Heartburn

What is it?

Heartburn is the cardinal symptom of gastroesophageal reflux disease (GERD) — the backward flow of stomach acid into the esophagus. It typically presents as a burning sensation behind the sternum, often rising toward the throat, and is classically worse after meals, when lying down, or when bending over. GERD affects up to 20% of adults in Western countries. Occasional heartburn is common and manageable with lifestyle changes and OTC antacids. Frequent heartburn (≥2 episodes per week) warrants treatment with proton pump inhibitors. Persistent symptoms despite treatment require endoscopy to rule out Barrett esophagus or esophageal cancer.

Common causes

When to see a doctor

• 1Difficulty swallowing or a feeling of food getting stuck
• 2Heartburn that does not respond to 2 weeks of OTC treatment
• 3Unexplained weight loss alongside heartburn
• 4Vomiting blood or black stools
• 5Chest pain not clearly distinguishable from cardiac pain — evaluate the heart first
• 6Symptoms occurring daily or disrupting sleep

What you can do

• ✓Do not eat within 2–3 hours of bedtime; large meals increase reflux risk
• ✓Elevate the head of your bed 6–8 inches (not just pillows, which flex the torso)
• ✓Avoid trigger foods: coffee, alcohol, chocolate, tomatoes, citrus, fatty and spicy foods
• ✓Lose weight if overweight — even modest weight loss significantly reduces GERD
• ✓Wear loose-fitting clothing; tight waistbands increase intra-abdominal pressure
• ✓Stop smoking — nicotine relaxes the lower esophageal sphincter

Conditions that cause this symptom

Medications that may help

Treatment depends on the underlying cause. Always consult your provider before starting any medication.

Frequently asked questions