Heartburn, also known as gastro-esophageal reflux disease (GORD) or indigestion, is a very common condition in which the stomach contents and/or acid are able to move back upward into the esophagus, and occasionally back into the mouth.
An estimated 15-20% of people experience an episode of heartburn at least once a week, with all age groups affected. [1] Most people can manage their symptoms with antacid tablets and avoiding trigger factors, but some chronic (ongoing) cases will require treatment.
A condition in which stomach acid or contents come back up into the gullet, or esophagus.
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
An abnormal, backwards flow of fluid within the body.
Gastro-oesophageal reflux disease. GESA - Gastroenterological Society of Australia. Accessed 22 July 2014 from
When food is eaten, it travels from the mouth, through the esophagus to the stomach. The esophagus is a muscular tube, which is part of the digestive system and uses rhythmic muscular movements (peristalsis), along with gravity, to move food downwards.
Just before the food reaches your stomach, it must pass through a small band of muscles called your lower esophageal sphincter. When you eat, your esophageal sphincter relaxes and lets food pass through, down into your stomach and then closes again - much like a valve. During heartburn, the esophageal sphincter does not work properly, allowing stomach contents and/or acid to rise upwards, irritating the esophagus. In some cases, the stomach content and acid can travel up all the way to the back of the mouth.
A closed and open lower esophageal sphincter.
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
Risk factors for heartburn include:
A hiatus hernia is a condition in which part of your esophagus or stomach bulges into your chest cavity, through a gap in your diaphragm called your hiatus. This distorts the anatomy and can affect the lower esophageal sphincter, contributing to heartburn. This condition typically develops gradually over time, in adults. Heartburn may be the only symptom of a hiatus hernia.
Being overweight or obese (obesity) puts extra pressure on your esophageal sphincter, making it easier for acid reflux to occur. You are also more likely to experience heartburn as you get older.
Being pregnant can put a great deal of pressure on your digestive system, especially as you reach the final few months. Your growing womb pushes your stomach upwards and your esophageal sphincter relaxes, allowing acid reflux to occur.
You may find that certain fatty or spicy foods, chocolate, coffee and other caffeinated drinks, tomato products, peppermint, hot drinks and also alcohol may cause symptoms.
The chemicals released when you smoke relax your esophageal sphincter, making heartburn more likely.
Taking certain medications can make your heartburn symptoms worse either by relaxing your esophageal sphincter or irritating your esophagus. The most commonly implicated drugs are:
A group of drugs that prevent the loss of bone mass by reducing the normal turnover of bone. They are used to treat osteoporosis and other bone diseases.
A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.
A condition in which stomach acid or contents come back up into the gullet, or esophagus.
A type of hernia that occurs when there is a weakness or tear in the diaphragm, causing the upper part of the stomach, and rarely other abdominal contents, to protrude into the thorax.
Chemical compounds containing a particular chemical group made up of one nitrogen atom and three oxygen atoms. These can be used to dilate blood vessels and also as preservatives in food.
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
An abnormal, backwards flow of fluid within the body.
Also called a calcium antagonist. A group of medications that is used to treat high blood pressure and other conditions. It works by blocking calcium from entering cells of the heart and blood vessels, which ultimately lowers blood pressure.
1. A dome-shaped muscular membrane that separates the chest from the abdomen and is important for breathing. 2. A thin, dome-shaped cap that covers a woman's cervix and acts as a contraceptive device by preventing the male's sperm from accessing the egg.
This is an uncomfortable burning sensation, or pain, felt behind your breastbone (sternum) and lower chest usually after you have eaten. Lying down or leaning forwards makes it worse. The pain can often worsen late at night some hours after eating as lying down allows acid to reflux into the esophagus.
You may experience an acidic, unpleasant taste in your mouth or throat caused by stomach acid refluxing back into your esophagus. Sometimes you may regurgitate small amounts of undigested food and liquids back into your mouth.
You may feel sick, especially after eating, smoking, drinking or lying down soon after a meal.
This is also called water brash and is a common symptom of heartburn, due to the fact that saliva neutralizes regurgitated stomach acid.
You may find yourself constantly belching, often with an acidic aftertaste. Your abdomen may also feel bloated and uncomfortable.
You may develop a cough at night, or when you lie down, and feel as though you are having difficulty breathing. If you already have asthma, heartburn can irritate your airways and make symptoms worse. You may find your voice becomes hoarse or you get constant laryngitis (inflammation of your voice box).
You may experience pain (odynophagia) or difficulty swallowing (dysphagia). You might also feel as if something is stuck in your throat or behind your breastbone. These symptoms should be mentioned to your doctor as they can also be signs of other conditions.
In long-term cases, acid reflux can damage your tooth enamel and cause tooth decay.
Heartburn can occur in young children, as their esophagus is much shorter than an adults, which means it is easier for their stomach contents to be regurgitated (brought up). If your child often brings up food, cries while arching their back and is irritable after feeding, heartburn may be the cause. These symptoms can be caused by other conditions, so it is important to seek advice from your doctor if you are concerned. Keeping your child's head higher than the level of their stomach during feeding and afterwards may reduce the incidence of reflux.
The part of the body that lies between the chest and the pelvis.
A condition in which stomach acid or contents come back up into the gullet, or esophagus.
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
An abnormal, backwards flow of fluid within the body.
The process of destruction of the tooth’s surface due to the accumulation of bacterial plaque, which produces acids that break down the tooth structure. The decay forms dark patches on the teeth, which grow into holes or cavities and can become painful if left untreated.
The outer layer of the tooth. Typically 1-2mm thick, this is the whitest part of the tooth, forming a protective shell over the underlying dentine.
Your doctor can usually suspect heartburn by asking about your symptoms and taking a full medical history. Further testing may be required, such as:
Gastroscopy uses a thin, flexible tube containing a camera and light to view the internal lining of the esophagus, stomach and parts of the small intestine. You will usually be given light sedation to make you relax during the procedure. Often, you will be asked to fast for 12 hours prior to the test. Gastroscopy can accurately provide a detailed view of the esophagus and exclude other causes for the symptoms.
An esophageal manometry is a test designed to discover if your esophageal sphincter is functioning properly. It involves a tube being inserted through your nose into your esophagus and down into your stomach to measure the pressure of your esophageal contractions. It is usually only done in cases where surgery is being considered.
A barium swallow is a procedure in which you swallow a radioactive substance that will show up on an X-ray. This test is usually done to examine your pharynx and esophagus. It can assess the function of the esophageal sphincter.
This procedure is usually only offered if you still have symptoms after a course of treatment and a gastroscopy hasn't revealed the cause. It will monitor whether acid reaches your esophagus during a 24-hour period. A thin tube, which is attached to a device measuring acid levels, is inserted through your nose into your esophagus and left there for 24 hours. You will be asked to record all your reflux symptoms in a diary during this time. An alternative form of this procedure involves attaching a similar device to your esophagus via endoscopy. This device transmits its readings and then is excreted with your stool.
This test involves inserting a thin, flexible, lit tube (endoscope) into the intestines, via the rectum or the throat.
A condition in which stomach acid or contents come back up into the gullet, or esophagus.
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
The throat cavity behind the nose and mouth, above the esophagus.
An abnormal, backwards flow of fluid within the body.
A scan that uses ionizing radiation beams to create an image of the body’s internal structures.
In the majority of heartburn cases, dietary and lifestyle changes, along with medication, are the mainstays of treatment. Your doctor may advise the following changes before prescribing you any medications:
There are numerous medications available for heartburn:
Surgery is generally offered in severe cases of heartburn that haven't responded to lifestyle changes and other forms of treatment. Laparoscopic (keyhole) surgery is generally used to perform fundoplication, which is the gold-standard treatment. It involves wrapping the top of your stomach around the lower part of the esophagus to tighten up the esophageal sphincter. The surgery can be combined with other procedures, particularly treatment of a hiatus hernia, if present. Heartburn surgery is a major surgical procedure, which is performed under general anesthesia and involves several days in hospital. It carries the potential for severe complications, such as difficulty swallowing, damage to internal organs, and even failure of the procedure. Careful consideration and thorough discussion with your surgeon are recommended before embarking on any surgery.
Absorbent gel-like wound dressings.
A condition in which stomach acid or contents come back up into the gullet, or esophagus.
A type of hernia that occurs when there is a weakness or tear in the diaphragm, causing the upper part of the stomach, and rarely other abdominal contents, to protrude into the thorax.
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
Medications that inhibit or reduce the activity of proton pumps (proteins that move protons, or hydrogen atoms, across cell membranes in the body). These medications can be used to reduce the production of gastric acid in order to treat peptic ulcers and heartburn.
An abnormal, backwards flow of fluid within the body.
While the majority of cases tend to improve with lifestyle changes and medications, if not adequately treated, heartburn can lead to damage to the lining of the esophagus. The lining of the esophagus is not designed to cope with persistent exposure to stomach acid, so it can lead to the following conditions:
You may develop ulcers in your esophagus, due to constant irritation from acid. These can cause pain, bleeding and make swallowing uncomfortable. Sometimes these ulcers can bleed, but you may not realize it, as it can be subtle, or lead to dark stools (rather than the typical blood stained stools). A simple stool test can detect the presence of any unseen blood in your stool. Antacids can be taken to reduce your stomach acid and alginates can be taken to relieve the symptoms.
Barrett's esophagus only occurs after repeated bouts of acid reflux, which change the type of cells that grow in your lower esophagus. It is more common if you are between 50-70 years of age. This condition carries a higher risk for esophageal cancer, but your doctor can arrange regular monitoring to help prevent this.
This is heavily linked to Barrett's esophagus. If caught early enough, this type of cancer can usually be treated.
If you have the following, you have a higher risk of developing esophageal cancer:
After repeated exposure to stomach acid, your esophagus can become form scar tissue. This can cause stricture, or narrowing of the esophagus, making it difficult for food to pass down to the stomach. Typical symptoms include difficulty swallowing, regurgitation and heartburn.
Repeated episodes of heartburn can leave your throat feeling hoarse and irritate your vocal cords. If stomach acid is inhaled into your lungs, it can cause aspiration pneumonia and symptoms similar to asthma. If acid continues to enter the lungs, it can cause damage resulting in permanent complications, such as bronchiectasis or pulmonary fibrosis.
Absorbent gel-like wound dressings.
A condition in which the airways are damaged and become dilated, losing their ability to clear mucous.
The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.
A condition in which stomach acid or contents come back up into the gullet, or esophagus.
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
A respiratory disease in which scar tissue forms in the lung tissues, sometimes as a result of other lung diseases.
An abnormal, backwards flow of fluid within the body.
An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.
An inflammation of the lungs and airways as a result of inhaling foreign material such as food, saliva or vomit.
Many cases of heartburn respond well to lifestyle changes and medications. If you experience recurrent heartburn, it is important to talk to your doctor, rather than simply endure the symptoms.
Maintaining a healthy body weight, not smoking, and avoiding pressure on the abdomen, such as wearing tight clothing or leaning over soon after eating, may help to prevent heartburn.
The part of the body that lies between the chest and the pelvis.