Heartburn

Topic Overview

Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper abdomen just beneath the lower breastbone (sternum). This discomfort may spread in waves upward into your throat, and you may have a sour taste in your mouth. Heartburn is sometimes called indigestion, acid regurgitation, sour stomach, or pyrosis. It is not caused by problems with your heart, although sometimes heart problems can feel like heartburn. See a picture of heartburn.

Heartburn may cause problems with swallowing, burping, nausea, or bloating. These symptoms can sometimes last up to 2 hours or longer. In some people, heartburn symptoms may cause sleep problems, a chronic cough, asthma, wheezing, or choking episodes.

Heartburn usually is worse after eating or made worse by lying down or bending over. It gets better if you sit or stand up.

Almost everyone will have troubles with heartburn now and then.

Heartburn occurs more frequently in adults than in children. Many women have heartburn every day when they are pregnant. This is because the growing uterus puts increasing upward pressure on the stomach.

Symptoms of heartburn and symptoms of a heart attack may feel the same. Occasionally, a person may dismiss serious symptoms as "just gas or indigestion." If you have a history of heart problems or risk factors for a heart attack, your heartburn symptoms may indicate a more serious problem and need to be checked by your doctor.

Dyspepsia is a medical term that is used to describe a vague feeling of fullness, gnawing, or burning in the chest or upper abdomen, especially after eating. A person may describe this feeling as "gas." Other symptoms may occur at the same time, such as belching, rumbling noises in the abdomen, increased flatus, poor appetite, and a change in bowel habits. Causes of dyspepsia can vary from minor to serious.

Causes of heartburn

Heartburn occurs when food and stomach juices back up (reflux) into the esophagus, which is the tube that leads from the throat to the stomach. This process is called gastroesophageal reflux. Common causes of reflux include:

• Incomplete closing of the valve (the lower esophageal sphincter, or LES) between the esophagus and the stomach.
• Foods and drinks, such as chocolate, peppermint, fried foods, fatty foods, or sugars; and coffee, carbonated drinks, or alcohol. Once heartburn occurs, the backflow of stomach juices can cause the esophagus to become sensitive to other foods, such as citrus fruits, tomatoes, spicy foods, garlic, and onions. Eating these foods may cause more heartburn.
• Pressure on the stomach caused by obesity, frequent bending over and lifting, tight clothes, straining with bowel movements, vigorous exercise, and pregnancy.
• Smoking and use of other tobacco products.
• Prescription and nonprescription medicines, such as aspirin, ibuprofen, prednisone, iron, potassium, antihistamines, or sleeping pills.
• A hiatal hernia, which occurs when a small portion of the stomach pushes upward through the diaphragm, which is the muscle that separates the lungs from the abdomen.
• Stress, which can increase the amount of acid your stomach makes and cause your stomach to empty more slowly.

Severity of heartburn

Mild heartburn occurs about once a month. Moderate heartburn occurs about once a week.

Severe heartburn occurs every day and can cause problems such as trouble swallowing, bleeding, or weight loss. Heartburn with other symptoms, such as hoarseness, a feeling that food is stuck in your throat, tightness in your throat, a hoarse voice, wheezing, asthma, dental problems, or bad breath, may be caused by a more serious problem, such as gastroesophageal reflux disease (GERD). A persistent inflammation of the lining of the esophagus occurs in GERD and can lead to other health problems. Heartburn may also be related to an infection with Helicobacter pylori (H. pylori) bacteria.

Persistent heartburn symptoms can be a sign of a more serious medical condition, such as severe inflammation of the esophagus or cancer of the stomach or esophagus.

Heartburn is more serious when it occurs with abdominal pain or bleeding.

• Abdominal pain, especially pain located directly below the breastbone, may be a sign of more serious problems, such as heart disease, peptic ulcer disease, gallbladder disease, a tear in the esophagus, or inflammation of the stomach (gastritis). For more information, see the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
• Vomiting of blood may indicate bleeding in the digestive tract, often from the esophagus or stomach. If you have bleeding in the esophagus, stomach, or part of the small intestine attached to the stomach (duodenum), stools may be dark red or black and tarry. Large amounts of bleeding can lead to shock, a life-threatening condition. For more information, see the topic Nausea and Vomiting, Age 4 and Older.

Heartburn in children

Almost all babies spit up, especially newborns. Spitting up decreases once the muscles of the esophagus, which is the muscular tube that connects the throat to the stomach, become more coordinated. This process can take as little as 6 months or as long as 1 year. Spitting up is not the same thing as vomiting. Vomiting is forceful and repeated. Spitting up may seem forceful but usually occurs shortly after feeding, is effortless, and causes no discomfort.

Children who vomit frequently after eating during the first 2 years of life have increased chances of having heartburn and reflux problems, such as GERD, later in life. Children with reflux problems also have increased chances of other problems, such as sinusitis, laryngitis, asthma, pneumonia, and dental problems. For more information, see the topic Vomiting, Age 3 and Younger.

Treatment

The treatment of heartburn depends on how severe your heartburn is and what other symptoms you have. Home treatment measures and medicines that you can buy without a prescription usually will relieve mild to moderate heartburn. It is important to see your doctor if heartburn occurs frequently and home treatment does not relieve your symptoms.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Emergencies

Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.

• Severe upper abdominal pain
• Chest pain that is crushing or squeezing, feels like a heavy weight on your chest, or occurs with any other symptoms of a heart attack. Note: Symptoms of a heart attack and symptoms of heartburn may feel the same. It is important to consider all your other symptoms to determine whether you have a more serious problem.
• Signs of shock

If the person has chest pain, after calling 911 or other emergency services:

• If the person becomes unconscious, see Rescue Breathing and Cardiopulmonary Resuscitation (CPR) in the topic Dealing With Emergencies.
• If emergency medical personnel are not going to arrive soon and the person is awake, alert, not vomiting, and not allergic to aspirin, have the person chew and swallow 1 adult-strength aspirin (325 mg) or 4 "baby" aspirin (80 mg each) before emergency medical personnel such as paramedics arrive. Be sure to tell emergency personnel that aspirin has been taken.

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Chest pain: Go to the topic Chest Pain.
• Abdominal pain: Go to the topic Abdominal Pain, Age 12 and Older or Abdominal Pain, Age 11 and Younger.
• Nausea and vomiting: Go to the topic Nausea and Vomiting, Age 4 and Older or Vomiting, Age 3 and Younger.
• Pregnancy: Go to the topic Pregnancy-Related Problems.

Yes

Do you have heartburn pain?

See significance of heartburn pain if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to the following question.

Yes

Do you have severe pain?

Call your health professional today if you answer "Yes" to the following question.

Yes

Do you have moderate pain that does not get better when you take medicines or use home treatment for the heartburn?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

Yes

Have you had moderate pain for longer than 1 week that goes away when you take medicines or use home treatment, but comes back after the treatment wears off?

Yes

Have you had mild pain for longer than 1 week that does not get better when you take medicines or use home treatment for the heartburn?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.

Yes

Have you had mild pain that comes and goes for longer than 2 weeks?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you have blood in your vomit?

See significance of blood in vomit if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Yes

Do you have more than a small streak of bright red blood in your vomit?

Yes

Do you have material that looks like coffee grounds in your vomit?

Call your health professional today if you answer "Yes" to the following question.

Yes

Have you had a streak of bright red blood in your vomit, and you are not sure whether the blood is coming from your nose or your mouth when you vomit?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.

Yes

Have you had streaks of blood in your vomit for 24 hours or longer, and you are sure the blood is coming from your nose or your mouth when you vomit?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you have heartburn and trouble swallowing?

See significance of trouble swallowing if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to the following question.

Yes

Are you unable to swallow food or fluids?

Call your health professional today if you answer "Yes" to the following question.

Yes

Are you unable to eat normally because it is hard for you to swallow?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.

Yes

Have you lost more than 5 lb (2 kg) during the past 3 to 6 months for no known reason?

Yes

Are you able to eat normally most of the time?

Yes

Are your swallowing problems slowly getting worse?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Has your heartburn pain continued after using prescription or nonprescription medicines for the pain?

See significance of heartburn not relieved by medicine if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Note: Heartburn that occurs once a month is considered mild. Heartburn once a week is considered moderate. Daily heartburn is considered severe.

Call your health professional immediately if you answer "Yes" to the following question.

Yes

Do you have severe heartburn after taking medicines to relieve your heartburn?

Call your health professional today if you answer "Yes" to the following question.

Yes

Do you have moderate heartburn after taking medicines to relieve your heartburn?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.

Yes

Have medicine and lifestyle changes prescribed by your health professional not relieved your mild to moderate heartburn after 1 week?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.

Yes

Have nonprescription medicines and lifestyle changes not relieved your mild to moderate heartburn after 1 week?

Yes

Have nonprescription medicines and lifestyle changes not relieved your mild heartburn after 2 weeks?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you think that your heartburn may be caused by a medicine?

See significance of heartburn caused by a medicine if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional today if you answer "Yes" to the following question.

Yes

Do you think that your heartburn may be caused by a medicine?

Note:

If your answer is "Yes": Call the health professional who prescribed the medicine before you take the next dose to find out if you should stop taking the medicine or take a different one. An appointment may not be needed. If you are taking any medicine that was not prescribed by a health professional, stop taking it. Call your health professional if you feel that you need to continue taking the medicine or need help controlling your symptoms.

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you have heartburn and a weight loss that you cannot explain?

See significance of weight loss if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.

Yes

Have you lost more than 5 lb (2 kg) over the past 3 to 6 months for no known reason?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Rectal bleeding or problems: Go to the topic Rectal Problems.
• Gas, bloating, and burping: Go to the topic Gas, Bloating, and Burping.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Home treatment, such as lifestyle changes and nonprescription medicines, may be all that is needed to treat mild to moderate heartburn. However, if your symptoms do not get better with home treatment, or if your symptoms occur frequently and last longer than 2 weeks, see your doctor to find out whether other medical conditions may be causing your symptoms.

Keep a record of your heartburn symptoms before and after making lifestyle changes or using nonprescription medicines so you can discuss any improvement with your doctor. See an example of a heartburn symptom record(What is a PDF document?).

Lifestyle changes to treat heartburn

Try lifestyle changes first to control your symptoms before you take nonprescription medicines. If you take medicines to relieve your heartburn without making lifestyle changes, your heartburn is likely to return.

• Change what and how you eat.
  • Eat smaller meals. Having a very full stomach increases your chances of having heartburn.
  • Do not lie down or exercise for 2 to 3 hours after you eat. When you are sitting up, gravity helps drain food and stomach acid into your stomach. Avoid eating large meals and snacks just before bedtime.
  • Avoid chocolate, fatty or fried foods, and peppermint- or spearmint-flavored foods.
  • Do not drink alcohol, including beer or wine; coffee and other caffeinated drinks; or carbonated drinks.
  • Limit acidic foods, such as grapefruit, oranges, tomatoes, or vinegar.
  • Limit spicy foods that contain lots of pepper or chilies.
  • Eat foods that are high in protein and low in fat. For more information, see the topic Healthy Eating.
• Decrease pressure on your stomach.
  • Avoid tight clothing. Tight belts, waistbands, and panty hose that press on your stomach may make your symptoms worse.
  • Put blocks underneath your bed frame or use a foam wedge under your mattress to raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm). Using extra pillows to raise your head does not work because pillows cause you to bend at your waist, which squeezes stomach acid up farther and can make heartburn worse.
  • Avoid lying on your right side.
  • Be careful when lifting and bending. Bending over tends to increase reflux. When lifting, bend at the knees.
• Do not take aspirin and similar drugs, which can irritate the esophagus and stomach, or take them with food or an antacid. For mild to moderate pain relief, try taking another nonprescription medicine, such as acetaminophen (for example, Tylenol).
• Make sure that you stand or sit up when you swallow pills. Take a few sips of water to moisten your throat before you swallow the medicine. Drink a full glass of water to swallow the medicine. Do not lie down right after you take a medicine.
• Do not smoke or use other tobacco products. Smoking causes the valve between the esophagus and the stomach to relax and not close completely. This allows stomach acid to back up (reflux) into the esophagus.
• Maintain a healthy weight. Lose weight if you are overweight. Being overweight puts added pressure on your stomach and increases the chances that stomach acid will back up into the esophagus. Even losing a few pounds can decrease your chance of developing heartburn or reduce your symptoms. For more information, see the topic Healthy Weight.
• Avoid alcohol.
• Decrease stress. For more information, see the topic Stress Management.

Medicines to treat heartburn

Antacids

Many people take nonprescription antacids for mild or occasional heartburn. If you use antacids more than just once in a while, talk with your doctor.

• Antacids such as Tums, Mylanta, or Maalox neutralize some of the stomach acid for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
• Some antacids, such as Gaviscon, have a foaming agent (alginate) that acts as a barrier between stomach acid and the esophagus.
• Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks and you should not take it if you can't take aspirin. It may make your tongue or stools black. The black color is usually not serious. Brushing your teeth and tongue after taking Pepto-Bismol may keep your tongue from turning black. If your child or teen gets chickenpox or flu, do not treat the symptoms with nonprescription medicines that contain bismuth subsalicylate (such as Pepto-Bismol and Kaopectate). If your child has taken this kind of medicine and he or she has changes in behavior with nausea and vomiting, call your doctor. These symptoms could be an early sign of Reye's syndrome, a rare but serious illness. Ask your doctor if your child younger than 12 should take these medicines.

Antacids work faster than acid reducers (H2 blockers), but their effect does not last more than 1 to 2 hours. H2 blockers can provide relief for up to 12 hours.

Antacids do have side effects. They may cause diarrhea or constipation. Also, antacids can interfere with how your body absorbs other medicines.

If you have any health risks, talk with your doctor before you start taking an antacid. If you have kidney disease, it is especially important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.

Stomach acid reducers

H2 blockers

Acid reducers, also called histamine receptor (or H2) blockers, decrease the amount of acid that the stomach makes, which may reduce irritation to the stomach lining and decrease heartburn. Some examples of nonprescription acid reducers are Pepcid AC, Tagamet HB, Zantac 75, or Axid AR. Talk with your doctor if you take an H2 blocker for more than 2 weeks.

Proton pump inhibitors

Proton pump inhibitors (PPIs), such as omeprazole (for example, Prilosec), reduce stomach acid and effectively treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn has not gotten better with other home treatment measures, antacids, or H2 blockers. You may need to use a PPI for up to 5 days before you have relief of your heartburn but they are safe to use for long-term management. They also are safe to use if you have kidney or liver problems. PPIs are available without a prescription.

Acid reducers can sometimes change the way other medicines work. If you are taking prescription medicines, be sure to talk with your doctor before you take a nonprescription acid reducer.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Heartburn is not relieved by home treatment and medicine.
• Blood appears in your vomit.
• Blood appears in your stools or you have black, tarry stools.
• You have symptoms of mild heartburn for more than 2 weeks.
• Swallowing problems are not improving.
• You continue to lose weight for no reason.
• Your symptoms become more severe or frequent.

Prevention

Most cases of heartburn can be prevented by following these home treatment tips.

• Change what and how you eat.
  • Eat smaller meals. Having a very full stomach increases your chances of having heartburn.
  • Do not lie down or exercise for 2 to 3 hours after you eat. When you are sitting up, gravity helps drain food and stomach acid into your stomach. Avoid eating large meals and snacks just before bedtime.
  • Avoid chocolate, fatty or fried foods, and peppermint- or spearmint-flavored food.
  • Do not drink alcohol, including beer or wine; coffee and other caffeinated drinks; or carbonated drinks.
  • Limit acidic foods, such as grapefruit, oranges, tomatoes, or vinegar.
  • Limit spicy foods that contain lots of pepper or chilies.
  • Eat foods that are high in protein and low in fat. For more information, see the topic Healthy Eating.
• Decrease pressure on your stomach.
  • Avoid tight clothing. Tight belts, waistbands, and panty hose that press on the stomach may make your symptoms worse.
  • Put blocks underneath your bed frame or use a foam wedge under your mattress to raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm). Using extra pillows to raise your head does not work because pillows cause you to bend at your waist, which squeezes stomach acid up farther and can make heartburn worse.
  • Avoid lying on your right side.
  • Be careful when lifting and bending. Bending over tends to increase reflux. When lifting, bend at the knees.
• Do not take aspirin, products that contain aspirin (such as Alka-Seltzer), or other nonsteroidal anti-inflammatory drugs (NSAIDs), which can irritate the esophagus and stomach, or take them with food or an antacid. For mild to moderate pain relief, try another nonprescription medicine, such as acetaminophen (for example, Tylenol).
• Make sure that you stand or sit up when you swallow pills. Take a few sips of water to lubricate your throat before you swallow the medicine. Drink a full glass of water to swallow the medicine. Do not lie down right after you take a medicine.
• Do not smoke or use other tobacco products. Smoking causes the valve between the esophagus and the stomach to relax and not close completely. This allows stomach acid to back up (reflux) into the esophagus.
• Maintain a healthy weight. Lose weight if you are overweight. Being overweight puts added pressure on your stomach and increases the chance that stomach acid will back up into the esophagus. Even losing a few pounds (kilograms) can decrease the chance of developing heartburn or reduce your symptoms. For more information, see the topic Healthy Weight.
• Avoid alcohol.
• Decrease stress. For more information, see the topic Stress Management.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms? Report any symptoms, such as abdominal pain, a change in bowel habits, or vomiting.
• How long have you had heartburn?
• Have you had this problem before? If so, do you know what caused the problem at that time? How was it treated? How did you respond to that treatment?
• Have you had any signs of bleeding from your digestive system?
• Have you had any difficulty swallowing when you eat or drink?
• How much tobacco do you use? How much alcohol do you drink? How much caffeine do you drink?
• Has your weight increased or decreased more than 5 lb (2 kg) recently?
• Have there been any changes in your diet? Are you eating certain foods more often?
• Have there been changes in your daily schedule, such as when you eat and when you go to bed?
• Are you taking any nonprescription or prescription medicines? Bring a list of all the medicines you are taking to your appointment.
• What home treatment measures have you tried? Did they help? Be sure to include lifestyle changes you have made.
• What nonprescription medicines have you taken or used to treat your heartburn? Did they help?
• Do you have any health risks?

It will be easier to make lifestyle changes if your family understands the reasons for the changes. Take a friend or family member to the appointment with you, and discuss diet and sleeping habits with your doctor.

Remember to take your heartburn symptom record(What is a PDF document?) to your doctor visit. Be sure to note any lifestyle changes you have made or nonprescription medicines you use.