Heartburn

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.

• 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, and later the bump presses on the stomach). Reflux in pregnancy is common and treatable, but which medicines are suitable changes, so ask a midwife, pharmacist or doctor rather than reaching for whatever worked before.
• 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.

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 about 20 cm, using risers under the bedposts rather than extra pillows. Pillows bend you at the waist and make reflux worse.
4. Sleep on your left side. On that side the stomach sits below the join with the oesophagus, and trials comparing sleep positions bear the difference out.
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 liquids, the raft-forming kind such as Gaviscon Advance, taken after meals. They float on top of the stomach contents and physically block reflux rather than changing how much acid you make, which is why they work quickly and can sit alongside other treatments.
9. H2 blockers such as famotidine, which reduce acid and start working within about an hour. Useful when you know a particular meal or occasion sets you off. The strengths sold over the counter differ between the UK and the US, so ask the pharmacist which applies to you.
10. Proton pump inhibitors such as omeprazole, which suppress acid more completely and are the usual treatment when heartburn is frequent. NICE recommends a defined course rather than an open-ended one, then stepping down to the lowest dose that keeps symptoms away. The dose and the length of the course are your prescriber's decision, not ours.

• 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.

Some of these are emergencies and some are appointments. The difference matters.

Go to hospital now if you are vomiting blood, or passing stools that are black and tarry. That means bleeding somewhere in the upper gut. In the UK that is 999 or A&E; in the US, 911 or the emergency department. Do not drive yourself.

See a doctor promptly for food sticking or pain on swallowing, unintentional weight loss, or heartburn that has not settled after a full course of treatment. NICE treats swallowing difficulty at any age, and new upper-gut symptoms alongside weight loss from your mid-fifties, as grounds for arranging an urgent endoscopy rather than another course of tablets.

Worth a routine appointment: heartburn that starts for the first time in your fifties or later, heartburn on most days, or heartburn you are treating with pharmacy medicines several times a week.