Heartburn

Heartburn is a burning feeling in your chest, caused by stomach acid travelling up towards your throat. If it happens regularly, it's known as gastro-oesophageal reflux disease (GORD).

What causes heartburn?

There's often no obvious reason for heartburn, but it can be caused or made worse by:

• certain food and drink, such as coffee, tomatoes, alcohol, chocolate, and fatty or spicy food
• being overweight or smoking – two of the most common causes
• pregnancy, due to a mix of hormone changes and the growing baby pressing on your stomach
• stress and anxiety
• some medicines, including anti-inflammatory painkillers such as ibuprofen.

Heartburn can also be linked to a hiatus hernia, where part of your stomach pushes up into your chest through your diaphragm (the muscle that separates your chest from your tummy), or to a stomach ulcer or a bacterial infection in your stomach.

Are there different types of heartburn?

Heartburn isn't usually divided into strict types, but doctors do distinguish between the following:

• Occasional heartburn: This happens now and again, often with an obvious trigger, and usually isn't a cause for concern
• Gastro-oesophageal reflux disease (GORD): This is when heartburn and acid reflux keep happening regularly
• Functional heartburn: This is a burning feeling behind the breastbone that continues despite treatment, without the usual signs of acid reflux or damage to the gullet on testing – this is only diagnosed once other causes have been ruled out.

How is heartburn diagnosed?

Most cases of heartburn are diagnosed from your symptoms alone, without the need for tests. Your GP will usually ask about your symptoms and possible triggers, and may suggest trying lifestyle changes or over-the-counter medicines first.

If your symptoms don't improve, are severe, or come with warning signs such as food sticking in your throat, frequent vomiting, unexplained weight loss, or blood in your vomit or stools, you may be referred for a gastroscopy. This is a test where a thin tube with a camera on the end is passed down your throat and into your stomach to look for a cause, and it may include testing for a stomach bacterial infection.

How is heartburn treated?

Lifestyle changes

Simple changes to your diet and lifestyle are usually the first step:

• Eat smaller, more frequent meals, and avoid eating for 3 to 4 hours before bed
• Cut back on food and drink that triggers your symptoms, such as coffee, alcohol, chocolate, and fatty or spicy food
• Try to lose weight if you're overweight, and avoid tight clothing around your waist
• Raise the head of your bed by 10 to 20cm using something solid like blocks or books, rather than extra pillows.

Over-the-counter medicines

A pharmacist can recommend antacids or alginates, which are best taken with or soon after food. These ease symptoms in the short term but won't cure the underlying problem, so shouldn't be used regularly for long periods.

Prescription medicines

If lifestyle changes and over-the-counter medicines aren't enough, a GP can prescribe a proton pump inhibitor (PPI), such as omeprazole or lansoprazole, which reduces the amount of acid your stomach makes. You'll usually take this for 4 to 8 weeks, depending on how severe your symptoms are. If a PPI doesn't help, your doctor may try a different medicine called an H2 receptor antagonist, such as famotidine.

Further investigations and surgery

If medicines do not help or your symptoms are severe, you may be referred to a specialist for further tests or, in some cases, surgery on your stomach or gullet to stop the acid reflux.

When should you see a doctor?

See a GP if lifestyle changes and pharmacy medicines aren't helping, if you have heartburn most days, or if you have other symptoms such as food getting stuck in your throat, frequently being sick, or losing weight without trying to. Contact a GP or call 111 if your symptoms start getting worse.

Heartburn can sometimes feel similar to the early signs of a heart attack, so get emergency help straight away if your chest pain comes with shortness of breath, sweating, or pain spreading to your arm, jaw, neck or back.