Heartburn: Causes, Symptoms, and Treatment

Heartburn Causes

Heartburn symptoms can start when the lower esophageal sphincter (LES) valve at the bottom of your esophagus doesn't close correctly. 

It should stay closed to keep food and stomach acids in your stomach. When you're eating, your LES opens so food can go into your stomach. Then it closes again. If it doesn't close, even just a little, or if it opens when it shouldn't, stomach acids can go back into your esophagus, causing heartburn pain. 

We don't know what causes the LES valve to weaken, but it could be caused by eating big meals too often, if you're overweight, or you have a hiatal hernia (a hernia in your upper stomach that pushes through your diaphragm).

Heartburn risk factors

Certain foods can relax your LES or increase stomach acid, including:

• Tomatoes
• Citrus fruits
• Garlic and onions
• Chocolate
• Coffee or caffeinated products
• Alcohol
• Peppermint
• Foods high in fats and oils

You're also more likely to get heartburn if you:

• Eat right before bedtime
• Smoke, vape, or use tobacco products
• Wear tight-fitting clothing or belts
• Lie down or bend over after eating
• Are stressed out
• Are pregnant
• Take certain medications, including some antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Are constipated

Heartburn Diagnosis

If your heartburn doesn't improve, it could be a more serious condition known as gastroesophageal reflux disease (GERD). Your doctor may be able to diagnose GERD just from your symptoms, but they also might want to do some tests, like: 

• X-ray: You’ll drink a chalky white solution called barium that coats the lining of your upper GI (gastrointestinal) tract, and you'll get an X-ray. This barium lets doctors see defects that could mean problems in your digestive system. 
• Endoscopy: Your doctor will insert a tiny camera on a flexible tube down your throat to give them a view of your upper GI tract. You may be asleep or awake, but you’ll get medicine to make you comfortable.
• Ambulatory acid probe test (esophageal pH monitoring): An acid monitor is put into your esophagus and connected to a small computer that you can wear on a belt or shoulder strap. It measures when stomach acid backs up into your esophagus and for how long. A newer technique called Bravo measures up to 48-hour acid; it is done using wireless pH sensors, so you won't need for a tube to be put into your esophagus.
• Esophageal motility testing (esophageal manometry): This test uses a catheter to measure the pressure and movement of your esophagus when you swallow.

Heartburn Treatment

Usually, you can treat heartburn with over-the-counter medicines, including:

• Antacids counteract the acid in your stomach to ease heartburn pain. They can also sometimes help with stomach pains, indigestion, and gas. Chewing them up really well before you swallow them might give you faster relief. If you use them too often, they can cause side effects, including constipation, diarrhea, a change in the color of your bowel movements, and stomach cramps.
• Acid (H2) blockers like cimetidine (Tagamet) and famotidine (Pepcid) reduce the amount of acid in your stomach. They don't work as fast as antacids, but the effects can last longer. 
• Proton pump inhibitors work to reduce stomach acid, too, and include esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec OTC).

If OTC medicines don’t work for you, your doctor may be able to give you a stronger prescription version.

It's rare, but surgery is sometimes needed to fix symptoms of heartburn. You may need an operation if:

• Other treatments haven’t helped.
• Your LES muscle doesn’t work properly.
• Your heartburn is caused by GERD.
• You have cancer in your esophagus. (Keep in mind that trouble swallowing, and not heartburn or GERD, is the most common symptom of this type of cancer.)

Heartburn Complications

Tell your doctor right away if you have confusion, chest tightness, bleeding, a sore throat, fever, irregular heartbeat, weakness, or unusual fatigue.

Get medical help right away if you have any chest pain, pressure, or burning that doesn’t go away (even with medications and lifestyle changes). These can also be signs of a heart attack.

Also get medical help if you're vomiting blood or what looks like dark coffee grounds. See a doctor right away if your stools are black, bloody, or a maroon color.

If your heartburn is severe and over-the-counter medicines don’t help, or if you've taken them for more than 2 weeks, call your doctor. Also see your doctor if you're losing weight without trying or having trouble swallowing. Your doctor can check to see what is causing the problem and what the best solution will be for you.

Occasional heartburn isn't dangerous. But GERD can sometimes lead to serious problems, such as:

• A long-term cough
• Laryngitis
• Inflammation or ulcers of the esophagus
• Problems swallowing because of a narrow esophagus
• Barrett's esophagus, a condition that can make it more likely to get esophageal cancer

Heartburn Prevention

There are things you can do to prevent heartburn, including changing what and when you eat. Other changes you can make that might help prevent heartburn include:

• Keep a healthy weight, and lose weight if you need to.
• Avoid foods and beverages that make your symptoms worse.
• Eat smaller meals throughout the day, and don't eat late at night. 
• Eat slowly.
• Don't smoke, vape, or use tobacco.
• Wait 3 hours after you eat before you lie down.
• Elevate the head of your bed 6 to 8 inches.

Takeaways

You get heartburn when acids in your stomach back up into your esophagus, the tube that goes between your mouth and stomach. The acid causes a painful, burning sensation in your chest. You usually get heartburn after you eat or when you're lying down, and the symptoms last for several hours. It's not life-threatening and is usually treated with lifestyle changes or over-the-counter medicines.

Heartburn FAQs

Does yogurt help with heartburn?

Low-fat yogurt is similar to milk in how it can soothe heartburn. Plus yogurt has probiotics (good bacteria) that also help with digestion. So eating a serving of low-fat yogurt may help relieve symptoms of heartburn. 

Is heartburn genetic?

Heartburn is often a symptom of gastroesophageal reflux disease, or GERD. Many studies have shown a link between genes and GERD, including several twins studies and a family study. All showed that genetics played a role, but we still need more research to know for sure how genes are involved.