Heartburn is a familiar feeling to many people. It involves an uncomfortable burning sensation in your chest, which is often accompanied by a sour taste in the back of your mouth, creeping up from your throat. While heartburn is most commonly caused by eating problematic foods, it can also be a symptom of certain medical conditions, including gastroesophageal reflux disease (GERD). Occasional heartburn can usually be treated successfully with over-the-counter options and doesn’t tend to cause lasting damage. But over time, persistent heartburn can damage your esophagus and may cause bleeding, inflammation, or difficulty swallowing. If you experience regular heartburn, it’s important to seek medical treatment. (1)
A Digestive Problem That Affects Up to 20 Percent of the U.S. Population
More than 60 million people in the United States experience heartburn at least once a month, according to the American College of Gastroenterology (ACG). The group also notes that according to some studies, over 15 million Americans have heartburn symptoms every single day. Heartburn is more common in older people and pregnant women. (2) In fact, according to a study, between 17 and 45 percent of pregnant women report episodes of heartburn. (3) According to one survey, 65 percent of people with heartburn experience symptoms both during the day and at night. (4) Among those who report nighttime symptoms, 75 percent experience trouble sleeping as a result, and 40 percent say that it affects their job performance the next day. While both occasional and frequent heartburn commonly cause discomfort, only about 6 percent of the population has heartburn that causes ongoing functional problems. (5)
Symptoms Can Last Up to Several Hours After Onset
Heartburn involves a burning, painful sensation behind your breastbone (sternum) in the center of your chest. This pain often gets worse after you eat, in the evening, when you bend over, or when you lie down. Episodes of heartburn can last between a few minutes and several hours. In addition to burning sensations in your chest, heartburn may also involve:
A burning sensation in your throatFluid in your throat that tastes bitter, sour, or saltyDifficulty swallowingA sense that food is stuck in your chest or lower throat
Heartburn often begins after you’ve eaten a large meal, but it can also be triggered by certain foods even if you don’t eat very much. (1,6)
Food and Lifestyle Habits Can Cause Stomach Acid to Flow Back Up
Heartburn occurs when the contents of your stomach flow up into your esophagus. A ring of muscle at the end of your esophagus where it joins your stomach — known as the lower esophageal sphincter — normally prevents your stomach contents from flowing back up into your esophagus by tightening after you swallow food. But sometimes this muscle doesn’t tighten completely, and the entrance to your stomach doesn’t fully close. When this happens, stomach acid can enter your esophagus and cause heartburn. (6) There is a wide range of potentially problematic foods and other factors that can contribute to heartburn. Foods that can trigger heartburn for many people include:
Tomatoes and tomato-based foods, including ketchup and saucesPeppermintChocolateAlcoholic beveragesCoffee and other caffeinated beveragesOnionsGarlicSpicy foodsFatty and fried foodsFull-fat dairy productsCitrus fruits and their juicesSoda and other carbonated drinks (1,6,7)
Certain immediate behaviors can contribute to heartburn, including:
Eating a large mealWearing tight pantsLying down too soon after eating
Some people are more likely than others to experience heartburn. Common risk factors for heartburn include:
SmokingEmotional stressBeing overweight or obesePregnancyHaving GERDHaving a hiatal hernia (in which part of your stomach pushes up through the opening in your diaphragm for your esophagus) (1,6)
There’s evidence that psychological distress may be linked to the perceived severity of heartburn in people who experience symptoms but show no signs of acid reflux in medical tests. In a 2017 study, researchers looked at a group of adults with heartburn and related symptoms who didn’t experience relief from taking a proton pump inhibitor (PPI) drug. (8) Participants were asked about the severity of their symptoms, as well as their overall stress and quality of life. They also had the acidity of their esophagus measured, which is a standard way to determine the severity of acid reflux. Among participants whose tests confirmed acid reflux, the perceived severity of their symptoms was directly related to the measured degree of reflux. Their symptom severity wasn’t related to their answers about stress and quality of life. But among participants whose tests didn’t show acid reflux, having more severe symptoms was related to reporting more stress and a worse quality of life. The higher risk of heartburn seen in people with excess body weight was confirmed in a 2017 study of GERD patients. (9) Participants were divided into two groups based on their body mass index (BMI): normal weight, and overweight or obese. All participants took PPI drugs as needed to treat their symptoms during a follow-up period of 10 years. Normal-weight participants reported an average of seven relapses involving heartburn each year, out of which only two qualified as severe. Overweight or obese participants reported an average of 11 heartburn episodes, six of them severe. Overweight or obese participants were also more likely to show inflammation in their esophagus when it was examined with a scope (a tube with an attached camera). Heartburn can also be a side effect of certain drugs, including:
Tricyclic antidepressantsTheophylline, used to treat asthma and other lung diseasesBeta blockers, used to treat heart disease and high blood pressureCalcium channel blockers, used to treat high blood pressureProgestin, a hormone found in birth control pillsSedatives, used to treat anxiety and insomniaDopamine-like drugs for Parkinson’s diseaseAnticholinergics, used to treat seasickness (7)
Prevent Heartburn by Changing Lifestyle Habits
A number of preventive measures may help reduce the frequency and severity of your heartburn, or even eliminate it. First, try eliminating any potentially problematic foods and beverages from your diet. Don’t forget that alcohol and fatty meals in general can be major triggers for some people. If you’re not sure what foods give you heartburn, keep a diary of what you eat and any symptoms you experience. If eliminating food triggers from your diet doesn’t relieve your symptoms, try changing your eating habits in the following ways:
Eat smaller meals.Eat slowly to avoid overstuffing yourself.Drink warm, caffeine-free beverages, like herbal tea.Don’t bend over soon after eating.Don’t exercise soon after eating.Leave 3 to 4 hours between eating and lying down or going to bed.
Other steps that may help relieve your heartburn include:
Lose weight if you’re overweight.Don’t smoke.Dress in loose, comfortable clothing.Raise the head of your bed by about 6 inches to elevate your head (raise your bed’s legs or mattress; extra pillows don’t work well).Exercise to improve your fitness and reduce stress.Try to relieve stress through meditation, yoga, or deep breathing. (1,6,7)
Treat Heartburn With Over-the-Counter Drugs or Prescription Medication
If preventive measures aren’t effective at reducing your heartburn, you may consider over-the-counter or prescription medication. Taking an antacid often delivers quick relief from heartburn symptoms. Common over-the-counter antacids include:
calcium carbonate (Maalox, Tums)aluminum hydroxide, magnesium hydroxide, and simethicone (Mylanta)
While antacids can offer symptom relief, they won’t prevent heartburn from recurring and aren’t a good solution for frequent heartburn. (7) If antacids aren’t effective, or if you need longer-lasting relief from heartburn, you may consider taking over-the-counter H2 blockers, which reduce stomach acid production. These drugs include:
famotidine (Pepcid AC)cimetidine (Tagamet)ranitidine (Zantac)
PPIs reduces stomach acid production even more. Over-the-counter options include:
esomeprazole (Nexium)lansoprazole (Prevacid)omeprazole (Prilosec) (6,7)
If your heartburn is severe or frequent, you may have GERD, and would benefit from seeing a doctor for evaluation — even before you begin taking any over-the-counter treatments regularly. You should see a doctor about your heartburn in the following cases:
Your symptoms worsen or become more frequent.You have trouble or pain while swallowing.Your symptoms worsen while taking over-the-counter drugs.You suspect a medication may be causing your heartburn.Your heartburn causes vomiting.Your heartburn makes you hoarse or causes wheezing.You experience unexplained weight loss.Your heartburn causes discomfort that interferes with your daily life. (1,7)
Your doctor will ask you questions about your symptoms and what might be causing them, and may perform tests to evaluate your esophagus and measure any acid reflux. In addition to recommending certain lifestyle and behavioral changes, your doctor may prescribe a stronger, prescription version of over-the-counter drugs that reduce stomach acid production. (7) Additional reporting by Quinn Phillips.
