Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2010;82(12):1452-1455

What is heartburn?

It is a burning feeling in the lower chest, with a sour or bitter taste in the throat and mouth. It usually occurs after eating a big meal or while lying down. The feeling can last for a few minutes or a few hours.

What causes heartburn?

When you eat, food passes from your mouth down a tube called the esophagus. To enter the stomach, the food must pass through an opening between this tube and your stomach. Usually, this opening closes as soon as food passes through. If it doesn't close all the way, acid from your stomach can get through the opening and into your esophagus. This is called reflux. Stomach acid can irritate the esophagus and cause heartburn.

What factors add to heartburn?

It is most common after overeating, when bending over, or when lying down. Pregnancy, stress, and certain foods can also make heartburn worse.

What can trigger heartburn?

  • Cigarette smoking

  • Coffee (regular and decaffeinated) and other drinks that contain caffeine

  • Alcohol

  • Soft drinks

  • Citrus fruits

  • Tomato products

  • Chocolate, mints, or peppermints

  • Fatty or spicy foods (such as pizza, chili, and curry)

  • Onions

  • Lying down too soon after eating

  • Being overweight or obese

  • Aspirin or ibuprofen (one brand name: Motrin)

  • Certain medicines (such as sedatives and some medicines for high blood pressure)

Can heartburn be serious?

If you have heartburn only now and then, it's probably not serious. If you have heartburn a lot, it can lead to swelling of the lining of the esophagus. If it becomes severe, your esophagus might narrow, and you might have bleeding or trouble swallowing.

If you get more than occasional heartburn, it may be a symptom of acid reflux disease, gastroesophageal reflux disease (GERD), an inflamed stomach lining (gastritis), hiatal hernia, or peptic ulcer.

What is hiatal hernia?

It is a condition in which part of the stomach is pushed up through the diaphragm (the muscle wall between the stomach and chest) and into the chest. Sometimes this causes heartburn because it makes it easier for acid to reach the esophagus.

How do I prevent heartburn?

  • Place 6- to 9-inch blocks under the legs at the head of your bed to raise it.

  • Try to eat at least two to three hours before lying down. If you take naps, try sleeping in a chair.

  • If you smoke, quit.

  • Lose weight if you're overweight.

  • Don't overeat.

  • Eat high-protein, low-fat meals.

  • Avoid tight clothes and tight belts.

  • Avoid foods and other things that give you heartburn.

Will antacids take care of heartburn?

For most people, over-the-counter antacids give fast, short-term relief. If you use antacids too much, they can cause diarrhea or constipation. Look for antacids that contain magnesium hydroxide and aluminum hydroxide. (One causes constipation and the other causes diarrhea, so they balance out.) Some brands of antacids include Maalox, Mylanta, and Riopan. Follow the directions on the package.

What if my symptoms get worse?

If lifestyle changes and antacids don't help your symptoms, talk with your doctor. He or she may want you to try a prescription medicine.

Tests are usually not needed unless your doctor suspects something other than heartburn.

What about medicines for heartburn?

Over-the-counter histamine blockers (some brand names: Pepcid, Tagamet, Zantac) reduce the amount of acid your stomach makes.

Other prescription medicines, such as omeprazole (brand name: Prilosec) and lansoprazole (brand name: Prevacid), also reduce stomach acid.

Is heartburn associated with heart attacks?

No. But sometimes pain in the chest may be mistaken for heartburn when it's really a sign of heart disease.

Call your doctor if:

  • You have trouble swallowing or pain when swallowing.

  • You're vomiting blood.

  • Your stools are bloody or black.

  • You're short of breath.

  • You're dizzy or lightheaded.

  • You have pain going into your neck and shoulder.

  • You break out in a sweat when you have pain in your chest.

  • You have heartburn more than three times a week for more than two weeks.

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