9 minute read

Heartburn: Causes, Symptoms & Treatment

Written by
Reviewed by
Dr Ai Nhi Bui

We've all been there. You just finished a big greasy hamburger, fries, and a beer, and the night is still young. Everyone is making plans for dancing and some more fun when out of the blue, you have the worst chest pain. The acid burn sears up your chest. You would give anything for some antacids.

You have just experienced heartburn, but what if it was a heart attack, acid reflux, or gastro-oesophageal reflux disease (GORD)? The worry just makes your heartburn worse. In this guide, learn more about heartburn, its causes, symptoms, and some remedies that may get you back to your social life in no time.

What exactly is heartburn?

Heartburn is the unpleasant and frequently painful sensation caused by acid rushing up your oesophagus and into your mouth. Just beneath the breastbone, the oesophagus links the stomach to the mouth. Heartburn discomfort is exacerbated by eating a large fatty meal, eating and then lying down for a snooze, or bending over.

Stomach acid has a pH of two. That means it is a very strong acid capable of dissolving nails. It's no wonder it causes so much pain.

Although the stomach is well protected from this acid, the oesophagus is not. When stomach acid enters the oesophagus, it causes irritation, burning, pain, and inflammation - also known as heartburn.

Heartburn vs acid reflux vs GORD

Heartburn is a symptom. It is used to describe the pain you experience when acid sloshes into the oesophagus. Acid reflux, also called gastro-oesophageal reflux disease or GORD, is more serious than an occasional episode of heartburn. If you have heartburn more than twice per week, it may be GORD. Heartburn and acid rising into the mouth (acid reflux) are the main symptoms of GORD, but it is possible to have GORD without these symptoms.

GORD is a chronic condition. The symptoms result from acid reflux that is frequent and longer-lasting. Other symptoms of GORD can be difficulty swallowing, a dry cough, hoarseness, nausea, vomiting, bad breath, wheezing, and waking up at night.

In general, if you have heartburn more than twice a week, do not respond to treatment or require frequent treatment to manage the symptoms, you should see a doctor to see if it is acid reflux causing GORD. GORD can cause some serious complications, so you would not want to wait.

Heartburn Causes

When you bit into that juicy hamburger, you chewed and swallowed it. The ball of hamburger was pushed down the oesophagus to your stomach. Once in the stomach, stomach acids and digestive juices started to break it down. If the hamburger and the stomach acid stays in the stomach, then all is well.

At the junction of the stomach and oesophagus is a band of muscle called the lower oesophageal sphincter (LOS). The LOS functions as a valve, relaxing to let food and drink pass into the stomach. It constricts to keep food, drink, and stomach juices in the stomach. If it loosens when it should not, stomach acid may backflow into the oesophagus. This situation is called acid reflux. Acid reflux causes the symptom, heartburn. Recurrent acid reflux can cause GORD.

Certain foods and beverages, alcohol, and some medications cause heartburn.

Foods that cause heartburn

Foods and drinks that relax the lower oesophageal sphincter (LOS) and cause heartburn and acid reflux include:

  • Caffeinated beverages like coffee or tea
  • Carbonated drinks
  • Chocolate contains methylxanthine, which is similar to caffeine
  • Fried, greasy or fatty foods
  • Peppermint
  • Spicy foods
  • Onions
  • Alcohol

Foods that cause symptoms of heartburn because of their high acid content:

  • Citrus products
  • Tomatoes and tomato products

Medications that cause heartburn

Many medications can cause heartburn, but common offenders include:

  • Antibiotics like tetracycline
  • Aspirin
  • Anti-inflammatories such as voltaren and nurofen
  • Asthma medications
  • Corticosteroids
  • Potassium
  • Iron supplements
  • Vitamin C

Other causes of heartburn

The diaphragm is a muscle that separates your chest cavity (where the lungs and heart are) and the abdominal cavity (where your stomach and intestines are located). The oesophagus is in the chest. There is a hole in the diaphragm for the oesophagus to pass into the abdomen.  

A hiatal hernia occurs when at least part of the stomach is pushed through the diaphragm from the abdomen into the chest. Hiatal hernias can occur if the diaphragm has a larger than normal opening or if there is increased pressure in the abdomen.

Because progesterone, a female sex hormone, relaxes the LOS, heartburn can worsen during pregnancy.

Obesity, as well as wearing tight-fitting clothing or a belt, raises abdominal pressure causing heartburn.

Heartburn or Heart Attack?

Heartburn pain is frequently confused with symptoms of a heart attack because it is unexpected, feels like pressure, and is located behind the breastbone. Many people have avoided seeking medical attention for chest pain because they mistakenly assumed it was heartburn.

Heartburn, angina (pain from decreased blood flow to the heart), and a heart attack can be difficult to distinguish. In most cases, if you seek treatment for chest pain, you'll immediately have tests to rule out a heart attack.

If you are unsure of the cause of your chest pain, or if you describe it as unusual or severe, or if you have any of the following symptoms, call 000:

  • Cold sweats
  • Fatigue
  • Nausea or vomiting
  • Dizziness
  • Fainting
  • Pain that radiates down your left arm or into your neck
  • Shortness of breath
  • Lightheadedness

Heartburn Symptoms

Common symptoms of heartburn include:

  • Burning sensation in the upper abdomen that moves into the chest
  • Pain that worsens when lying down or bending over
  • Pain associated with eating a large meal
  • Pain that awakens you from sleep if you ate within the last two hours
  • Pain that is relieved by antacids
  • A sour or bitter taste in your mouth

Diagnosing Heartburn

An occasional episode of heartburn can usually be diagnosed based on symptoms. When you have heartburn more than twice a week, you may have gastroesophageal reflux disease (GORD).

The first step in diagnosis is a history and physical exam. If your symptoms are consistent with heartburn, you may be prescribed a trial of a medication that decreases stomach acid production. If your symptoms improve, this supports the diagnosis.

If your symptoms do not improve, the next step may be an imaging study to look at the oesophagus.

Heartburn Treatment

If you’re experiencing occasional heartburn, there are few different treatment options you can try:

  • Chewing gum or sucking on a lozenge after a meal: Either of these will increase saliva production. Saliva has an alkaline pH which will help neutralise stomach acid's acidic pH.
  • Herbal teas: Drinking tea or other warm liquids can help dilute stomach acid and soothe the oesophagus. Ginger tea soothes stomach and oesophageal irritation.
  • Antacids: Antacids are used for occasional heartburn because they can neutralise stomach acid. Antacids are not intended for long-term use. If heartburn occurs twice a week or more often, consult with a doctor. Antacids may interfere with some medications.
  • Medications: H2-receptor antagonists and proton pump inhibitors may decrease stomach acid production.

Preventing Heartburn

There are lifestyle modifications that can minimise the chances of developing persistent heartburn.

These changes might include:

  • Managing your weight: Being overweight or obese increases abdominal pressure, putting excess pressure on the LOS.
  • Eating smaller, more frequent meals: Eating smaller meals puts less pressure on the LOS.
  • Avoiding constricting clothing: Tight clothing increases pressure in the abdomen, which increases the risk of heartburn.
  • Avoiding foods and drinks that trigger heartburn: Avoid alcohol and foods known to weaken the LOS or irritate the oesophagus.
  • Sleeping with the head of your bed elevated: Lying flat increases the pressure the stomach contents put on the LOS. Elevating the head of the bed prevents stomach acid from reaching the top of the oesophagus and potentially being aspirated into the lungs.
  • Quitting smoking: Nicotine relaxes the LOS and increases the likelihood that acid will reflux into the oesophagus.
  • Drinking water: Drink small amounts of water throughout the day to help wash stomach acid out of the oesophagus.

Heartburn treatment online with Rosemary Health

Occasional heartburn can usually be treated and managed at home, but if your heartburn occurs more than twice per week or you have severe or persistent symptoms, you can get prescription heartburn treatment online through Rosemary. Start your online visit today and say goodbye to reflux.

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