Cooling Off Heartburn

Overview

Heartburn is a burning feeling in your chest, just behind your breastbone. It happens when acid from your stomach splashes back up into your food pipe (the oesophagus — the tube that carries food from your mouth to your stomach). Despite the name, heartburn has nothing to do with your heart. It is a common problem, and for most people it can be eased with simple changes and short-term help from a pharmacy.

Yes, heartburn is very common. Most adults get it at some point, often after a large or spicy meal. Frequent heartburn (sometimes called acid reflux or GORD — gastro-oesophageal reflux disease) is also common and affects a large number of people worldwide.

Anyone can get heartburn, including children and babies. It is more likely in people who are overweight, are pregnant, smoke, eat large or late meals, or take certain medicines. Older adults are more likely to have other health conditions that need checking, and babies often bring up milk because their food pipe is still developing.

Symptoms

Common symptoms

• A burning or warm feeling in the chest, often behind the breastbone and after eating
• A sour or bitter taste in the back of the mouth
• Food or liquid coming back up into your throat (regurgitation)
• Feeling full, bloated or burping more than usual
• A burning feeling that is worse when you lie down, bend over or lie on your back
• A hoarse voice, sore throat or a cough that keeps coming back
• Symptoms that are worse at night and disturb sleep

Symptoms in children

• Frequent spitting up or bringing up milk, especially after feeds
• Crying or being fussy during and after feeding
• Arching the back or pulling away from the bottle or breast
• Coughing, hiccups or a hoarse cry
• Poor weight gain or refusing feeds
• In older children: a burning chest feeling, a sour taste, or tummy pain after meals

Symptoms in older adults

• Symptoms may be milder or less obvious than in younger people
• Chest discomfort that can be hard to tell apart from other conditions
• More chance of other health problems or medicines playing a part
• A cough, hoarse voice or throat clearing may be the main complaint
• Any new chest pain should be checked urgently, because heart problems can feel similar

Causes

Main causes

• The ring of muscle at the bottom of the food pipe (the valve that keeps stomach contents in place) relaxing at the wrong time
• A hiatal hernia, where part of the stomach pushes up through the diaphragm (the sheet of muscle under the lungs)
• Large meals, or eating late and lying down soon afterwards
• Fatty, spicy, very rich or acidic foods and drinks for some people
• Alcohol, caffeine, chocolate, peppermint and fizzy drinks
• Smoking
• Being overweight, which puts extra pressure on the stomach
• Pregnancy, because of hormone changes and pressure from the growing baby
• Some medicines, including certain painkillers and heart medicines
• Stress and not sleeping well, which can make symptoms feel worse

Risk factors

• Being overweight or carrying extra weight around the middle
• Smoking or using tobacco
• Eating large meals late in the evening
• Drinking a lot of alcohol or caffeine
• Being pregnant
• Taking certain medicines long term
• Having a hiatal hernia
• A family history of reflux problems
• Tight clothing or lying down soon after eating

When to see a doctor

See a doctor urgently if:

• Chest pain that is new, severe, or feels like pressure or squeezing — get emergency help first
• Vomiting blood, or black tar-like stools
• Trouble swallowing or food getting stuck
• Losing weight without trying
• Symptoms that come with shortness of breath, sweating or feeling very unwell

Book a routine appointment if:

• Heartburn on most days, or that keeps coming back over weeks
• Symptoms that are not helped by lifestyle changes and pharmacy treatments
• Heartburn that disturbs your sleep or affects your eating
• A cough or hoarse voice that will not settle
• Heartburn in pregnancy, so your doctor or midwife can advise on safe options
• A child with feeding problems, poor weight gain or frequent vomiting

Diagnosis

Most people are diagnosed from their symptoms and a short conversation with a doctor or pharmacist. Your doctor will ask what the burning feels like, when it happens, what makes it better or worse, what you eat and drink, and what medicines you take. Often they will suggest some lifestyle changes first and see how you get on.

Tests that may be done

• Review of your symptoms and medicines, plus a physical check-up
• A short trial of lifestyle changes or pharmacy treatment to see if symptoms settle
• A test for a stomach bacteria called H. pylori (a common cause of stomach irritation) using a breath or stool sample
• An endoscopy, where a thin flexible tube with a camera looks down your food pipe and stomach — used if symptoms are unusual or do not settle
• A heart tracing (ECG) if there is any doubt about chest pain
• Blood tests to check for anaemia or other causes
• Acid monitoring or pressure tests of the food pipe in specialist cases

What to expect at your appointment

An appointment is usually a chat and a check-up, not a lot of tests. If you need an endoscopy, you will usually be given a sedative or throat spray to keep you comfortable, and it takes only a few minutes. You can normally go home the same day.

Treatment

Treatment aims to reduce how often acid splashes back up, protect your food pipe and ease the burning. Most people start with everyday changes and pharmacy remedies. If symptoms continue, your doctor can suggest stronger treatments on prescription and, in rare cases, refer you to a specialist.

Self-care at home

• Eat smaller meals more often rather than one large meal
• Leave about three hours between your last meal and lying down
• Raise the head of your bed by about 10 to 15 cm, or sleep on a wedge pillow, so gravity helps keep acid down
• Keep a simple diary of foods and drinks that set off symptoms, and cut back on those
• Cut down on alcohol, caffeine, fizzy drinks and rich or spicy foods if they bother you
• Stop smoking — ask your doctor or pharmacist for support to quit
• Lose weight gradually if you are carrying extra weight
• Loosen tight belts and waistbands, especially after eating
• Chew sugar-free gum after meals — it helps make more saliva, which can soothe the food pipe
• Avoid bending over or lying down straight after eating

Medical treatments

Pharmacies sell simple remedies that neutralise stomach acid and give quick, short-term relief, plus treatments that reduce how much acid the stomach makes. Some of these are available over the counter and some need a prescription from your doctor. Your doctor or pharmacist will help you choose one that suits you, taking into account other medicines you take and any health conditions you have, and will explain how long to use it. Always read the label and follow their advice. If symptoms return once treatment stops, tell your doctor rather than continuing medicines on your own long term.

When is surgery considered?

Surgery is only considered for a small number of people whose symptoms stay severe despite treatment, or who cannot take long-term medicines. It usually involves tightening the valve at the bottom of the food pipe. Your specialist would discuss the benefits and risks with you in detail.

Living with this condition

Heartburn is usually managed by paying attention to when and how you eat, what you drink, and how you sleep. Many people find that a few steady habits — smaller meals, an earlier evening meal, a raised pillow, and a bit less alcohol — make a big difference. Keep a note of what helps and what triggers symptoms, so you can make choices that suit your life.

Lifestyle tips

• Plan your evening meal earlier and keep it lighter
• Keep water nearby and sip it through the day
• Wear comfortable clothes that are not tight around the waist
• Take a short gentle walk after meals rather than sitting or lying down
• Avoid late-night snacks and alcohol close to bedtime
• If you smoke, get support to stop — this is one of the single biggest helps
• Manage stress with breathing exercises, relaxing hobbies or time outdoors
• Tell your doctor about all medicines you take, including ones you buy yourself

Diet and exercise

There is no single heartburn diet that suits everyone, but many people do better with smaller meals, less fried and very rich food, and fewer fizzy drinks. Some find tomatoes, citrus, chocolate, mint or coffee are triggers — your own diary will tell you. Try not to cut out whole food groups without advice, as balance matters. Gentle regular activity such as walking or swimming helps with weight and digestion. Very intense exercise straight after eating, or exercises that involve lying flat or heavy lifting, can bring on symptoms for some people.

Mental health and emotional wellbeing

Heartburn can wear you down. Broken sleep, worry about eating out, or fear of chest pain can make you feel anxious or low, and stress in turn can make symptoms feel worse. This is very common and nothing to feel ashamed of. Talking to your doctor about how it is affecting you is part of the treatment, not a separate issue. If you ever feel overwhelmed or unable to cope, please reach out for help right away — contact your local crisis support service or emergency services at your local emergency number.

Prevention

You cannot always prevent heartburn, but you can greatly reduce how often it happens. Smaller meals, an earlier evening meal, less alcohol and caffeine, stopping smoking, keeping to a healthy weight and raising the head of your bed all help. If you know a food triggers symptoms, having less of it — or having it earlier in the day — can make a real difference.

Screening programmes

There is no routine screening programme for heartburn. The aim is to notice ongoing symptoms early and get them checked. If heartburn lasts for weeks, comes back often, or comes with trouble swallowing or weight loss, see your doctor rather than waiting.

Complications

If left untreated

• Ongoing discomfort and poor sleep that wears you down
• Inflammation of the food pipe (oesophagitis), which can be sore and cause bleeding
• Narrowing of the food pipe, which can make swallowing difficult
• A change in the lining of the food pipe called Barrett's oesophagus, which is uncommon but needs monitoring
• A long-standing cough, hoarse voice or throat irritation
• Rarely, ulcers or bleeding in the food pipe

Long-term outlook

The outlook for most people is very good. With a few simple changes and short-term treatment, symptoms often settle quickly, and many people find they can manage heartburn themselves with confidence. If symptoms keep coming back, your doctor has plenty of options to help, and serious complications are uncommon — especially when symptoms are checked early.

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