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Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper belly just below the lower breastbone (sternum). This discomfort may spread in waves upward into your throat. You may have a sour taste in your mouth. Heartburn is sometimes called indigestion, acid regurgitation, sour stomach, or pyrosis. It isn't caused by problems with your heart. But sometimes heart problems can feel like heartburn.
Heartburn may cause burping, nausea, bloating, or trouble swallowing. These symptoms can sometimes last up to 2 hours or longer. In some people, heartburn symptoms may cause sleep problems, a chronic cough, asthma, wheezing, or choking episodes.
Heartburn usually is worse after you eat. It's often made worse if you lie down or bend over. It gets better if you sit or stand up.
Almost everyone will have troubles with heartburn now and then.
Heartburn occurs more often in adults than in children. Many women have heartburn every day when they're pregnant. That's because the growing uterus puts increasing upward pressure on the stomach.
Symptoms of heartburn and symptoms of a heart attack may feel the same. Sometimes your heartburn symptoms may mean a more serious problem. They may need to be checked by your doctor.
Dyspepsia is a medical term that's used to describe a vague feeling of fullness, gnawing, or burning in the chest or upper belly, especially after eating. A person may describe this feeling as "gas." Other symptoms may occur at the same time. They include belching, rumbling noises in the belly, increased passing gas (flatus), poor appetite, and a change in bowel habits. Causes of dyspepsia can vary from minor to serious.
Causes of heartburn
Heartburn occurs when food and stomach juices back up (reflux) into the esophagus. This is the tube that leads from the throat to the stomach. This process is called gastroesophageal reflux. Common causes of reflux include:
- Incomplete closing of the valve (the lower esophageal sphincter, or LES) between the esophagus and the stomach.
- Certain foods and drinks that make your symptoms worse. These may include chocolate, mint, alcohol, pepper, spicy foods, high-fat foods, or drinks with caffeine in them, such as tea, coffee, colas, or energy drinks. If your symptoms are worse after you eat a certain food, you may want to stop eating it to see if your symptoms get better.
- Pressure on the stomach. This can be caused by obesity, frequent bending over and lifting, tight clothes, straining with bowel movements, vigorous exercise, and pregnancy.
- Smoking and use of other tobacco products.
- Prescription and nonprescription medicines, such as aspirin, ibuprofen, prednisone, iron, potassium, antihistamines, and sleeping pills.
- A hiatal hernia. It occurs when a small portion of the stomach pushes upward through the diaphragm. This is the muscle that separates the lungs from the belly.
- Stress. It can increase the amount of acid your stomach makes and cause your stomach to empty more slowly.
Severity of heartburn
Mild heartburn occurs about once a month. Moderate heartburn occurs about once a week.
Severe heartburn occurs every day. It can cause problems such as bleeding, trouble swallowing, and weight loss. Heartburn may occur with other symptoms, such as hoarseness, a feeling that food is stuck in your throat, tightness in your throat, a hoarse voice, wheezing, asthma, dental problems, or bad breath. In this case, heartburn may be caused by a more serious problem, such as gastroesophageal reflux disease (GERD). A lasting inflammation of the lining of the esophagus occurs in GERD. It can lead to other health problems. Heartburn may also be related to an infection with Helicobacter pylori (H. pylori) bacteria.
Heartburn symptoms that won't go away can be a sign of a more serious medical condition, such as severe inflammation of the esophagus or cancer of the stomach or esophagus.
Heartburn is more serious when it occurs with belly pain or bleeding.
- Belly pain, especially pain directly below the breastbone, may be a sign of more serious problems. These include heart disease, peptic ulcer disease, gallbladder disease, a tear in the esophagus, and inflammation of the stomach (gastritis).
- Vomiting of blood may mean bleeding in the digestive tract, often from the esophagus or stomach. If you have bleeding in the esophagus, stomach, or part of the small intestine attached to the stomach (duodenum), your stools may be dark red or black and tarry. Large amounts of bleeding can lead to shock, a life-threatening condition.
Heartburn in children
Almost all babies spit up, especially newborns. Spitting up decreases when the muscles of the esophagus become more coordinated. This process can take as little as 6 months or as long as 1 year. Spitting up isn't the same thing as vomiting. Vomiting is forceful and repeated. Spitting up may seem forceful. But it usually occurs shortly after feeding, is effortless, and causes no discomfort.
Children who often vomit after eating during the first 2 years of life are more likely to have heartburn and reflux problems, such as GERD, later in life. Children with reflux problems also have increased chances of other problems, such as sinusitis, laryngitis, asthma, pneumonia, and dental problems.
The treatment of heartburn depends on how bad your heartburn is and what other symptoms you have. Home treatment and medicines that you can buy without a prescription usually will relieve mild to moderate heartburn. Make sure to see your doctor if heartburn occurs often and isn't relieved by home treatment.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Symptoms of a heart attack may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.
Many prescription and nonprescription medicines can cause heartburn. A few examples are:
- Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
- Steroids, such as prednisone.
- Some heart medicines.
Caffeine and alcohol also can cause heartburn.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Home treatment, such as lifestyle changes and nonprescription medicines, may be all that's needed to treat mild to moderate heartburn. But if your symptoms don't get better with home treatment, or if your symptoms occur often, there may be other medical problems may be causing your symptoms.
Keep a record of your heartburn symptoms before and after you make lifestyle changes or use nonprescription medicines so you can track any improvement or changes.
Medicines to treat heartburn
The two main types of medicines for heartburn are antacids and stomach acid reducers.
Many people take nonprescription antacids for mild or occasional heartburn.
- Antacids such as Tums, Mylanta, or Maalox neutralize some of the stomach acid. They work for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
- Some antacids, such as Gaviscon, have a foaming agent (alginate). It acts as a barrier between stomach acid and the esophagus.
- Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks. And you shouldn't take it if you can't take aspirin. It may make your tongue or stools black. The black color usually isn't serious. Brushing your teeth and tongue after you take Pepto-Bismol may keep your tongue from turning black.
Antacids work faster than acid reducers (H2 blockers). But their effect doesn't last more than 1 to 2 hours. H2 blockers can provide relief for up to 12 hours.
Antacids have side effects. They may cause diarrhea or constipation. And they can interfere with how your body absorbs other medicines.
Be careful when you take over-the-counter antacids. Many of these medicines have aspirin in them. Read the label to make sure that you aren't taking more than the recommended dose. Too much aspirin can be harmful.
Stomach acid reducers
- H2 blockers.
Histamine receptor (or H2) blockers decrease the amount of acid that the stomach makes. This may reduce irritation of the stomach lining and decrease heartburn. Some examples of nonprescription acid reducers are Pepcid AC (famotidine) and Tagamet HB (cimetidine).
- Proton pump inhibitors.
Proton pump inhibitors (PPIs), such as omeprazole (for example, Prilosec), reduce stomach acid and treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn hasn't gotten better with other home treatments, antacids, or H2 blockers. You may need to use a PPI for up to 5 days before you have relief of your heartburn. You can buy PPIs without a prescription.
Many people may use over the counter medicines for occasional heartburn. There are some cautions you should be aware of.
- If you are pregnant and have heartburn symptoms, be sure to talk to your doctor before you take any heartburn medicines. Some medicines may not be safe to take while you are pregnant.
- If you use antacids more than just once in a while, talk with your doctor. If you have any health risks, be sure to talk with your doctor before you start to take an antacid. If you have kidney disease, it's even more important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of these two substances in people who have kidney disease.
- Talk with your doctor if you take an H2 blocker for more than 2 weeks.
- Acid reducers can sometimes change the way other medicines work. If you take prescription medicines, be sure to talk with your doctor before you take a nonprescription acid reducer.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- Symptoms are not relieved by home treatment and medicine.
- Swallowing problems don't improve.
- Weight loss continues for no reason.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: June 6, 2022
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine