Heartburn in older adults

Overview

Heartburn is that uncomfortable burning feeling in your chest, just behind your breastbone. It happens when stomach acid flows back up into the tube that carries food from your mouth to your stomach (the esophagus). For older adults, heartburn can feel a bit different and may need extra attention.

Yes, heartburn is quite common in older adults. Many people over 65 experience it at least once a week.

Heartburn affects people of all ages, but older adults are more likely to have it because of age-related changes in the digestive system, taking certain medications, and other health conditions.

Symptoms

Common symptoms

• A burning sensation in the chest, usually after eating, at night, or when lying down
• A sour or bitter taste in the mouth
• Feeling like food is stuck in the throat

Symptoms in older adults

• Chest pain that may be mild or feel like pressure (not always a sharp burning sensation)
• Chronic cough or hoarseness, especially at night
• Feeling full or bloated after small meals
• Difficulty swallowing or a feeling that food gets stuck

Causes

Main causes

• Weakening of the lower esophageal sphincter (the muscle that keeps stomach acid down) due to age
• Hiatal hernia (part of the stomach pushes up into the chest)
• Taking certain medications, especially for high blood pressure, arthritis, or osteoporosis (like some pain relievers or bone medications)

Risk factors

• Being over 65
• Being overweight or obese

When to see a doctor

See a doctor urgently if:

• If you have chest pain that feels like a heart attack
• If you vomit blood or have black, tarry stools
• If you have trouble swallowing or pain when swallowing

Book a routine appointment if:

• If heartburn happens more than twice a week
• If over-the-counter medicines do not help after two weeks

Diagnosis

Your doctor will ask about your symptoms and medical history. They may suggest some tests to see if acid is affecting your esophagus and to rule out other problems.

Tests that may be done

• Upper endoscopy: a thin, flexible tube with a camera is gently passed down your throat to look at your esophagus and stomach.
• pH monitoring: a small tube measures acid levels in your esophagus over 24 hours.
• Barium swallow: you drink a chalky liquid, and X-rays show how your esophagus and stomach work.

What to expect at your appointment

Diagnosis is usually straightforward. The tests are not painful, though some may feel a bit uncomfortable. Your doctor will explain each step and help you feel at ease. Most people are able to go home the same day.

Treatment

Treatment for heartburn in older adults focuses on relieving symptoms and healing the esophagus. It often starts with lifestyle changes and may include medicines or, rarely, surgery if other treatments do not work.

Self-care at home

• Eat smaller, more frequent meals rather than large ones.
• Avoid foods and drinks that trigger your heartburn (like fatty foods, chocolate, coffee, alcohol, or citrus).
• Do not lie down for at least three hours after eating.
• Raise the head of your bed by 6-8 inches so gravity helps keep acid down.
• Wear loose clothing around your waist.

Living with this condition

Living with heartburn means being mindful of what you eat and how you eat. You can still enjoy most foods, but you may need to adjust portions or timing. Many people find that their symptoms improve greatly with simple changes.

Lifestyle tips

• Plan your meals and avoid eating right before bedtime.
• Keep a food diary to identify your triggers.
• Stay upright after meals — go for a gentle walk rather than sitting or lying down.
• Manage stress with relaxation techniques, as stress can worsen heartburn.

Diet and exercise

A balanced diet with plenty of vegetables, fruits, and whole grains is good for overall health. Avoid high-fat and spicy foods if they bother you. Gentle exercise like walking can help digestion and weight management. Avoid vigorous exercise soon after eating.

Prevention

Not all heartburn can be prevented, but you can reduce how often it happens by avoiding triggers, eating smaller meals, and maintaining a healthy weight. Medications that protect the esophagus may also be helpful if you are at risk.

Complications

If left untreated

• Esophagitis – inflammation of the esophagus that can cause pain and bleeding
• Stricture – narrowing of the esophagus, making swallowing difficult
• Barrett's esophagus – changes in the lining of the esophagus that can increase the risk of esophageal cancer (rare)

Long-term outlook

With proper care, most older adults with heartburn can manage their symptoms very well. Simple lifestyle changes and safe medications can prevent complications and keep you comfortable. Even if you need long-term treatment, you can still enjoy a full, active life.

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