Heartburn

Heartburn can last for a few minutes or for a few hours and can be annoying and painful. It does not have anything to do with your heart. 

Other heartburn symptoms include:

• A burning feeling in your chest and/or a feeling that something is lodged in your throat
• A cough or hiccups that come back repeatedly 
• A sour taste at the back of your mouth and/or bad breath
• Bloating, nausea and/or feeling sick
• Chest pain
• Regurgitating food

Heartburn is a common condition, sometimes accompanied by indigestion, that usually occurs after eating — especially overeating or late-night eating.

Heartburn symptoms can also occur when you’re lying in your bed or bending over, as it’s easier for stomach acid to seep into your oesophagus.

In most cases, heartburn can be relieved by taking a heartburn remedy and making lifestyle changes.

When you swallow food, it passes down your oesophagus into your stomach. Here it is digested by stomach acid, which is made by cells lining your stomach. These cells also make mucus to protect your stomach lining from being damaged by the acid. However, your oesophagus lining is not well-protected from acid.

Where your oesophagus meets your stomach there is a circular band of muscle (sphincter) that is normally closed to prevent food and acid from the stomach leaking into the oesophagus. When you swallow, this sphincter opens up to allow the food in your oesophagus to enter your stomach.

When the sphincter between your oesophagus and stomach doesn't work properly, acid can leak from the stomach into your oesophagus (acid reflux) and cause heartburn. In most cases, it isn't known why the sphincter stops working properly. However, in some cases, the pressure in the stomach rises and forces the sphincter open, eg after a big meal, due to hiatus hernia, during pregnancy or when bending forward. 

Most people have heartburn occasionally, but for one in three people it occurs every few days and for one in 10 people it occurs at least once a day. Heartburn is usually mild and passes quickly. But in severe cases, it can affect your quality of life. 

Many people get heartburn caused by acid reflux without any obvious cause. However, symptoms can be triggered by certain foods and drinks, including:

• Alcoholic drinks
• Chocolate
• Citrus fruits and citrus fruit juices
• Coffee
• Fatty, fried or spicy foods
• Onions, garlic and tomatoes

You are more likely to suffer from heartburn symptoms if you are:

• A smoker
• Overweight
• Pregnant — pregnancy weakens the sphincter at the top of your stomach
• Stressed

Certain medicines can also cause heartburn including anti-inflammatories, such as ibuprofen and aspirin.

Other causes of heartburn include: 

• Hiatus hernia
• Oesophagitis — inflammation of the oesophagus lining
• Stomach ulcers 

Heartburn is often a symptom of two common conditions:

• Gastro-oesophageal reflux disease (GORD) — frequent, chronic (long-term) heartburn caused by frequent acid reflux
• Hiatus hernia — when part of your stomach pushes into the lower chest

You should see your GP if over-the-counter medications and lifestyle changes are not helping your heartburn and you have any of these symptoms: 

• Food getting stuck in your throat
• Losing weight unintentionally 
• Two bouts of heartburn a week 
• Vomiting without a reason

Your GP will discuss your heartburn symptoms with you and may refer you for tests. These tests may include:

• A gastroscopy (endoscopy) — a thin, tube-like telescope is passed down your oesophagus into your stomach and used to look for signs of inflammation 
• An X-ray of your digestive system
• Ambulatory pH testing — to check the acidity levels in your oesophagus as you move around

If a diagnosis can't be made after these tests, you may have a test to check the acid levels in your stomach.

The results will help your GP exclude or diagnose any possible conditions and provide you with the treatment you may need. They may also refer you to a gastroenterologist, a consultant specialising in the digestive system.

Seek medical attention immediately if you have very painful heartburn accompanied by any of the following symptoms:

• A cold sweat
• Dizziness
• Pain or a burning sensation radiating down your arms or neck
• Shortness of breath

Most heartburn symptoms can be relieved with lifestyle changes, medication and, in rare cases, surgery.

Lifestyle Changes

To help relieve heartburn symptoms and prevent heartburn, you should:

• Eat smaller, more frequent meals and eat earlier in the evening, at least three hours before bedtime
• Follow an acid reflux diet to avoid trigger foods and drinks, this may involve: 
• Avoiding foods such as chocolate, peppermint, spicy foods and tomatoes
• Avoiding drinks such as alcohol, coffee and other hot drinks
• Eating more fibre, non-acidic fruits and vegetables  
• Lose any excess weight and don't wear clothes that feel tight around your waist — these put extra pressure on your stomach, as do bending forward, lying down flat and sitting hunched 
• Sleep with your head and chest tilted up above waist level
• Stop smoking — the chemicals in cigarettes relax the sphincter between your oesophagus and stomach, which makes it easier for stomach acid to leak into your oesophagus 
• Try to relax

Certain medicines can irritate your oesophagus and increase your risk of acid reflux, such as: 

• Anti-inflammatory painkillers
• Calcium channel blockers or nitrates used to treat heart problems
• Diazepam used to treat anxiety, fits and muscle spasms
• Theophylline used to treat lung diseases 

If you are on any prescribed medicines and are concerned they’re giving you heartburn, do not stop taking them without first speaking to a doctor.

Medication

Your doctor may prescribe medication to reduce the amount of acid produced in your stomach — there are two different types: 

• H2 blockers such as cimetidine, famotidine, nizatidine and ranitidine
• PPIs (proton pump inhibitors) such as esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole

These medications are usually prescribed for one or two months. PPIs are usually prescribed first to reduce your symptoms and resolve any inflammation. Your doctor may then prescribe antacids. 

Antacids are also available as over-the-counter treatments. They are alkaline liquids or tablets and reduce the acidity of your stomach acid. They should be taken with or soon after eating food as this is when heartburn is most likely to occur. Antacids may work for longer if taken with food. 

Some people with heartburn need to remain on medications that reduce acid production. In these cases, a high dose is prescribed for one or two months, after which a lower dose is used daily. 

PPIs have been linked to an increased risk of gastric cancer if used long term in individuals with a history of infection with Helicobacter pylori. H2 blockers are therefore sometimes preferred for long-term use.

Surgery

If lifestyle changes and medication fail to relieve your heartburn, your doctor might suggest a procedure called a gastroscopy to look inside your oesophagus. However, this procedure will usually only be considered if you have gastro-oesophageal reflux disease (GORD).

Your doctor might also suggest a procedure called a laparoscopic fundoplication to stop your acid reflux. This surgery is as successful as taking medications to reduce acid production but is an option you may want to consider if your quality of life is significantly affected by heartburn.

If you are suffering from painful gallstones or gallbladder disease, your GP may recommend gallbladder removal surgery.