What is heartburn?

Heartburn is a feeling of burning pain or discomfort in your chest, often after eating. It is a symptom of gastro-oesophageal reflux.

Heartburn is sometimes also called:

• reflux
• acid reflux
• indigestion

What are the symptoms of heartburn?

Heartburn refers to pain, discomfort or burning in your chest caused by acid reflux. It might feel like it’s rising from your lower chest to your neck or throat.

Heartburn often happens or gets worse:

• after a meal
• when you are lying down or bending over

If you have heartburn, you may also sometimes notice fluid rising into your throat or mouth. It has a sour or bitter taste. This is called regurgitation, and is another symptom of reflux.

What causes heartburn?

Heartburn happens when acid from your stomach refluxes (rises up) into your oesophagus (the tube connecting your mouth to your stomach). Acid can even rise into your throat or mouth.

Normally, a ring of muscle at the lower end of your oesophagus stops stomach acid from escaping. If the muscle relaxes when it shouldn’t, or is weak, stomach acid can rise into your oesophagus.

The acid can cause pain and irritation in your oesophagus.

What are the triggers for heartburn?

Some people get heartburn no matter what they eat or drink. Others find they only get it after eating certain foods or meals.

Common food and drink triggers for heartburn are:

• large meals
• fatty or spicy foods
• coffee
• carbonated (fizzy) drinks
• citrus fruits
• tomato products
• alcohol
• chocolate
• peppermint

Smoking cigarettes can also trigger heartburn.

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

• being overweight or obese
• some types of weight loss surgery
• being pregnant
• having a hiatus hernia
• taking certain medicines (check with your doctor)
• exercising too soon after eating
• lying down too soon after eating

When should I see my doctor?

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.

If you have heartburn 2 times a week or more, see your doctor as this could be a symptom of gastro-oesophageal reflux disease (GORD).

Also see your doctor if over-the-counter pharmacy treatments do not help your heartburn, or you rely on them often.

You should also see your doctor if you experience:

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

How is heartburn diagnosed?

Your doctor will often be able to diagnose heartburn by asking questions about your symptoms and what triggers those symptoms.

In some cases, usually when symptoms are not responding to treatment, your doctor may recommend you have a gastroscopy.

This test involves a long, thin tube with a camera on the end being passed through your mouth and oesophagus into your stomach. It lets your doctor see inside your oesophagus and stomach. Your doctor can also take biopsies (small tissue samples) during this procedure.

How is heartburn treated?

Most people have heartburn from time to time.

If you have heartburn, your doctor will probably recommend diet and lifestyle changes.

If you take medicines for reflux, this should be in addition to lifestyle measures.

Lifestyle measures

Heartburn that is mild and occasional can usually be managed with lifestyle changes:

• Eat smaller, more frequent meals instead of large meals.
• Eat meals slowly.
• Avoid any foods and drinks that trigger your heartburn.
• Avoid lying down soon after a meal — wait for 3 hours.
• Avoid eating for several hours before vigorous exercise.
• Don’t eat too late at night.
• Lift the head of your bed so you are raised from the waist up.
• Lose weight, if you are overweight.
• Stop smoking, if you smoke.
• Avoid tight clothing — wearing loose clothes can help.

If your symptoms do not get better with these changes, using antacids or other acid-reducing medicines can help.

Antacids

You may also want to try over-the-counter medicines called antacids, which neutralise stomach acid.

Check with your doctor or pharmacist before taking medicines for heartburn. Ask them how to take these medicines to relieve your symptoms.

Ask your doctor or pharmacist if these medicines are safe for you to take if you are:

• pregnant
• taking other medicines

Proton pump inhibitors

Short-term treatment with medicines that control stomach acid may be helpful. Your doctor may recommend medicines called proton pump inhibitors (PPIs) if lifestyle measures and antacids have not helped your heartburn.

Regularly taking PPI medicines for longer than recommended for heartburn (usually up to 8 weeks) can increase your risk of side effects. A lot of people take heartburn medicines when they don’t need to. They also take them for too long.

Some people can take these medicines occasionally, when they have symptoms. You should work with your doctor to take the lowest dose of medicine needed to control your symptoms.

Talk to your doctor about any medicines you are taking for reflux or heartburn to see if it is safe to reduce or stop them.

Histamine receptor antagonists

Histamine receptor antagonists (also called H2 blockers) may be recommended for people who can’t take proton pump inhibitors. These medicines also reduce the amount of acid in your stomach.

Anti-reflux surgery

Anti-reflux surgery is occasionally recommended for more serious cases. It is usually only recommended if:

• lifestyle changes and medicines do not help
• you have side effects from anti-acid medicines
• you would prefer to have an operation than take medication for the rest of your life

Complications of heartburn

Acid reflux and heartburn can be related to problems such as:

• dental erosion
• a persistent, dry cough
• hoarse voice
• sore throat
• halitosis (bad breath)
• disturbed sleep
• a damaged oesophagus

These problems can also have other causes, so see your doctor if you have symptoms that are troubling you.

Resources and support

You can find out more about heartburn and reflux at the Gastroenterological Society of Australia.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.