When to seek care for heartburn

Overview

Heartburn is a burning feeling in the chest, just behind your breastbone. It happens when stomach acid flows back up into the tube that connects your mouth to your stomach (the esophagus). This is also called acid reflux.

Yes, heartburn is very common. Many people experience it from time to time, especially after eating a heavy meal or certain foods.

Heartburn can affect people of all ages, but it is more common in adults, pregnant women, and people who are overweight. It can also occur in children and older adults.

Symptoms

Common symptoms

• A burning feeling in the chest, often after eating or at night
• A sour or bitter taste in the mouth
• Feeling like food is stuck in the throat
• Coughing or hoarseness
• Trouble swallowing (dysphagia)

Symptoms in children

• Vomiting or spitting up frequently
• Coughing or wheezing, especially at night
• Irritability or crying after meals
• Poor weight gain or refusing to eat

Symptoms in older adults

• Heartburn that is less intense but more frequent
• Difficulty swallowing or feeling like food gets stuck
• Chest pain that might be mistaken for a heart problem
• Hoarseness or chronic cough

Causes

Main causes

• Acid reflux – stomach acid flows back into the esophagus
• Weakness or relaxation of the lower esophageal sphincter (the muscle that keeps stomach contents from coming up)
• Hiatal hernia – part of the stomach pushes up into the chest cavity

Risk factors

• Eating large meals or lying down right after eating
• Being overweight or obese
• Pregnancy
• Smoking or exposure to secondhand smoke
• Certain foods and drinks, such as spicy, fatty, or fried foods, citrus, tomatoes, chocolate, caffeine, and alcohol
• Some medications, including aspirin, ibuprofen, and certain blood pressure medicines

When to see a doctor

See a doctor urgently if:

• You have heartburn more than twice a week
• Your symptoms are severe or get worse over time
• You have trouble swallowing or pain when swallowing
• You have unexplained weight loss

Book a routine appointment if:

• Occasional heartburn that does not improve with lifestyle changes
• Heartburn that wakes you up at night
• You need to take over-the-counter antacids or acid reducers more than twice a week
• You have a persistent cough or hoarseness

Diagnosis

Your doctor will ask about your symptoms, medical history, and lifestyle. They may also do a physical exam. If symptoms are frequent or severe, they may recommend tests to check for GERD or other conditions.

Tests that may be done

• Upper endoscopy – a thin, flexible tube with a camera is passed down your throat to look at the esophagus and stomach
• pH monitoring – a test to measure acid levels in the esophagus
• Barium swallow – you drink a chalky liquid and X-rays are taken to see the shape of your esophagus and stomach
• Manometry – a test to measure the pressure and movement of the esophagus

What to expect at your appointment

Most heartburn can be managed without tests. If your doctor recommends a test, it is usually quick and can be done as an outpatient. You may be asked to stop certain medications before the test. The results will help guide your treatment.

Treatment

Treatment for heartburn depends on how often and how severe your symptoms are. It often starts with lifestyle changes and may include medications to reduce or block stomach acid. For chronic GERD, surgery may be an option if other treatments do not work.

Self-care at home

• Eat smaller and more frequent meals
• Avoid foods and drinks that trigger your heartburn
• Do not lie down for at least 2 to 3 hours after eating
• Elevate the head of your bed by about 6 to 8 inches using blocks or a wedge pillow
• Lose weight if you are overweight
• Stop smoking if you smoke
• Wear loose-fitting clothes to reduce pressure on your stomach

Medical treatments

Your doctor may recommend over-the-counter or prescription medications that help reduce or neutralize stomach acid. These include antacids, H2 blockers, and proton pump inhibitors (PPIs). Always follow your doctor's advice on which medicine is right for you and for how long to take it. Do not take medications longer than recommended without talking to a doctor.

When is surgery considered?

If lifestyle changes and medications do not control your symptoms, or if you develop complications like severe esophagitis or Barrett's esophagus, your doctor might mention a surgical procedure called fundoplication. This wraps the top of the stomach around the esophagus to strengthen the valve and prevent acid reflux. Surgery is only considered after careful evaluation.

Living with this condition

Living with heartburn means being aware of what triggers your symptoms and making small changes to avoid them. Many people manage successfully with diet adjustments and over-the-counter remedies. If symptoms are frequent, working with your doctor to find the right treatment plan can help you feel better.

Lifestyle tips

• Keep a food diary to identify personal triggers
• Eat slowly and chew food thoroughly
• Avoid eating within 3 hours of bedtime
• Stay upright after meals – sit or stand, do not recline
• Manage stress with relaxation techniques like deep breathing or meditation

Diet and exercise

A diet low in fatty, fried, and spicy foods can help. Eat more whole grains, lean proteins, and non-citrus fruits. Regular, moderate exercise is good, but avoid vigorous activity right after eating. Walking after meals may help digestion.

Mental health and emotional wellbeing

Chronic heartburn can be frustrating and affect your sleep and mood. It is normal to feel stressed or worried about persistent symptoms. Talk to your doctor if heartburn is affecting your mental health – they can offer support and resources.

Prevention

You can reduce your chances of getting heartburn by maintaining a healthy weight, eating smaller meals, avoiding trigger foods, not lying down after meals, and quitting smoking. However, some people may still get heartburn due to anatomical or genetic factors.

Screening programmes

There is no routine screening test for heartburn. If you have persistent or severe symptoms, your doctor may recommend an endoscopy to check for complications like Barrett's esophagus, especially if you have long-standing GERD.

Complications

If left untreated

• Esophagitis – inflammation or sores in the esophagus
• Stricture – narrowing of the esophagus that makes swallowing hard
• Barrett's esophagus – changes in the lining of the esophagus that increase the risk of esophageal cancer
• Aspiration pneumonia – stomach acid gets into your lungs
• Sleep problems from nighttime reflux

Long-term outlook

For most people, heartburn is a manageable condition. With lifestyle changes and the right treatment, symptoms often improve. Even if you have GERD, the outlook is very good with proper care. Serious complications are rare, especially if you see your doctor early and follow their advice.

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• Your GP or local health clinic · United Kingdom

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