Topic Overview

Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper abdomen just beneath the lower breastbone (sternum) and ribs. This discomfort may spread in waves upward into the throat. A sour taste in the mouth may occur with this burning sensation. Heartburn may be called indigestion, acid regurgitation, sour stomach, or pyrosis. See an illustration of heartburn.

Heartburn may cause burping, nausea, or bloating. It often is worse after eating. Difficulty swallowing may also be related to heartburn. The discomfort and pain of heartburn can last up to 2 hours and sometimes longer. It usually is made worse by lying down or bending over and often is made better by sitting or standing up. In some people, heartburn symptoms may cause sleep problems, a chronic cough, asthma, wheezing, or choking episodes.

Don't be concerned if you have heartburn now and then; nearly everyone does.

About 20% of all adults will have heartburn at least once a month.
Between 5% and 15% of adults have severe heartburn.
More than 50% of people with heartburn are between 45 and 64 years old.
About 25% of pregnant women have daily heartburn, and 50% of pregnant women have heartburn at least once a month. As the uterus expands during pregnancy, it puts increasing upward pressure on the stomach.
Symptoms of heartburn and symptoms of a heart attack may feel the same. If you have a history of heart problems or risk factors for a heart attack, your heartburn symptoms may indicate a more serious problem and need evaluation by your health professional.

Causes of heartburn

Heartburn occurs when there is an abnormal backflow (reflux) of food and stomach juices into the esophagus, the tube that leads from the throat to the stomach. Common causes of reflux include the following:

The valve (lower esophageal sphincter, or LES) where the esophagus joins the stomach may temporarily relax.
Relaxation of the LES allows stomach contents to back up (reflux) into the esophagus. This is the most common symptom of gastroesophageal reflux disease (GERD). See an illustration of gastroesophageal reflux.
Many items we consume can weaken or relax the LES. In some people this can be enough to cause reflux. Eating chocolate, peppermint, fried foods, fatty foods, or sugars; drinking coffee, carbonated drinks, or alcohol; or using tobacco can affect the LES. Once heartburn occurs, the backflow of stomach juices can cause the esophagus to become sensitive to certain foods, such as citrus fruits, tomatoes, spicy foods, garlic, and onions. Eating these foods may cause more heartburn.
Pressure on the stomach can cause reflux of stomach acid through the LES. Factors that increase the pressure on the stomach and the likelihood of heartburn include obesity, frequent bending over and lifting, tight clothes, straining with bowel movements, vigorous exercise, and pregnancy.
Several nonprescription and prescription medications can irritate the esophagus and cause heartburn.
Heartburn is more likely to occur if you have a hiatal hernia. See an illustration of a hiatal hernia.
Stress can increase acid production in your stomach and slow stomach emptying, which increases the risk for heartburn.
Exercise can cause heartburn, especially if you eat before exercising or drink concentrated sports drinks.
Severity of heartburn

Heartburn that occurs once a month is considered mild. Heartburn once a week is considered moderate. Mild to moderate heartburn usually is not a concern. Home treatment measures and nonprescription medications are usually all that is needed to relieve mild to moderate heartburn discomfort.

Daily heartburn is considered severe and can cause problems such as swallowing difficulties, bleeding, or weight loss. Heartburn with other symptoms, such as hoarseness, a feeling that food is stuck in your throat, a feeling of tightness in the throat, laryngitis, wheezing, asthma, dental problems, or bad breath, may indicate that GERD is present. A persistent inflammation of the lining of the esophagus occurs in GERD and can lead to other health problems. Heartburn may also be related to an infection with Helicobacter (H.) pylori bacteria.

Persistent heartburn symptoms can be a sign of a more serious medical condition, such as severe inflammation of the esophagus or a tumor. It is important to be evaluated by your health professional if heartburn occurs frequently and home treatment does not relieve the discomfort.

Heartburn is more serious when it occurs with abdominal pain or bleeding. Abdominal pain, especially pain located directly below the breastbone, may be a sign of more serious problems, such as heart disease, peptic ulcer disease, gallbladder disease, a tear in the esophagus, or inflammation of the stomach (gastritis). Vomiting blood may indicate bleeding in the digestive tract, often from the esophagus or stomach. If there is bleeding in the esophagus, stomach, or part of the small intestine attached to the stomach (duodenum), stools may be dark red or black and tarlike (tarry). Large amounts of bleeding can lead to shock, a life-threatening condition.

Children with heartburn symptoms

It is normal for babies and young children to spit up, but this is not considered vomiting. Children who vomit frequently after eating during the first 2 years of life are at risk for heartburn and reflux problems, such as GERD, later in life. Children with reflux problems are also at increased risk for sinusitis, laryngitis, asthma, pneumonia, and dental problems.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.