What is Heartburn?

Heartburn is the main symptom of GERD, also called gastroesophageal reflux disease and acid reflux disease. Heartburn is often described as a burning sensation behind the breastbone in your chest. The pain can be sharp and can sometimes last a long time. It usually starts after a meal and worsens at night when you lie down or bend over.

Many people experience heartburn that comes and goes infrequently every once in a while. This is neither a serious medical condition nor a cause for concern. It can usually be helped with simple dietary and medicinal practices. Patients who have chronic heartburn, however, or heartburn that is so severe that it affects quality of life, can sometimes be treated by a medical practitioner. Talk to a doctor if your heartburn symptoms include trouble breathing, trouble swallowing or pain in your jaw and mouth, as you may be having a heart attack.  You should also see a doctor if you have just started having heartburn, are over the age of 35 – especially if you are losing weight unintentionally, coughing up blood, or having dark colored stools or abdominal pain.

What Causes Heartburn?

Mild heartburn is caused by the same issue as GERD. The chest pain happens as a result of stomach acid leaking retroactively up the esophagus. This can be caused be dysfunctional muscular function of the lower esophageal sphincter (LES), which is supposed to close shut after food or liquid moves into the stomach to prevent backward movement into the esophagus. Improper LES function can be more of a structural problem or it can simply mean that the muscle is weak or too relaxed. Heartburn is also triggered by certain foods and beverages—like alcohol, coffee, foods with high fat content, onions and sodas—but this varies depending on the patient and should be tracked on an individual basis.

Can a Doctor Diagnose Heartburn?

Diagnosing heartburn with an upper gastrointestinal (upper GI tract) exam usually only happens if the patient might have GERD. Sometimes this is done with an x-ray test such as barium swallow or an upper GI series to examine the shape and muscle movement of your esophagus. Other times, more invasive endoscopy procedures can be performed to collect tissue samples with biopsy or to look for complications of heartburn, such as Barrett’s esophagus (which occurs when stomach acid has actually caused damage to occur in the lining of the esophagus). Your doctor may also want to study your heartburn case further by measuring your stomach acid or monitoring esophageal movement with an ambulatory (pH) test or esophageal motility test. Both of these tests involves having a long, thin tube called a catheter inserted through your nose and installed for several hours.

What Treatment is Available if Home Remedies for Heartburn Fail?

If simple at-home heart burn remedies such as changing your diet, exercising regularly and wearing loose clothing fail to be effective, there are stronger treatments available to treat heartburn. You can take antacids before you eat or sleep that will neutralize the acid in your stomach so it is less irritating. Strong prescriptions are also available if you talk to your doctor. These include medications to reduce the production of acid in your belly and medications aimed to black it altogether while the esophagus heals itself. Patients over the age of 50 should discuss long term complications of these medications for an extended period of time, as the Food and Drug Administration has reported that extended use may lead to increased chances of bone fractures, which can be treated with supplemental calcium and vitamin D if necessary.


Reviewed 12/29/2011 by David M. Nolan, M.D.
Diplomate of the American Board of Internal Medicine, 2011
Currently a Fellow of Gastroenterology, at UCI 2011-2014