What heartburn is and how it varies
Heartburn is a burning feeling behind the breastbone that rises toward the throat, often with a sour or bitter taste in the mouth. It occurs when stomach contents flow back up into the esophagus (reflux). Many people feel it now and then, and it is not necessarily a disease. If it returns several times a week, it may be gastroesophageal reflux disease. Triggers include fatty and spicy food, coffee, chocolate, alcohol, smoking, overeating, excess weight, stress and some medicines.
Heartburn after eating
Burning some time after a meal is most often tied to overeating, fatty or spicy food, fizzy drinks and coffee. Small portions, eating slowly and avoiding your triggers help. If heartburn follows almost every meal, with heaviness in the upper belly, nausea and belching, gastritis or reflux is possible: see a gastroenterologist.
Heartburn at night and when lying down
When you lie down, acid reaches the esophagus more easily, so heartburn often strikes at night. Do not lie down right after dinner and do not overeat in the evening. You can raise the head of the bed by 10 to 20 cm rather than just adding pillows, so that the whole body stays on a slope. If heartburn wakes you several times a week, see a doctor.
Heartburn in pregnancy
Heartburn is common in pregnancy because the uterus grows and hormones change. Small, frequent meals, no food right before bed and a raised head of the bed help. A pregnant woman should take any heartburn medicine only after talking to a doctor.
Heartburn and chest pain: when it is not the stomach
Burning behind the breastbone can also come from the heart, so be careful. If chest pain or pressure appears on exertion, spreads to the arm, shoulder, jaw or back, or comes with shortness of breath, a cold sweat, weakness or dizziness, do not write it off as heartburn: call 112. This matters most if you have never had heartburn before or have heart disease.
Heartburn with cough, hoarseness and trouble swallowing
Reflux does not always show as burning: it can bring a dry cough, especially at night, hoarseness and a lump-in-the-throat feeling (see Cough and Sore throat). If food seems to stick when you swallow, swallowing hurts, you lose weight for no reason or are often sick, do not put off a visit. For related complaints, see Nausea and vomiting and Abdominal pain.
What you can do before the visit
- Eat small portions and do not lie down for several hours after a meal.
- Notice what sets it off: fatty or spicy food, coffee, chocolate, fizzy drinks, alcohol, smoking. Cut them out where you can.
- If you are overweight, losing some reduces heartburn; avoid clothes that are tight at the waist.
- Raise the head of the bed rather than stacking pillows.
- Some medicines, such as ibuprofen and related painkillers, can worsen heartburn: discuss this with your doctor, but do not stop a prescribed medicine on your own.
- If heartburn is occasional, a pharmacist can suggest an over-the-counter remedy; if it is frequent, do not put off seeing a doctor.
- Keep a short diary: when heartburn came, what you ate and what you took.
How a doctor finds the cause
The doctor asks about how often it happens, trigger foods, night symptoms, medicines and weight, and examines you. For frequent heartburn or warning signs, a gastroscopy is arranged, and if needed testing for the infection that causes gastritis, and an ultrasound. Often a medicine that lowers stomach acid is chosen for a period the doctor sets, along with changes to diet and routine.