Heartburn: causes, relief and when to seek care

Heartburn is a burning sensation behind the breastbone that can follow stomach contents moving upward into the food pipe.

The discomfort may rise towards the throat and leave a sour or bitter taste in the mouth. It can be more noticeable after a large meal, when bending, or when lying flat. Some people also describe regurgitation, a feeling of food coming back up, or throat irritation.

Seek urgent medical help for chest pressure, severe chest pain, breathlessness, sweating, fainting, or pain spreading to the arm, jaw, back, or shoulder. These symptoms need prompt assessment because they can have causes outside the digestive system.

Arrange a medical review promptly if swallowing becomes difficult or painful, vomiting continues, vomit contains blood, stools are black, or you are losing weight without trying.

Heartburn can occur with acid reflux, gastritis, a hiatus hernia, obesity, or a peptic ulcer. The listed conditions are not a ranking of likelihood, and similar discomfort can have other causes.

Acid reflux can irritate the food pipe when stomach contents travel upward. Gastritis and peptic ulcers involve the stomach lining or an ulcerated area, while a hiatus hernia can change how the upper stomach sits at the diaphragm.

A clinician will ask where the discomfort starts, what brings it on, whether it wakes you, and whether swallowing or appetite has changed. They may review medicines, including anti-inflammatory pain medicines, and ask about smoking, alcohol, and eating patterns.

Depending on the pattern and warning signs, assessment may include an examination, blood tests, a test for stomach infection, or a camera test that looks at the food pipe and stomach.

Relief may involve changing meal timing, avoiding personal trigger foods, and using medicines that reduce or neutralise stomach acid when appropriate. A clinician can advise on acid reflux medication and whether it suits your other medicines and health conditions.

If an ulcer, stomach inflammation, or infection is suspected, treatment focuses on that finding rather than repeatedly treating the burning alone. Persistent symptoms may need follow-up to check that the plan is working.

Try smaller meals, allow time between eating and lying down, and notice whether specific drinks or foods bring on symptoms. Raising the head end of the bed may help people whose symptoms occur at night; extra pillows can bend the body rather than support the upper chest.

If weight is contributing to pressure on the stomach, a gradual, supported weight-management plan can be part of care. Avoid tobacco exposure where possible and discuss medicines that seem to aggravate symptoms before stopping a prescribed treatment.

Keep note of sour taste, regurgitation, nausea, cough, throat clearing, bloating, and pain in the upper abdomen. A short symptom diary with meals, position, and medicines can make a consultation more useful.

Ongoing irritation can disturb sleep, affect meals, and inflame the food pipe. Reviewing repeated or worsening symptoms helps identify whether reflux, stomach inflammation, an ulcer, or another problem needs targeted care.