Overview

Heartburn is a burning pain in your chest, just behind your breastbone. The pain is often worse after eating, in the evening, or when lying down or bending over.

Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own with lifestyle changes and over-the-counter medications.

Heartburn that is more frequent or interferes with your daily routine may be a symptom of a more serious condition that requires medical care.

Symptoms

Symptoms of heartburn include:

  • A burning pain in the chest that usually occurs after eating and may occur at night
  • Pain that worsens when lying down or bending over
  • Bitter or acidic taste in the mouth

When to see a doctor

Seek immediate help if you experience severe chest pain or pressure, especially when combined with other signs and symptoms such as pain in the arm or jaw or difficulty breathing. Chest pain may be a symptom of a heart attack.

Make an appointment with your doctor if:

  • Heartburn occurs more than twice a week
  • Symptoms persist despite use of over-the-counter medications
  • You have difficulty swallowing
  • You have persistent nausea or vomiting
  • You have weight loss because of poor appetite or difficulty eating

Causes

Heartburn occurs when stomach acid backs up into the tube that carries food from your mouth to your stomach (esophagus).

Normally when you swallow, a band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow down into your stomach. Then the muscle tightens again.

If the lower esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus (acid reflux) and cause heartburn. The acid backup may be worse when you're bent over or lying down.

Risk factors

Certain foods and drinks can trigger heartburn in some people, including:

  • Spicy foods
  • Onions
  • Citrus products
  • Tomato products, such as ketchup
  • Fatty or fried foods
  • Peppermint
  • Chocolate
  • Alcohol, carbonated beverages, coffee or other caffeinated beverages
  • Large or fatty meals

Being overweight or pregnant also can increase your risk of experiencing heartburn.

Complications

Heartburn that occurs frequently and interferes with your routine is considered gastroesophageal reflux disease (GERD). GERD treatment may require prescription medications and, occasionally, surgery or other procedures. GERD can seriously damage your esophagus or lead to precancerous changes in the esophagus called Barrett's esophagus.