About this symptom
Heartburn is a burning feeling in the middle of the chest or throat. It happens when stomach acid flows back up into the food pipe, which is called acid reflux. It is often worse after eating, when you lie down or when you bend over, and you may notice a sour taste, belching or bloating.
Heartburn is common and usually not serious. If it happens often, it may be gastro-oesophageal reflux disease (GERD), and over time the acid can damage the food pipe.
Possible causes
This is not a diagnosis. These are the causes doctors think about, with the ones that are most urgent to rule out first.
- Heart attackPressure, tightness or squeezing in the chest, which can also feel like burning or fullness, with sweating, breathlessness or pain spreading to the arm, jaw or back.Read about it
- Stomach ulcerBurning pain in the upper tummy, often worse at night, with indigestion and feeling sick. Vomiting blood or black, sticky stools needs emergency care.Read about it
- Acid refluxBurning in the middle of the chest and a sour taste in the mouth, worse after meals, when lying down or when bending over.Read about it
- Hiatus herniaPart of the stomach moves up into the chest, which can bring on or worsen acid reflux.
- PregnancyHormone changes and the baby pressing on the stomach cause it, mostly in later pregnancy. Ask a pharmacist or doctor which medicines are suitable.
- MedicinesAnti-inflammatory painkillers such as ibuprofen can bring it on or worsen it. Ask a doctor before stopping any prescribed medicine.
- Food, drink and habitsHeartburn that follows large, fatty or spicy meals, coffee, tomatoes, chocolate, alcohol or smoking, and eases when you avoid them.
When to get help
A heart attack can feel like burning in the chest. If you are not sure whether it is heartburn, treat it as chest pain: read Chest pain and Heart attack, and call for an ambulance.
See a doctor soon if you have:
- Heartburn on most days, or that does not settle with simple changes
- Trouble or pain when swallowing, or food that sticks
- Being sick often, or losing weight without trying
- Having been told you have iron deficiency anaemia
Occasional heartburn after a big meal, with none of these signs, can be managed at home.
What you can do at home
These steps help usual heartburn. For new or different chest pain, get help first.
Do
- Eat smaller, more frequent meals
- Raise the head of the bed by about 10 to 20 cm. Extra pillows do not help
- Lose weight if you are overweight, and find ways to relax
Do not
- Do not eat in the 3 to 4 hours before bed
- Do not smoke or drink too much alcohol
- Do not wear clothes that are tight around the waist
- Do not stop a prescribed medicine on your own
Pharmacy medicines that neutralise or reduce stomach acid ease heartburn for a short time but do not treat the cause, so they are not for regular long-term use. Never use one to test whether chest pain is from the heart.
What the doctor will do
The doctor will ask when the burning comes, what brings it on and what eases it, and about swallowing, weight loss, being sick, black stools, smoking, alcohol and medicines. If the pain could be from the heart, an may be done first.
Frequent heartburn is usually treated with medicines that lower stomach acid for a few weeks, along with the changes above. If these do not help, or there are warning signs, tests may include:
- A gastroscopy, a thin camera passed down the throat to look at the food pipe and stomach
- A test for the stomach bacterium H. pylori, which is treated with
- A test of acid in the food pipe, or an upper digestive tract X-ray
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“If it burns, it must be acidity and not the heart.”What is true?
Fact
A heart attack can feel like burning, fullness or indigestion. If chest pain is sudden, does not go away, spreads to the arm, jaw or back, or comes with sweating, breathlessness or feeling sick, call for an ambulance rather than deciding it is acidity.
Myth“Taking an antacid every day is harmless.”What is true?
Fact
Antacids and similar medicines ease symptoms for a short time and do not cure the cause. They should not be used regularly for long periods. If you need them most days, see a doctor.
Myth“Avoid all spicy food and the heartburn will go.”What is true?
Fact
Triggers differ from person to person. Coffee, tomatoes, alcohol, chocolate, and fatty or spicy food are common ones, but often there is no obvious cause. Noting your own triggers, eating smaller meals and not eating just before bed help more than a blanket ban.
Myth“Extra pillows at night will stop the burning.”What is true?
Fact
Extra pillows are not recommended, because they can raise the pressure in the tummy and make symptoms worse. Raising the head of the bed by about 10 to 20 cm, so the chest and head are above the waist, may help.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How can I tell heartburn from a heart attack?
You cannot reliably tell at home, because a heart attack can feel like burning or indigestion. Call for an ambulance if the pain is tight, heavy or squeezing, spreads to the arm, jaw, neck or back, or comes with sweating, breathlessness or feeling sick. Do not drive yourself.
Why is heartburn worse at night or after meals?
Acid flows back up more easily when you lie down or bend over, and after a large meal. Avoiding food for 3 to 4 hours before bed and raising the head of the bed may help.
Is it safe to take an antacid every day?
Antacids ease symptoms for a short time but do not treat the cause, so they are not meant for regular long-term use. If you need them most days, see a doctor, who can look for the cause and suggest other treatment.
Can heartburn be treated without medicines?
Often yes. Smaller meals, not eating late, avoiding your triggers, stopping smoking and losing weight if you are overweight help many people. See a doctor if these changes and pharmacy medicines are not helping.
