Pyrosis; Non-cardiac chest pain
Heartburn is a painful burning feeling just below or behind the breastbone. Most of the time it comes from the esophagus. The pain often rises in your chest from your stomach. It may also spread to your neck or throat.
Almost everyone has heartburn sometimes. If you have heartburn very often, you may have gastroesophageal reflux disease (GERD).
Normally when food or liquid enters your stomach, a band of muscle at the end of your esophagus closes off the esophagus. This band is called the lower esophageal sphincter (LES). If this band does not close tightly enough, food or stomach acid can back up (reflux) into the esophagus. The stomach contents can irritate the esophagus and cause heartburn and other symptoms.
Heartburn is more likely if you have a hiatal hernia. A hiatal hernia is a conditions which occurs when the top part of the stomach pokes into the chest cavity. This weakens the LES so that it is easier for acid to back up from the stomach into the esophagus.
Pregnancy and many medicines can bring on heartburn or make it worse.
Medicines that can cause heartburn include:
Talk to your health care provider if you think one of your medicines may be causing heartburn. Never change or stop taking medicine without talking to your provider first.
You should treat heartburn because reflux can damage the lining of your esophagus. This can cause serious problems over time. Changing your habits can be helpful in preventing heartburn and other symptoms of GERD.
The following tips will help you avoid heartburn and other GERD symptoms. Talk to your provider if you are still bothered by heartburn after trying these steps.
First, avoid foods and drinks that can trigger reflux, such as:
Next, try changing your eating habits:
Make other lifestyle changes as needed:
If you still do not have full relief, try over-the-counter medicines:
Get urgent medical care if:
Call your health care provider if:
You think one of your medicines may be causing heartburn. DO NOT change or stop taking your medicine on your own.
Heartburn is easy to diagnose from your symptoms in most cases. Sometimes, heartburn can be confused with another stomach problem called dyspepsia. If the diagnosis is unclear, you may be sent to a doctor called a gastroenterologist for more testing.
First, your provider will do a physical exam and ask questions about your heartburn, such as:
You may need the following tests:
If your symptoms do not get better with home care, you may need to take medicine to reduce acid that is stronger than over-the-counter medicines. Any sign of bleeding will need more testing and treatment.
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 140.
Katz PO, Gerson LB, Vela MF. Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2013;108:308-28. PMID: 23419381
Last reviewed on: 1/11/2015
Reviewed by: Todd Eisner, MD, Private practice specializing in Gastroenterology, and Affiliate Assistant Professor, Florida Atlantic University School of Medicine, Boca Raton, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.