Also known as: Pyrosis
Heartburn is a burning sensation in the chest, typically behind the breastbone, that occurs when stomach acid flows back into the esophagus. Despite its name, heartburn has nothing to do with the heart. It is very common, especially after meals or when lying down, and is usually manageable with lifestyle and dietary changes.
Heartburn is an extremely common symptom, experienced by more than 60 million Americans at least once a month and about 15 million daily. The burning sensation occurs when stomach acid flows backward (refluxes) from the stomach into the esophagus — the tube connecting the throat to the stomach. The esophagus lacks the protective lining that the stomach has, so exposure to acid causes the familiar burning discomfort.
A ring of muscle at the bottom of the esophagus called the lower esophageal sphincter (LES) normally acts as a one-way valve, opening to let food into the stomach and closing to keep stomach contents from flowing back. When the LES relaxes inappropriately or is weakened, acid can reflux into the esophagus. Factors that can weaken the LES or increase reflux include eating large meals, lying down after eating, certain foods and drinks, obesity, and pregnancy.
Occasional heartburn is normal and can be managed with lifestyle changes and over-the-counter antacids. However, frequent heartburn — occurring two or more times per week — may indicate gastroesophageal reflux disease (GERD), a chronic condition that can damage the esophageal lining over time if left untreated. Recognizing when heartburn needs medical attention is important for preventing complications.
There are several possible reasons you may be experiencing Heartburn. Here are the most common ones.
Eating large portions stretches the stomach and puts pressure on the LES, making reflux more likely. Fatty foods delay stomach emptying, keeping acid-producing contents in the stomach longer.
Gravity normally helps keep stomach contents down. When you lie down soon after eating, acid can more easily flow back into the esophagus. This is why heartburn often worsens at bedtime.
Citrus fruits, tomatoes, chocolate, mint, garlic, onions, spicy foods, caffeine, and alcohol can all relax the LES or increase acid production, triggering heartburn in susceptible individuals.
Excess abdominal weight puts mechanical pressure on the stomach, pushing its contents upward toward the esophagus. Weight loss is one of the most effective long-term strategies for reducing heartburn frequency.
Hormonal changes during pregnancy relax the LES, and the growing uterus puts increasing pressure on the stomach. Heartburn affects up to 80% of pregnant women and typically improves after delivery.
When part of the stomach pushes up through the diaphragm into the chest cavity, it can weaken the LES and allow acid to reflux more easily. Small hiatal hernias are common and often asymptomatic, but larger ones can cause significant heartburn.
Certain medications can relax the LES or irritate the esophagus, including NSAIDs, aspirin, some blood pressure medications (calcium channel blockers), and some sedatives. Taking medications with a full glass of water can help.
These approaches may help manage heartburn at home. Always consult a healthcare provider if symptoms persist or worsen.
Allowing time for the stomach to empty before lying down significantly reduces nighttime heartburn. If you need to lie down sooner, elevate the head of your bed 6-8 inches using blocks under the bed frame or a wedge pillow.
Smaller meals put less pressure on the LES than large ones. Eat slowly, chew thoroughly, and stop eating before you feel overly full. Five smaller meals may work better than three large ones.
Keep a food diary to track which foods worsen your heartburn. Common triggers include spicy foods, citrus, tomato-based foods, chocolate, mint, caffeine, and alcohol. Eliminating triggers can dramatically reduce episodes.
Tight belts, waistbands, and shapewear can put pressure on the abdomen and push stomach contents upward. Wearing comfortable, loose-fitting clothes around the midsection can help reduce reflux.
Antacids like calcium carbonate (Tums) neutralize stomach acid and provide quick relief. H2 blockers (like famotidine) and proton pump inhibitors (like omeprazole) reduce acid production and can be effective for more frequent heartburn. Follow package directions for appropriate use.
Doctors diagnose heartburn and GERD primarily through symptom history. If symptoms are classic (burning behind the breastbone after meals, worse when lying down, relieved by antacids), a trial of acid-reducing medication may serve as both a diagnostic and therapeutic step. If symptoms persist, an upper endoscopy (EGD) allows direct visualization of the esophageal lining to check for inflammation, erosion, or other complications. Esophageal pH monitoring measures acid exposure over 24 hours for an objective assessment. Esophageal manometry tests the muscle function of the esophagus and LES.
Consult a doctor if heartburn occurs more than twice a week, does not improve with over-the-counter antacids, is accompanied by difficulty swallowing, unintended weight loss, or persistent vomiting. Chest pain that is new, severe, or accompanied by shortness of breath should be evaluated to rule out cardiac causes.
Steps you can take to reduce the likelihood of experiencing heartburn.
Maintain a healthy weight — even modest weight loss can reduce heartburn frequency
Eat meals at least 2-3 hours before lying down or going to bed
Avoid personal trigger foods and limit overall fat, caffeine, and alcohol intake
Elevate the head of your bed if nighttime heartburn is a problem
Do not smoke — smoking weakens the lower esophageal sphincter and worsens reflux
Heartburn typically produces a burning sensation behind the breastbone that is related to meals, worsened by lying down, and relieved by antacids. Heart attack pain is more often described as pressure, squeezing, or heaviness and may radiate to the jaw, arm, or back, accompanied by shortness of breath, sweating, and nausea. However, the two can feel similar. If you are unsure or if chest pain is new, severe, or accompanied by other symptoms, seek immediate medical care to be safe.
Occasional antacid use (calcium carbonate, for example) is generally safe. However, daily use of any heartburn medication should be discussed with a healthcare provider. Long-term use of proton pump inhibitors (PPIs) has been associated with potential effects on bone density, magnesium levels, and gut bacteria. If you need daily medication, your doctor can advise on the safest approach and investigate any underlying causes.
Yes, frequent or severe heartburn that goes untreated can damage the esophageal lining over time, leading to esophagitis (inflammation), strictures (narrowing), or Barrett's esophagus (cell changes that may increase cancer risk). This is why persistent heartburn occurring more than twice a week should be evaluated and treated. Most people with well-managed GERD never develop these complications.
Yes, sleeping position significantly affects nighttime heartburn. Sleeping on the left side may reduce reflux because of the stomach's anatomy — the esophageal opening sits above the level of stomach acid in this position. Elevating the head of the bed 6-8 inches (using bed risers or a wedge pillow, not just extra pillows) also helps keep acid in the stomach by using gravity. Sleeping on the right side or flat can worsen reflux.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.