Digestive symptoms

Heartburn

Also called: pyrosis, acid indigestion, burning chest

Heartburn is the burning sensation behind the breastbone caused by stomach acid flowing back into the oesophagus. Most people get it occasionally after large or trigger-food meals. Frequent heartburn (more than twice a week) is gastro-oesophageal reflux disease (GORD/GERD), which deserves treatment. Lifestyle changes fix many cases; alginates and acid-reducing medication handle the rest.

What is happening

Stomach acid is normally kept in the stomach by a muscular ring at the top called the lower oesophageal sphincter. When that ring leaks, acid travels up into the oesophagus. The oesophageal lining is not designed to handle acid, so it inflames. The pain is felt as a burning behind the breastbone, sometimes radiating up to the throat with a sour taste.

Common triggers

  • Large meals that stretch the stomach.
  • Lying down within 3 hours of eating.
  • Chocolate, mint, coffee, alcohol, fatty fried meals (all relax the sphincter).
  • Tomato, citrus, spicy meals (acidic or irritate the oesophageal lining directly).
  • Tight clothing around the waist.
  • Smoking.
  • Pregnancy (progesterone relaxes the sphincter, the bump compresses the stomach).
  • Hiatus hernia (part of stomach pushed up through the diaphragm).
  • Some medications: ibuprofen, aspirin, certain blood pressure drugs.
  • GLP-1 medications (Ozempic, Wegovy, Mounjaro), which slow gastric emptying and can worsen reflux symptoms in some people.

What works

  1. Smaller meals, finishing 3 hours before bed.
  2. Walk for 10 to 15 minutes after eating.
  3. Raise the head of the bed by 10 to 20 cm using risers (not extra pillows, which bend you at the waist and worsen reflux).
  4. Sleep on your left side. Anatomy puts the stomach below the oesophagus on this side.
  5. Lose excess weight if you are overweight or carry it around the middle.
  6. Cut alcohol and reduce coffee for 2 weeks to gauge effect, then add back at smaller doses.
  7. Stop smoking if you smoke.
  8. Alginate-based liquids (Gaviscon Advance) after meals: form a raft that physically blocks reflux and can be retained in the stomach for several hours.
  9. H2 blockers (famotidine 20 mg) for known trigger occasions: onset within about an hour.
  10. PPI (omeprazole 20 mg daily) for 4 to 8 weeks if symptoms persist; step down after.

Heartburn vs GERD vs indigestion

  • Heartburn: the symptom (burning chest).
  • GERD/GORD: the diagnosis when heartburn is chronic (twice a week or more) or causing damage.
  • Indigestion (dyspepsia): a broader category including nausea, fullness, upper-belly discomfort. Heartburn is one type of indigestion.

Red flags worth a GP visit

  • Difficulty or pain on swallowing.
  • Unintentional weight loss.
  • Vomiting blood or stools that look black and tarry.
  • New heartburn starting after age 55.
  • Heartburn that does not improve on a full PPI course.

Common questions

Is heartburn the same as a heart attack?
No. Heartburn is oesophageal. A heart attack is cardiac. They can feel similar (chest pain) but differ in pattern: heartburn relates to meals and lying down, eases with antacids. Heart attack pain is constant, often radiates to arm or jaw, comes with sweating and breathlessness. If you are not sure, treat as cardiac and call 999.
Can stress cause heartburn?
Indirectly. Stress increases visceral sensitivity (you feel acid more) and changes eating patterns (larger evening meals, more alcohol, more caffeine). Treating the lifestyle drivers usually helps more than treating the stress alone.
Is daily PPI safe long-term?
Reasonably safe but with trade-offs. Long-term PPI use can affect B12, iron, magnesium and calcium absorption, and shifts the gut microbiome. NICE recommends step-down approach: short course, then assess if you can come off. If you need ongoing PPI, regular reviews with a GP are sensible.
What about apple cider vinegar?
No good evidence. The premise (low stomach acid causes reflux) is not supported by mainstream physiology. Some people anecdotally feel better, but there are no trials supporting it for reflux and the acid can erode tooth enamel.

Sources

The Book of Suna is general information, not medical advice. It is not a substitute for talking to a qualified healthcare professional about your own situation.