Heartburn

Was this helpful?
(16)

What is heartburn?

Heartburn is the sensation of burning and pain in the region behind the breastbone (sternum) and in the upper abdomen. It is typically a symptom of a condition known as acid indigestion or acid reflux. The burning pain of heartburn is the result of stomach acid moving upward into the back of the throat, causing inflammation. Most often, heartburn occurs during or right after eating or when you lie down too soon after eating.


Most often, heartburn occurs during or right after eating, or when you lie down too soon after eating. Other causes of heartburn include acute gastritis (gastric ulcer), and ischemic heart disease (atherosclerotic heart disease). Females with ischemic heart disease more often experience heartburn as opposed to chest pain.

Heartburn is an extremely common disorder in the United States. In some people, it is a sign of gastroesophageal reflux disease (GERD), and in others, it may be an isolated event not related to disease. It is common for people who are obese to suffer from heartburn. This is due to increased pressure on the valve between the esophagus and the stomach, which normally prevents reflux.


Heartburn typically develops after you eat or drink certain types of food. Most commonly, heartburn results from overeating, drinking alcohol while eating, or consuming greasy or spicy foods. Heartburn can also occur if the valve between the stomach and the esophagus becomes dysfunctional and allows stomach contents to enter the esophagus.

Some people with heartburn have mild symptoms such as a slight burning after eating that subsides quickly, while others may have stomach acid that reaches the mouth along with a burning feeling in the abdomen, chest and neck. Heartburn can be treated effectively with medications that reduce stomach acid or help the stomach empty its contents faster. You can reduce your risk of heartburn by avoiding overly spicy or fried foods, not overeating, eating at least two hours before bedtime, and maintaining a healthy body weight.

Heartburn alone is rarely a serious condition; however, epigastric pain may be a sign of a life-threatening condition such as a heart attack. Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms such as severe breathing problems, chest pain, chest tightness, chest pressure, or palpitations; or if you vomit blood or black material (resembling coffee grounds).

Seek prompt medical care if you are being treated for heartburn but mild symptoms recur or are persistent.

What are the symptoms of heartburn?

Heartburn is caused by the backward movement of stomach contents into the esophagus, which may result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of heartburn

You may experience heartburn symptoms daily or just once in a while. At times any of these common symptoms can be severe:

In some cases, symptoms of heartburn can be a sign of a heart attack or other serious condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Chest pain, chest tightness, chest pressure, palpitations

  • Heartburn symptoms that persist despite use of usual remedies

  • Radiating pain down your shoulder and arm

  • Respiratory or breathing problems such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

  • Vomiting blood or black material (resembling coffee grounds)

What causes heartburn?

Heartburn is commonly the result of overeating, drinking alcohol while eating, or consuming greasy or spicy foods. It can also be a sign of gastroesophageal reflux disease (GERD). Once you experience heartburn, it may never return or it may recur frequently. Heartburn can also result if the valve between the stomach and the esophagus becomes dysfunctional and allows stomach contents to enter the esophagus.

What are the risk factors for heartburn?

A number of factors increase the risk of developing heartburn. Not all people with risk factors will get heartburn. Risk factors for heartburn include:

  • Alcohol use

  • Caffeine consumption

  • Foods or substances containing mint

  • Foods such as chocolate; spicy, fatty or fried foods; and foods with tomato sauce, onions, or garlic

  • Obesity

  • Pregnancy

  • Smoking

Reducing your risk of heartburn

You may be able to lower your risk of heartburn by:

  • Achieve and maintain a healthy weight

  • Eating in moderation

  • Elevating the upper part of your body when lying down and at night with pillows or foam wedge

  • Limiting alcohol consumption and avoiding alcohol with meals

  • Quitting smoking

  • Waiting several hours after eating before lying down

How is heartburn treated?

Over-the-counter antacids are the mainstay of treatment for heartburn. Other medications that decrease stomach acid, such as proton pump inhibitors and histamine H2-receptor antagonists, are also effective treatments.

Antacids for treating heartburn

Over-the-counter antacids used to treat heartburn include:

  • Aluminum hydroxide (Gaviscon)

  • Calcium carbonate (Tums)

  • Calcium carbonate and magnesium hydroxide (Rolaids)

  • Simethicone (Maalox Anti-Gas, Mylanta Gas, Gas-X)

Proton pump inhibitors for treating heartburn

Proton pump inhibitors that are effective in the treatment of heartburn include:

  • Esomeprazole (Nexium)

  • Lansoprazole (Prevacid)

  • Omeprazole (Prilosec)

  • Pantoprazole (Protonix)

  • Rabeprazole (Aciphex)

Histamine H2-receptor antagonists for treating heartburn

Histamine H2-receptor antagonists that are effective in the treatment of heartburn include:

  • Cimetidine (Tagamet)

  • Famotidine (Pepcid)

  • Nizatidine (Axid)

  • Ranitidine (Zantac)

Other treatment options for heartburn include prokinetics, such as bethanechol (Urecholine) and metoclopramide (Reglan), which improve the function of the valve between the esophagus and the stomach and help the stomach empty its contents more quickly.
Because heartburn medications have different mechanisms of action, they can be used in combination if a single type of medication is ineffective for relieving symptoms. Your health care provider can help you design a treatment plan that is most effective for you. Finally, if heartburn is not relieved by medication, surgical procedures designed to improve the valve strength and function are an option.

What are the potential complications of heartburn?

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of heartburn include:

  • Acute gastritis (gastric ulcer)

  • Brrett’s esophagus (cellular changes in the esophageal lining that are precursors to esophageal cancer

  • Cancer of the esophagus

  • Erosive esophagitis (inflammation of the esophagus)

  • Esophageal scarring and narrowing

Was this helpful?
(16)
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 18
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Understanding heartburn and reflux disease. American Gastroenterological Association. http://www.gastro.org/patient-center/digestive-conditions/heartburn-gerd.
  2. Gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD) in Adults. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/.
  3. Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet 2006; 367:2086.
  4. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.