Heartburn

What is heartburn?

Heartburn is a feeling of burning pain or discomfort in the chest, usually after eating. It is also called reflux or indigestion.

When should I call an ambulance or go to the emergency department?

If you experience chest pain and have any doubt about whether it is heartburn or a heart attack, you should call triple zero (000) immediately and ask for an ambulance. You can use the healthdirect Symptom Checker to help you make this decision.

What causes heartburn?

Normally, a ring of muscle at the lower end of the oesophagus (the tube connecting the mouth to the stomach) relaxes to let food in and tightens to prevent stomach acid from escaping.

However, if the muscle relaxes when it shouldn’t, or is weak, stomach acid can rise up into the oesophagus where it can cause pain and irritation. Heartburn can also occur when the stomach is producing a lot of acid, such as when you are stressed.

Common triggers for heartburn

Some people experience heartburn regardless of what they eat. Others find they only get it after eating certain foods or meals. Common food triggers for heartburn include:

• large meals
• fatty or spicy foods
• coffee and cola drinks
• citrus foods
• alcohol
• chocolate
• peppermints

Smoking cigarettes can also be a trigger for heartburn.

Other things that can increase the risk and the severity of heartburn include:

• being overweight or obese
• being pregnant
• taking certain medications (check with your doctor)
• exercising too soon after eating

What are the symptoms of heartburn?

Heartburn causes pain, discomfort or burning in the chest. It might feel like it is rising from the lower chest to the neck. The pain typically gets worse when you are lying down or bending over.

When should I see my doctor?

If over-the-counter pharmacy treatments do not work, or you rely on them often, see your doctor.

You should also see your doctor if you experience:

• weight loss
• difficulty swallowing (dysphagia) or pain with swallowing
• vomiting — especially if it has blood in it

How is heartburn diagnosed?

In most cases, your doctor will be able to diagnose heartburn by asking questions about your symptoms and what triggers those symptoms.

If you have heartburn more than 2 times a week, it could be a symptom of gastro-oesophageal reflux disease (GORD) or other gastrointestinal diseases. These are usually diagnosed by endoscopy, which uses a tube with a camera passed through the mouth into the stomach.

How is heartburn treated?

Most healthy people have heartburn from time to time. Heartburn that is mild and occasional can usually be managed with lifestyle changes, such as:

• eating smaller, more frequent meals instead of large meals
• avoiding any food you know triggers heartburn
• avoiding lying down soon after a meal — wait for 3 hours
• not eating too late at night
• lifting the head of your bed so you are raised from the waist up
• losing weight, if you are overweight
• stopping smoking, if you smoke
• avoiding tight clothing

You may also want to try over-the-counter medicines called antacids, which neutralise stomach acid. If you are pregnant, check with your doctor or pharmacist if these medications are safe for you to take.

A lot of people take heartburn medicines when they don’t need to. The Royal Australian College of General Practitioners recommends that you discuss any medication you are taking for reflux or heartburn with your doctor or specialist to see if it is safe to reduce or stop it. For further information, visit the Choosing Wisely Australia website.

Your doctor will probably recommend the lifestyle changes and antacids. If your symptoms do not respond or you have GORD, you may need prescription medicines.