Heartburn: Causes, Symptoms, Treatments & When to See a Doctor

What Is Heartburn?

Heartburn is a burning sensation behind the breastbone caused by stomach acid refluxing into the esophagus. Occasional heartburn is common; frequent episodes (≥2×/week) may indicate GERD (gastroesophageal reflux disease), which can lead to esophagitis, strictures, or Barrett's esophagus if untreated.

Common Triggers

• Foods: spicy, fried, fatty, acidic (tomatoes, citrus), chocolate, mint, onions, garlic.
• Drinks: alcohol, caffeine, carbonated beverages.
• Behaviors: large meals, eating <3 hours before bed, lying flat after eating.
• Risk factors: overweight/obesity, pregnancy, hiatal hernia, smoking.
• Medications: NSAIDs, calcium channel blockers, certain antibiotics, bisphosphonates, potassium supplements.

Symptoms

• Burning chest pain (often after meals or at night)
• Sour/bitter taste in mouth (regurgitation)
• Difficulty swallowing (dysphagia)
• Chronic cough, hoarseness, sore throat (especially morning)
• Bloating, nausea, burping
• Sensation of a lump in throat (globus)

Treatment Options

OTC Medications

• Antacids (calcium carbonate, magnesium hydroxide): neutralize acid fast; short duration.
• H2 Blockers (famotidine, cimetidine): reduce acid production; 6–12 hr duration.
• PPIs (omeprazole, esomeprazole, lansoprazole): most potent acid suppression; take 30 min before breakfast; 14-day OTC courses.

Prescription Therapies

• Higher-dose PPIs or H2RAs.
• Prokinetics (metoclopramide) to accelerate gastric emptying—limited use due to side effects.
• Baclofen (GABA-B agonist) reduces transient LES relaxations—refractory cases.

Lifestyle Modifications (First-Line)

• Identify and avoid personal triggers (food diary helps).
• Eat smaller meals; chew thoroughly.
• Stop eating 3 hours before bed.
• Elevate head of bed 6–8 inches.
• Lose weight if BMI ≥25.
• Quit smoking; limit alcohol.
• Wear loose clothing around waist.

Red Flags: Seek Medical Attention

• Heartburn ≥2×/week for weeks
• Dysphagia or odynophagia (painful swallowing)
• Unintentional weight loss
• Chest pain with exertion/radiation (cardiac workup needed)
• Vomiting blood or coffee-ground material
• Black/tarry stools
• Symptoms persist despite 2-week PPI trial

Prevention Is the Best Medicine

Consistent lifestyle changes—weight management, trigger avoidance, meal timing, sleep position—prevent most heartburn. If symptoms persist, don't self-medicate indefinitely. Chronic acid exposure causes real damage. Get evaluated.