heartburn. Over time, you can identify the foods most likely to trigger your symptoms so you can avoid them.
  
• Time your meals right: Don’t have dinner too close to bedtime or lie down soon after eating. A good rule of thumb is to avoid lying down within three to five hours after eating.
• Reduce portion size: Eat smaller meals more frequently rather than eating fewer but larger meals.
• Quit smoking: Discuss smoking cessation with your healthcare provider. Medications and nicotine replacement therapy products can help you quit.
• Modify your bed: Raising the head of your bed can help reduce the risk of nighttime heartburn. Lying on your left side may also help reduce acid reflux symptoms.
• Manage your weight: Losing weight or maintaining a healthy weight through diet and exercise can help lower the likelihood of heartburn.

2. Over-the-counter medications: There are a variety of over-the-counter medications for heartburn, such as:

• Antacids: Medications known as antacids reduce acid levels to quickly ease heartburn.
  
• Protectants: These drugs form a protective barrier between the gastric acid and your esophagus, which includes the medication sucralfate.
• Histamine receptor antagonists: Commonly called H2 blockers, these medications, like cimetidine and famotidine, block the actions of body chemicals that trigger the production of acid. They are not typically recommended for more frequent heartburn.
• Proton pump inhibitors: These drugs, which include esomeprazole, lansoprazole and omeprazole, interfere with the production of stomach acid. They’re usually taken long term and recommended for people who have severe heartburn that isn’t well controlled with other drugs.

3. Prescription medications and medical procedures: When over-the-counter medications don’t do enough to alleviate heartburn symptoms, healthcare providers may prescribe stronger proton pump inhibitors. Topical steroids may also be prescribed for short-term use to relieve chronic inflammation caused by acid.

If you have a hiatal hernia, your healthcare provider may recommend hernia repair surgery to treat heartburn. Other procedures used for uncontrolled chronic heartburn include:

• Nissen fundoplication: surgery that involves tightening the area where the esophagus meets the stomach to prevent acid leakage
  
• Transoral incisionless fundoplication: a nonsurgical procedure where the esophagus-stomach junction is tightened using an endoscope
• LINX device procedure: surgery to implant a ring of tiny magnets that helps keep the sphincter muscle tightly closed

4. Home remedies: Some people use baking soda, apple cider vinegar, ginger, aloe vera juice and chamomile tea as home remedies for heartburn. However, there isn’t enough information to know whether any of these remedies will work for everyone who tries them. 

Fatty milk may aggravate reflux, but nonfat milk can line the stomach and provide immediate — but short-term — relief of heartburn symptoms. Drinking a glass of nonfat milk may help alleviate heartburn, but over-the-counter medications may be more effective for some people.

The best heartburn treatment for you will depend on many factors, including the cause, severity and frequency of symptoms. Your healthcare provider can help you decide which options are right for you.

Updated November 2023.