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Heartburn is a burning sensation in the lower chest that's most often related to gastroesophageal reflux disease (GERD).

Treatment may depend on the cause of your heartburn. In most cases, heartburn can be treated with medications, lifestyle changes or surgery.



Copyright © Nucleus Medical Media, Inc.

Causes of Heartburn

Stomach acid that moves up into the esophagus causes heartburn. A muscle at the top of the stomach allows food to enter the stomach. This muscle also closes to prevent food and acid from moving back up into the esophagus. Certain conditions can keep this muscle from closing completely, which allows acid to flow out and cause heartburn.

Are You at Risk?

Factors that increase your chance of heartburn include:

  • Obesity
  • Smoking
  • Exercising or strenuous activity immediately after eating
  • Lying down, bending over or straining after eating
  • Pregnancy
  • Prior surgery for heartburn such as vagotomy
  • Diabetes
  • Scleroderma
  • Certain nervous system disorders
  • In-dwelling nasogastric tube

Foods and beverages associated with heartburn include:

  • Alcohol, especially in excess
  • Caffeine drinks, such as coffee or carbonated soft drinks
  • Citrus fruits
  • Chocolate
  • Fried foods
  • Spicy foods
  • Foods made with tomatoes, such as pizza, chili or spaghetti sauce

Medications and supplements associated with heartburn include:

  • Anticholinergics
  • Calcium channel blockers
  • Theophylline, bronchial inhalers and other asthma medications
  • Nitrates
  • Sildenafil
  • Bisphosphonates

Heartburn Symptoms

Heartburn symptoms usually occur after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.

Common heartburn symptoms may include:

  • Burning feeling that starts in the lower chest and moves up the throat
  • Feeling that food is coming back up
  • Sour or bitter taste in the throat

Other symptoms and complications of reflux include:

  • Sore throat
  • Hoarseness
  • Chronic cough
  • Feeling of a lump in the throat
  • Asthma
  • Waking up with a sensation of choking
  • Difficulty swallowing

If reflux persists, the acid can damage the esophagus. Symptoms of esophageal damage include:

  • Bleeding and ulcers in the esophagus
  • Vomiting blood
  • Black or tarry stools
  • Inflammation and scarring of the esophagus
  • Barrett's esophagus — precancerous condition that can lead to esophageal cancer
  • Dental problems, which may occur because of the effect of stomach acid on tooth enamel

When Should I Call for Immediate Medical Help?

Heartburn and chest pain due to a heart attack can feel similar. Get medical help right away if you have:

  • Squeezing or chest pressure
  • Pain in the left shoulder, left arm or jaw
  • Trouble breathing
  • Sweating, clammy skin
  • Nausea
  • Weakness
  • Lightheadedness
  • Pain that starts during activity or stress

If you're not sure of the cause of any pain in your chest, call for emergency help right away.

Diagnosing Heartburn

Your doctor may be able to make a diagnosis based on your symptoms. Your doctor may also take images of your esophagus or stomach with an upper GI series. A sample of your esophagus may be taken and sent for examination. This is often done during an endoscopy.

Other tests may include:

  • 24-hour pH (acid) monitoring
  • Manometry to test muscle strength in the lower esophagus

Heartburn Treatment

Treatment depends on the cause of your heartburn and may focus on prevention or repairing damage that causes heartburn.

Lifestyle Changes

To help decrease the occurrence of heartburn:

  • Keep a food diary and record your body's reaction to certain foods. 
  • Avoid foods that trigger heartburn symptoms.
  • Eat smaller portions.
  • Allow at least 2-3 hours between meals and lying down and exercise.
  • Lose weight.
  • Quit smoking.
  • Avoid belts and clothing that are too tight. This may increase pressure on the abdomen.
  • Elevate head of bed 6-8 inches.


Medication may help relieve symptoms and repair any damage to the esophagus. Many prescription heartburn medications are available over-the-counter. Your doctor may recommend the following.

  • Proton-pump inhibitors block acid production in the stomach
  • H-2 blockers decrease the amount of acid secreted by the stomach
  • Antacids neutralize stomach acid


Surgery may be an option if symptoms are severe and you cannot tolerate medication. The most common surgery for heartburn is fundoplication. Your doctor wraps the stomach around the esophagus and creates pressure on the muscle at the opening to the stomach.

Endoscopic Procedures

Endoscopic techniques do not involve incisions in the skin. Instead, your doctor inserts a lighted device called an endoscope through your mouth and down the esophagus. Your doctor can perform a variety of procedures with this scope to decrease the backward flow of stomach acid into the esophagus.

If surgery or endoscopy is successful, you may no longer need heartburn medication.


Speak with your doctor to get a referral. If you don't have a primary care doctor, we can help you find one. Call us at 434.243.3675.

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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