Heartburn is a burning sensation behind the breastbone. It is caused by many different conditions. However, periodic heartburn does not mean there is a problem. Chronic heartburn, with or without other digestive symptoms more than 2 times per week for several weeks, may indicate gastroesophageal reflux disease (GERD). Acid reflux irritates the esophagus, which can cause permanent damage over the course of time.
The lower esophageal sphincter (LES) is a muscular ring between the esophagus and the stomach. It relaxes to let food pass into the stomach, then closes shut to prevent it from backing up. Certain conditions can keep this muscle from closing completely, which allows acid to flow upward, causing heartburn.
These conditions may include:
Factors that may increase your chance of chronic heartburn or GERD include:
Foods and drinks that may cause symptoms include:
Medications and supplements that cause symptoms may include:
Heartburn and other digestive symptoms usually occur after overeating or lying down after a big meal. The symptoms may last for a few minutes or a few hours.
Common symptoms may include:
The regular reflux of stomach acid can cause irritation of the tissue and other structures of the throat. This irritation can lead to other symptoms, such as:
Long-term complications of GERD may include:
It is common to experience heartburn occasionally. If you have heartburn at least 2 times per week, make an appointment to see your doctor. Call your doctor if you have any complications from chronic heartburn.
The muscles of the esophagus can tighten or spasm. This can cause pain that radiates through the chest and back, similar to how a heart attack may feel. Do not assume that chest pain is an esophageal spasm.
If you have chest pains or other symptoms of a possible heart attack, call for emergency medical services right away:
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may be able to make a diagnosis based on your symptoms. Your doctor may also take x-rays (using contrast material) of your esophagus or stomach with an upper GI series. A biopsy of your esophagus may be taken. A biopsy is a tissue sample that is examined under a microscope. This is often done during an endoscopy.
Other tests may include:
Talk to your doctor about the best treatment plan for you. Treatment will depend the cause of the heartburn. Treatment focuses on preventing symptoms from occurring and healing any damage to the esophagus.
To help decrease chronic heartburn symptoms:
Medication may help relieve symptoms and repair any damage to the esophagus. Many prescription heartburn medications are available over-the-counter. Your doctor may recommend.
Surgery may be an option if symptoms are severe, other treatment methods fail, or medication cannot be tolerated. Surgical treatments include:
The most common surgery for GERD is fundoplication. The doctor wraps the stomach around the esophagus. This creates pressure on the muscle at the opening to the stomach. This can be done as an open or laparoscopic procedure.
A lighted device called an endoscope is inserted through the mouth and down the esophagus. Many procedures can be done using endoscopy to decrease the backward flow of stomach acid into the esophagus. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach, tightening the LES muscle.
LINX is a small band with magnetic beads made from titanium. Laparoscopic surgery is used to place the band around the end of the esophagus where it meets the stomach. This band helps support LES function. When the LES should be closed, the magnetic beads are attracted together. Pressure from swallowed food or drink pushes the beads apart, allowing entry into the stomach.
Some people will be able to stop taking medications after surgery. Others may need less medication, or may experience significant relief from other symptoms of GERD.
American Gastroenterological Association
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Institute for Health Information
Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-adults/Pages/overview.aspx. Accessed July 9, 2015.
Gastroesophageal reflux disease (GERD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated April 11, 2016. Accessed September 28, 2016.
Heartburn. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/heartburn.html. Updated March 2014. Accessed July 9, 2015.
Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp#.VumYEU2FPmI. Updated June 19, 2015. Accessed July 9, 2015.
9/30/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD: Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168(16):1798-1804.
4/25/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD: Shimamoto T, Yamamichi N. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: A cross-sectional study of 8,013 healthy subjects in Japan. PLoS One. 2013;8(6):e65996.
Last reviewed March 2017 by EBSCO Medical Review BoardDaus Mahnke, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.