Everything you need to know about heartburn

Heartburn is a symptom of pain and burning in the upper chest. It is caused by stomach acid rising into the esophagus (food pipe). You can get relief from heartburn symptoms using medications or home remedies.

Heartburn is common, but it’s important to see a doctor when it occurs frequently or when symptoms worsen. Heartburn can be a symptom of a more serious health problem.

Symptoms and sensations

Heartburn is a common problem that most people have experienced at some point. Heartburn can feel like an uncomfortable burning sensation. It is often felt in the chest or behind the breastbone, leading to confusion with more serious illnesses such as heart problems.

Heartburn can also be felt in the neck or throat. This is because acid rising from the stomach into the esophagus causes the symptoms.

Intensity and Frequency

Heartburn can range from uncomfortable to quite painful. It may last a short time or last for hours. It may also disappear without treatment.

Heartburn symptoms can worsen after eating, especially when you eat foods that are more likely to trigger them. Heartburn may also occur more frequently at night or when you are lying down.

Some people may also find that their heartburn starts or worsens when they bend over because stomach contents can follow gravity and move up into the esophagus.

Emergency Heartburn Symptoms

If there is any concern that heartburn-like symptoms may be due to a heart attack, seek care immediately. Although heart attack symptoms can vary, they can include:

• Chest pain in the center or left side of the chest
• Pain or discomfort in the arms, back, shoulders, neck or jaw
• Shortness of breathe
• Sweating (for no reason)
• Dizziness
• Fast or irregular heartbeat

Some symptoms may appear to be part of heartburn or occur at the same time, but should be taken more seriously. These signs and symptoms are a reason to seek care from a healthcare professional:

• Blood in stool or feces
• Chest pains
• Chronic cough
• Difficulty swallowing
• Loss of appetite
• Persistent vomiting or vomiting that contains blood or looks like coffee grounds
• Unexplained weight loss

Heartburn without other symptoms can be disturbing, but it is not an emergency. It’s something to address at your next appointment with a healthcare professional, especially if it occurs frequently. They can explore how to prevent or control the problem and what to do if it gets worse.

Who gets severe heartburn?

In some people, heartburn can come on suddenly and be severe. It can be difficult for a person to know whether the symptoms are just heartburn or whether heartburn means another health problem is causing it.

However, when symptoms are frequent and interfere with sleep or daily activities, it’s time to see a doctor to see if there is another problem.

People who are most at risk for heartburn include those who:

• Are overweight or obese
• They are pregnant
• Have a hiatal hernia (when the upper part of the stomach protrudes through the muscular diaphragm that separates the chest cavity from the abdominal cavity)
• Smoke cigarettes or frequently be around secondhand smoke

Some medications can cause heartburn or make it worse. It’s important to talk to a healthcare professional when this happens, as other options may be available. Some of these medications include:

• Benzodiazepines (used for sedation)
• Medicines for high blood pressure called calcium channel blockers
• Medicines used to treat asthma
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Tricyclic antidepressants

Do not stop or change prescribed medications before discussing them with a healthcare professional.

What about chronic heartburn?

It is important to monitor the symptoms of heartburn and how often they occur. If heartburn becomes chronic, it could be a sign of another illness.

Heartburn is one of the symptoms of gastroesophageal reflux disease (GERD). Heartburn symptoms may be part of GERD if they occur more than twice a week or if they don’t improve after over-the-counter (OTC) treatments, such as antacids or acid-reducing medications.

Heartburn treatment

Heartburn can be prevented and controlled in several ways. Some people may need more than one option to manage heartburn symptoms. If nothing seems to work or it’s difficult to figure out what’s causing your heartburn (like what foods trigger it), see a doctor for advice.

Drugstore Heartburn Relief

Over-the-counter medications to prevent or control heartburn include the following options.

Antacids they act on stomach acid, reducing the likelihood of causing symptoms. They can be helpful after heartburn symptoms begin and can work quickly to eliminate symptoms. Brands found at the drugstore include Mylanta, Rolaids and Tums.

Histamine-2 (H2) blockers include OTC brands such as Axid AR (nizatidine), Pepcid Complete or Pepcid AC (famotidine), and Tagamet HB (cimetidine). An H2 blocker stops the stomach lining from producing acids by binding to histamine type 2 receptors. They can start working one to three hours after they are taken. They may be less effective for some people than proton pump inhibitors (PPIs).

Proton pump inhibitors (PPIs) are for long-term use and are generally recommended for 14 days. Symptoms may take several days (up to four) to begin to disappear. PPIs block the last part of the acid creation process in the stomach. Brand names of PPIs include Nexium 24HR (esomeprazole), Prevacid 24HR (lansoprazole), Prilosec OTC (omeprazole magnesium), and Zegerid OTC (omeprazole and sodium bicarbonate).

Minimizing and eliminating triggers

Some people may find that heartburn occurs after eating certain foods or when they lie down right after eating.

It may help to avoid or reduce your consumption of foods often associated with heartburn symptoms, such as:

• Alcoholic drinks
• Chocolate
• Coffee
• Fatty, spicy, fatty and acidic foods
• Peppermint
• Processed foods (such as chips or fast food)
• Tomatoes and foods made with tomatoes (pizza and spaghetti)

Certain medications can also contribute to the development of heartburn. Do not stop taking any prescribed medication without discussing it with a healthcare professional. Some of these medications include:

Other lifestyle changes that can help avoid or prevent heartburn symptoms include:

• Avoid lying down for two or three hours after eating to allow gravity to prevent stomach acid from rising into the esophagus
• Eating smaller meals, especially dinners
• Eat slower
• Elevating the head of the bed or sleeping on a wedge pillow
• Manage your weight if you are overweight or obese, as these are risk factors for heartburn
• Quit smoking, as tobacco use can cause heartburn

Prescription and Surgical Treatments

A healthcare professional may recommend H2 blockers and PPIs for heartburn. These medications are available over the counter and with a prescription. Prescription forms may have a higher dosage or be prescribed for longer than 14 days. If prescriptions are needed, it could mean that GERD is the cause of the symptoms.

Surgery is not used as a treatment for occasional heartburn. When heartburn becomes frequent or chronic, medications and lifestyle changes do not help, or there is a diagnosis of GERD or another esophageal condition, surgery may be considered.

Surgical procedures for GERD strengthen the lower esophageal sphincter (LES). When the LES is stronger or works more effectively, it can help prevent acid from moving up from the stomach into the esophagus. Procedures and surgeries used for GERD include Nissen fundoplication, transoral incisionless fundoplication (TIF), Stretta, Bard EndoCinch System, and Linx surgery.

Self-care to control heartburn

Home remedies for heartburn are generally low risk, although research evidence may not support them. However, chronic or recurrent heartburn should not be ignored.

Home remedies for heartburn include:

• Apple cider vinegar (which must be diluted with another liquid or food to avoid irritating the throat)
• Baking soda mixed with water or other liquid
• Chewing gum, which increases saliva production and enhances swallowing
• Drink skimmed milk
• Drinking ginger tea or taking ginger supplements
• Eat low-fat yogurt
• Lemon water (dilute the lemon juice so as not to cause throat irritation)

Adding these foods to the diet may also be helpful for some people:

• Alkaline foods (bananas, cauliflower, fennel, melon and nuts)
• Foods with high water content (broths, celery, cucumber, herbal tea, lettuce and watermelon)
• Green vegetables (asparagus, broccoli and green beans)
• Root vegetables (beets, carrots and sweet potatoes)
• Whole grains (brown rice, couscous and oats

Take note of which foods trigger heartburn and reduce or avoid those foods.

How long does heartburn last with treatment?

Heartburn can come on quickly after a trigger, such as eating a spicy or high-fat meal. Symptoms can last for hours if left untreated. Preventing heartburn by avoiding triggers whenever possible, such as foods, meals too close to bedtime, large meals and smoking, is a good strategy.

Treatment usually reduces the intensity or duration of heartburn. The effects will depend on the treatment method chosen.

Antacids can work quickly, but may need to be used again within a few hours. H2 blockers can take hours to take effect if they are taken after heartburn symptoms begin. PPIs take days to take effect, so it’s best to use them preventatively, such as when heartburn is a more frequent problem.

Home remedies may be less effective than medications in some cases. A home remedy may work for a few hours or completely resolve symptoms. The benefit of some home remedies is that they are less likely to cause adverse effects.

When to consult a healthcare professional

When heartburn occurs frequently, it may be caused by an underlying condition, such as GERD. In that case, it’s time to see a doctor.

Other reasons to see a doctor as soon as possible include:

• Black or tarry stools
• Blood in stool or feces
• Chest pain
• Lose weight without trying
• Loss of appetite (lasting more than a day or two)
• Difficulty swallowing or pain when swallowing
• Vomiting that doesn’t stop, vomiting blood, or vomiting a substance that looks like coffee grounds

Summary

Heartburn can be quite uncomfortable, but it is usually short-lived and does not always need a doctor’s attention. Several types of treatments are available to prevent heartburn or treat it immediately. Lifestyle and dietary changes are also helpful in preventing heartburn.

When heartburn occurs more than a few times a week, is painful, or interferes with everyday life, it’s time to see a doctor. Symptoms that are reason to seek immediate care include chest pain, any sign of bleeding in the colon or esophagus, and repeated vomiting.