Heartburn is a burning sensation in the upper abdomen or chest area that is caused by acid reflux of the stomach contents. Contrary to its name, it is a disorder associated with digestion, not the heart.

Heartburn is not usually a serious condition. However, severe and chronic (long-term) heartburn may lead to a more serious condition called gastroesophageal reflux disease (GERD), in which the esophagus can become damaged due to the reflux.

More than 60 million adults experience heartburn at least once a month. Some studies have indicated that more than 15 million adults experience heartburn daily, according to the American College of Gastroenterology.

There are several dietary and lifestyle factors that may contribute to heartburn. They include eating foods that trigger heartburn (e.g., spicy foods), medical conditions (e.g., pregnancy) and lifestyle habits (e.g., smoking).

Signs and symptoms of heartburn may include a burning sensation in the middle of the chest, a sensation of food or drink coming back into the throat and an acidic taste in the back of the mouth. The symptoms of heartburn are sometimes confused with symptoms of a heart attack. If patients suspect they are experiencing symptoms of a heart attack (such as a feeling of fullness or tightness in the chest or pain that spreads to the shoulders, neck, arms or jaw) they should seek immediate medical attention.

Heartburn may be diagnosed by a physician during a physical examination with a medical history and list of medications. Tests that may be performed include endoscopy, barium swallow, esophageal pH testing and  esophageal manometry.

Heartburn may be prevented or treated in a variety of ways. For mild cases, the patient may make lifestyle changes, such as maintaining a healthy weight and restricting foods and beverages that worsen the condition. Cases that do not respond to lifestyle changes may be treated with medications, such as antacids and H2 blockers. Very severe cases that do not respond to lifestyle changes and medications may require surgery.

Heartburn is a burning sensation that is felt in the chest behind the breastbone. It is caused by the backflow (reflux) of stomach acid into the esophagus.

Heartburn typically occurs within one hour of eating a meal or two hours of lying down. It can last from a few minutes to several hours.

After eating, the food passes from the mouth to the stomach through the esophagus, which is approximately 10 inches long (depending on one's size). To enter the stomach, food must pass through an opening called the lower esophageal sphincter (LES) that serves as a valve between the esophagus and the stomach. When food reaches the LES, the LES relaxes and allows it to enter the stomach. After food enters the stomach, the LES contracts to prevent food and other stomach contents from backing up into the esophagus.

When the LES is weakened or remains relaxed for too long, contents of the stomach can reflux into the esophagus. The tissue lining the esophagus differs from the stomach lining and is more susceptible to acid.

Heartburn is not usually a serious condition. However, severe and chronic heartburn can indicate that a patient has a more serious condition called gastroesophageal reflux disease (GERD), in which the lining of the esophagus may become damaged due to stomach acid reflux.

Contrary to its name, heartburn has nothing to do with the heart. However, heartburn is sometimes confused with symptoms of a heart attack. Sophisticated medical equipment is sometimes needed to distinguish between the two.

Anybody, even children, can be affected by heartburn. It is particularly common among pregnant women, because pregnancy increases pressure on the stomach and diaphragm. Hormonal changes may also cause the LES to relax.

Heartburn is one of the most common ailments in the United States. More than 60 million adults experience heartburn at least once a month. Some studies have indicated that more than 15 million adults experience heartburn daily, according to the American College of Gastroenterology.

Heartburn is caused by the backflow (reflux) of stomach acid into the esophagus. Although many believe that reflux has to be extremely acidic in order to produce heartburn symptoms, recent research suggests that even mildly acidic reflux can cause heartburn in some individuals.

There are many dietary and lifestyle factors that may contribute to the development of reflux by:

• Promoting the relaxation of the lower esophageal sphincter (LES), which serves as a valve between the stomach and the esophagus. When the LES does not close properly, stomach acid may reflux into the esophagus.
  
  
• Increasing the amount of acid produced in the stomach.
  
  
• Increasing stomach pressure.
  
  
• Making the esophagus more sensitive to stomach acid.

Eating habits are believed to be among the most common contributing factors of heartburn. The condition has long been associated with the consumption of certain foods, including citrus fruits, chocolate, peppermint, tomatoes, raw onions, garlic, black pepper and fatty or spicy foods. Certain beverages, including coffee, tea, and caffeinated, carbonated and alcoholic beverages have also been linked to the development of heartburn. However, according to recent research, there is no evidence to suggest that avoiding such foods and beverages will help prevent or alleviate heartburn.

Heartburn has also been associated with eating too fast or eating less than two hours before bedtime.

Certain body positions can also contribute to heartburn. These include lying down, especially too soon after eating, and maneuvers that increase pressure on the abdomen, such as bending over and straining to pass stool.

Certain medical conditions can also contribute to heartburn, including:

• Pregnancy.
  
  
• Gastroesophageal reflux disease (GERD). A condition in which the stomach contents flow back (reflux) into the esophagus and damage its lining.
  
  
• Hiatal hernia. The protrusion of the stomach into the chest through a tear or weakness in the diaphragm.
  
  
• Diabetes. Diabetes can cause delayed emptying of the stomach (gastroparesis) which may lead to backflow of stomach contents into the esophagus.
  
  
• Gastritis. Inflammation of the inner lining of the stomach. The most common form of gastritis is erosive gastritis, in which acid and/or other factors inflame, damage and wear down the stomach lining.
  
  
• Peptic ulcers. Peptic ulcers occur when stomach acid and other digestive juices erode the inner lining of the stomach or first part of the small intestine.

Heartburn may also be related to certain medications (e.g., antibiotics, aspirin, ibuprofen) as well as the following lifestyle habits:

• Being overweight
• Smoking
• Stressful lifestyles
• Wearing tight clothing around the waist
• Exercise that increases pressure on the abdomen (e.g., running)

The most common signs and symptoms of heartburn include:

• Burning sensation in the middle of the chest that begins at the breastbone and moves up toward the throat.
  
  
• Sensation of food or beverage coming back into the throat or back of the mouth.
  
  
• Bitter or acidic taste in the back of the throat.
  
  
• Increase in pain behind the breastbone, particularly when lying down or bending over.

Patients who experience any of the following symptoms should consult a physician because it may indicate that the esophagus has been damaged due to chronic heartburn. They include:

• Symptoms that persist even after treatment.
  
• Symptoms that worsen over time.
  
• Dysphagia (difficulty swallowing).
  
• Bleeding. This can include vomiting blood or having bloody stool.
  
• Shortness of breath, coughing or hoarseness of the voice.
  
• Unexplained weight loss.

The symptoms of heartburn are sometimes confused with symptoms of a heart attack or angina (chest pain caused by reduced flow of blood to the heart muscle). Symptoms of a heart attack or angina may include:

• A feeling of fullness or tightness, or a dull or crushing pain in the center of the chest. These symptoms often occur with activity or exertion.
  
  
• Pain that spreads to the shoulders, neck, arms or jaw.
  
  
• Pain in the chest may be accompanied by an irregular heartbeat, cold sweat, shortness of breath, nausea, vomiting, lightheadedness, weakness or dizziness.
  
  
• Symptoms often respond quickly to nitroglycerin (medication used to relax and dilate blood vessels and improve blood flow).
  

Heartburn may be diagnosed by a physician during a physical examination that includes a medical history and list of medications. Patients may be referred to a gastroenterologist, which is a physician that specializes in the function and disorders of the gastrointestinal tract. Not all patients with infrequent heartburn consult a physician for diagnosis.

Heartburn is often diagnosed after a patient describes the symptoms that are being experienced. Tests may be performed, particularly if a physician suspects that heartburn has damaged the esophagus or other organs. Tests may include:

• Endoscopy.  One of the most common tests used to evaluate the esophagus. A small tube with a light and camera (endoscope) is inserted into the esophagus, stomach and small intestine. This allows a physician to determine whether tissue damage is present. Samples of tissues may be taken (biopsy) to determine the extent of the damage.
  

  

• Barium swallow (upper GI series). A test in which an x-ray is taken after liquid barium is ingested. This can detect abnormalities and sometimes inflammation of the esophagus (esophagitis).
  
  
• Esophageal pH monitoring. This involves passing a thin tube through the nose and into the esophagus. The tube is attached to a small monitoring device and is worn for 24 hours. The device records how much stomach acid reaches the esophagus. The patient records symptoms experienced during the 24-hour period and the physician compares acid levels with symptoms.
  
  
• Esophageal manometry. This involves a device similar to the pH monitor that measures muscle contractions to determine whether the lower esophageal sphincter (LES) is functioning properly.

There are a number of ways to treat heartburn. Patients with heartburn may wish to keep a diary in which they record information about their episodes. The diary may contain information about the date and time of occurrence, other symptoms experienced and factors that may have contributed to it. This may help patients identify what triggers heartburn and how to prevent it.

Traditionally, physicians have recommended that patients who experience heartburn avoid certain foods and beverages, including citrus fruits, chocolate, fatty foods, spicy foods, tomato sauce, mint and carbonated and/or caffeinated beverages, which may increase acid production or relax lower esophageal sphincter (LES) muscles. However, recent research questions the necessity of such dietary changes.

Other recommended lifestyle modifications include:

• Eating more slowly.
  
  
• Eating smaller meals more frequently throughout the day.
  
  
• Avoiding eating two to three hours before bedtime whenever possible.
   
• Exercising regularly. Though exercise can help prevent or alleviate heartburn, patients should avoid activities that may put too much pressure on the abdomen, such as heavy lifting.
  
  
• Raising the head of the bed 6 to 8 inches (15.2 to 20.3 centimeters). Elevating the head and shoulders over the stomach allows gravity to prevent acid from refluxing. Propping the head up with pillows will not help reflux and may increase pressure on the stomach or esophagus.
  
  
• Wearing loose-fitting clothing. Patients should not wear tight clothing (e.g., pants, belts) because it increases pressure on the abdomen.
  
  
• Reducing stress. Patients should attempt to limit stress, which can worsen heartburn.
  
  
• Sucking on hard candy. This increases the production of saliva, which protects the esophagus from stomach acid.
  
  
• Maintaining a healthy body weight. Research indicates that even just a few extra pounds can increase the incidence of heartburn.
  
  
• Stopping smoking. Cigarette smoking inhibits the production of saliva and increases stomach acid.

Cases of heartburn that do not respond to lifestyle changes may be treated with medications. Common heartburn medications include:

• Antacids. Medications that neutralize stomach acid. They are available without a prescription.
  
  
• Foaming agents. Medications that work by covering the contents of the stomach with foam to prevent reflux. They are available without a prescription.
  
  
• H2 blockers. Medications that reduce the acid levels in the stomach by blocking the chemical used to make acid. They are available over-the-counter and by prescription.
  
  
• Proton pump inhibitors (PPIs). Medications that reduce the amount of acid in the stomach. They are available over-the-counter and by prescription. It is important to note that recent research indicates that use of PPIs may increase a person's risk of hip fracture.
  
  
• Prokinetics. Medications that strengthen the lower esophageal sphincter (LES) muscle and increase stomach contractions, which helps food to pass through the digestive system more quickly. They do not affect the level of stomach acid produced. They are only available by prescription.
  

If medications are not successful in treating heartburn, or if heartburn leads to serious complications, surgery may be required. The surgery most commonly performed is called fundoplication, a procedure in which the top part of the stomach is wrapped around the lower part of the esophagus to strengthen the LES and prevent acid reflux. There are endoscopic procedures that attempt to duplicate the effect of such surgery, but they have been performed in only a relatively small number of patients and the long-term results are not known.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following heartburn-related questions:

1. What is heartburn?
   
   
2. How common is heartburn?
   
   
3. What is causing my heartburn?
   
   
4. When I get heartburn, I sometimes feel as if I am having a heart attack. How can I tell the difference?
   
   
5. Is there a chance I may have gastroesophageal reflux disease?
   
   
6. Are there lifestyle changes that I can make that may reduce my risk of getting heartburn?
   
   
7. What type of medication should I take to treat my heartburn?
   
   
8. Is the medication available over the counter or do I need a prescription?
   
   
9. What should I do if the medication does not work?
   
   
10. Under what circumstances may surgery be necessary?