Heartburn

Overview

What is heartburn?

Heartburn is an uncomfortable burning feeling in your chest that can move up your neck and throat. This can be a symptom of many different conditions, including acid reflux, gastroesophageal reflux disease (GERD) and even pregnancy.

When you are experiencing heartburn, you may also have a bitter or sour taste in the back of your throat. Heartburn can last from a few minutes to several hours. It often feels worse after you eat or when you lay down too quickly after eating.

How common is heartburn?

Occasional heartburn is fairly common. However, if you have regular and severe heartburn, it can actually be an indicator of a chronic acid reflux condition called GERD. You should talk to your healthcare provider if you frequently experience heartburn.

What does heartburn feel like?

Heartburn typically feels like a burning in the center of your chest, behind your breastbone. When you have heartburn, you may also feel symptoms like:

  • A burning feeling in your chest that can last anywhere from a few minutes to a couple of hours.
  • Pain in your chest when you bend over or lay down.
  • A burning feeling in your throat.
  • A hot, sour, acidic or salty taste in the back of your throat.
  • Difficulty swallowing.

Possible Causes

What causes heartburn?

To know why heartburn happens, it can help to understand how your esophagus and stomach work. When you eat, the food passes down a long tube that connects your mouth and stomach. This tube is called the esophagus. At the bottom of the esophagus is a valve, called the esophageal sphincter. This valve opens to let food through and then closes to keep your stomach contents down. Inside your stomach is a very strong acidic mixture that starts the process of breaking down your food (digestion). Your stomach is designed to hold this mixture. However, your esophagus isn’t able to hold this mixture without getting hurt.

Sometimes, the valve that separates your stomach and esophagus doesn’t close properly, and some of the acidic mixture from your stomach goes back up the esophagus. This is called reflux. When you have reflux, you’ll often feel the burning sensation that’s heartburn. There are a few medical conditions that can cause reflux and make you feel heartburn, including:

  • Pregnancy.
  • Hiatal hernia (when the stomach bulges up into the chest).
  • Gastroesophageal reflux disease (GERD).
  • Certain medications, especially anti-inflammatory drugs and aspirin.

Heartburn can also be caused by your eating habits — including the foods you eat, how large your meals are and how close to bedtime you eat — and certain lifestyle habits.

What can trigger heartburn?

Heartburn can be triggered by many different things that are a part of your daily life. For many people, heartburn can be caused by certain eating and lifestyle habits. These habits can involve things like eating large portions of food, eating too close to bedtime or even having high stress levels.

Certain foods and drinks can also trigger heartburn for some people. Some foods and drinks that could trigger your heartburn can include:

  • Onions.
  • Citrus fruits.
  • High-fat foods.
  • Tomatoes.
  • Tomato-based products.
  • Alcohol.
  • Citrus juices.
  • Caffeinated beverages.
  • Carbonated beverages.

Your lifestyle habits can also play a part in why you might experience heartburn. These everyday factors often contribute to medical conditions that cause heartburn, like GERD or hiatal hernia. Some lifestyle habits that can trigger your heartburn include:

  • Being overweight.
  • Being a smoker.
  • Having a high stress level.
  • Wearing tight clothes and belts.

Care and Treatment

How is heartburn treated?

In most cases, heartburn can be treated at home with over-the-counter medications and changes to lifestyle habits that cause the feeling. Occasional heartburn is common and is typically not serious. However, if you have frequent and severe heartburn, reach out to your healthcare provider. This could be a sign of a chronic condition like GERD. GERD can lead to other serious conditions like esophagitis, Barrett’s esophagus and even cancer. Sometimes, your doctor may want to do an endoscopy to check for underlying medication conditions. An endoscopy is the examination of your digestive tract with a lighted flexible instrument.

Over-the-counter medications for heartburn typically include antacids and acid blockers.

How do antacids work to treat heartburn?

Antacids reduce the amount of stomach acid, relieving your heartburn. These medications can also be used to soothe stomach upset, indigestion and other pains in your stomach. Some antacids contain simethicone, which reduces gas. Antacids that you can get without a prescription include:

  • Tums®.
  • Rolaids®.
  • Maalox®.
  • Gaviscon®.

Make sure you always follow the instructions on the package or talk to your doctor about the right way to use an antacid. If you use tablets, chew them well before swallowing for faster relief.

Are there any side effects of antacids?

Some antacids contain magnesium or sodium bicarbonate, which can act like a laxative. Do not take antacids if you have any symptoms of appendicitis or bowel inflammation. Side effects of antacids may include:

Serious side effects can occur with an overdose or overuse of antacids.

How do acid blockers work to treat heartburn?

Products like Pepcid AC® are called histamine H2 blockers, or acid blockers. Acid blockers reduce the production of stomach acid. They relieve heartburn, acid indigestion and sour stomach. Always follow the directions on the packaging or talk to your healthcare provider about how to take this medication. Acid blockers you can buy without a prescription include:

  • Pepcid AC®.
  • Tagamet HB®.

Take your acid blocker medicine regularly for as long as directed by your healthcare provider, even if you do not have any pain or if your symptoms get better.

Stronger acid blockers are prescription medications. These can be used to block stomach acid, treat stomach and duodenal ulcers, erosive esophagitis, and GERD. They work by reducing the production of stomach acid. Your healthcare provider will give you a specific prescription for this type of acid blocker.

The United States Food and Drug Administration (FDA) recently reported elevated levels of a possible carcinogen, NDMA, in the drugs ranitidine (Zantac®) and nizatidine (Axid®). You should speak to your healthcare provider if you are taking one these medications.

Are there any side effects of acid blockers?

Side effects of acid blockers include:

  • Headache.
  • Dizziness.
  • Diarrhea.

If you have any of the following possibly serious side effects after taking acid blockers, tell your healthcare provider right away:

  • Confusion.
  • Chest tightness.
  • Bleeding.
  • Sore throat.
  • Fever.
  • Irregular heartbeat.
  • Weakness or unusual fatigue.

Should I take antacids and acid blockers together to treat heartburn?

Your healthcare provider may want you to take antacids when you start taking acid blockers. Antacids will control your symptoms until the acid blockers start to work. If your doctor prescribes an antacid, take it an hour before (or an hour after) you take an acid blocker.

What are prescription medications for heartburn?

If over-the-counter antacids and acid blockers do not relieve your heartburn, your healthcare provider may give you a prescription for other medicines, such as:

  • Prescription-strength acid blockers: In prescription-strength (usually higher doses), Zantac®, Tagamet®, Pepcid® and Axid® can generally relieve heartburn and treat GERD.
  • Proton pump inhibitors: These are drugs that block acid production more effectively. Proton pump inhibitors include Aciphex®, Nexium®, Prevacid®, Prilosec® and Protonix®.

There are some proton pump inhibitors that can be purchased over-the-counter. Talk to your healthcare provider about these medications and what is best for you.

Can I prevent heartburn?

You can often prevent and manage heartburn by making changes to your diet and lifestyle. These changes include:

  • Not going to bed with a full stomach. Eat meals at least three to four hours before you lie down. This gives your stomach time to empty and reduces the chance of experiencing heartburn overnight.
  • Avoiding overeating. Cutting back on the size of your portions during meals can help lower your risk of heartburn. You can also try eating four or five small meals instead of three larger ones.
  • Slowing down. Eating slowly can often help prevent heartburn. Put your fork down between bites and avoid eating too quickly.
  • Wearing loose-fitting clothes. Belts and tight clothing can sometimes cause heartburn. By changing your wardrobe to avoid these items, you might be able to prevent having heartburn.
  • Avoiding certain foods. For many people, there are certain foods that trigger heartburn. Avoiding these foods can help. Try keeping a log of these foods so that you can watch out for them in the future. Your healthcare provider may also suggest that you avoid alcohol.
  • Maintaining a healthy weight. Losing weight can often help relieve heartburn.
  • Not smoking. Nicotine can weaken the lower esophageal sphincter (the valve that separates your stomach and esophagus). Not smoking is recommended for your general health, as well as the strength of this valve.
  • Sleeping on your left side. This may help digestion and the removal of acid from your stomach and esophagus more quickly.
  • Raising the head of your bed so that your head and chest are higher than your feet. Place 6-inch blocks or books under the bed posts at the head of the bed. Do not use piles of pillows. They may cause you to put more pressure on your stomach and make your heartburn worse.
  • Planning your exercise to avoid heartburn. Wait at least two hours after a meal before exercising. If you work out any sooner, you may trigger heartburn. You should also drink plenty of water before and during exercise. Water aids digestion and prevents dehydration.

When to Call the Doctor

When should I call my doctor about my heartburn?

Even though heartburn is common, it can sometimes lead to more serious health problems. Severe, chronic heartburn has been linked to inflammation and narrowing of the esophagus, respiratory problems, chronic cough, GERD, and Barrett’s esophagus, which may lead to esophageal cancer.

You should contact your doctor if:

  • Your heartburn won’t go away.
  • Your heartburn symptoms become more severe or frequent.
  • It’s hard or hurts to swallow.
  • Your heartburn causes you to vomit.
  • You have had substantial, unexpected weight loss.
  • You take over-the-counter antacids for more than two weeks (or for a longer time than recommended on the label) and you still have heartburn symptoms.
  • You have heartburn symptoms even after taking prescription medicines.
  • You have serious hoarseness or wheezing.
  • Your discomfort interferes with your lifestyle or daily activities.

Will heartburn go away on its own?

For many people, occasional heartburn is common. By watching what you eat and avoiding certain triggers (diet and lifestyle habits), you may be able to prevent heartburn or manage it. If you find that you frequently experience heartburn and that it keeps getting worse, it could be a sign of a medical condition like GERD. In these cases, your heartburn will not go away without treatment. Talk to your healthcare provider so that you can develop a treatment plan.

Resources

Where can I learn more about heartburn?

Last reviewed by a Cleveland Clinic medical professional on 01/22/2020.

References

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy