Heartburn

What is heartburn?

Heartburn is a type of indigestion. It occurs when acid in your stomach flows back up your oesophagus (food pipe), which runs from your stomach to the back of your throat. This acid irritates the lining of your oesophagus causing the pain known as heartburn.


What are the symptoms of heartburn?


Symptoms may include a burning sensation in the centre of your chest which travels up towards your throat, a taste of acid at the back of your throat, and small bits of food re-entering your mouth.

The symptoms usually start after meals and get worse when you bend over or lie flat. Heartburn may get worse at night when you are lying down and may improve after belching or drinking milk.

You may find it painful to swallow some types of food and drink, particularly hot drinks and spicy foods.


Why do people get heartburn?


There is a muscle at the bottom of your oesophagus which acts as a valve and keeps food and acid in the stomach. If there is a lot of pressure on your stomach (eg, if you are pregnant, wear tight clothes or a belt, if you bend over, or if you are overweight) acid may be forced up through this valve into your oesophagus. The medical term for this is gastro-oesophageal reflux disorder (GORD).

If your stomach becomes too full (eg, if you eat a large meal or drink large amounts of beer) this can also push acid up through the valve into your oesophagus.

When acid touches the lining of your oesophagus it will burn and cause you pain. This is because the lining of the oesophagus is not as tough as the lining of the stomach. Spicy foods and hot drinks can make this pain worse.

Smoking can cause the valve to work less effectively and increase the amount of acid produced in the stomach.

Once the acid is in your oesophagus it may cause damage to the lining, which over a period of time can make swallowing difficult.


Will I need any tests?


A diagnosis can usually be made from your symptoms alone. If your doctor is not sure of the exact diagnosis, or your symptoms do not get better with treatment, you may be referred to a hospital specialist for tests.


There are two main hospital tests:

  • Barium swallow - this is where you swallow a white liquid that can be seen on an x-ray as it passes through your digestive system. This will show up any acid reflux and help to rule out other medical problems such as stomach ulcers.
  • Endoscopy - this is a procedure in which a fibre-optic tube which relays images to a video camera is passed through the mouth down into the stomach. This allows the doctor to examine your oesophagus and stomach. The doctor may take a sample (biopsy) from the lining of your oesophagus or stomach for laboratory tests.

What treatment is available?

The most important treatment is for you to change your lifestyle (see below). In addition there are several different types of medicine that can help heartburn:

  • Medicines which neutralise any excess acid are known as antacids and contain aluminium hydroxide, calcium carbonate, magnesium salts or sodium bicarbonate; most will contain a combination of two or more of these ingredients. Many antacids will also contain alginates (see below) or a medicine called simeticone, which helps gas bubbles in the stomach to join together and be expelled

  • Medicines that float on the top of the stomach contents and stop acid reflux are known as alginates. Medicines containing alginate compounds include Acidex®Gaviscon® and Peptac®

  • Medicines that reduce the amount of acid produced by the stomach. There are two groups of medicines that have this effect: H2-antagonists and proton pump inhibitors. H2-antagonists include cimetidine (eg, Tagamet®), famotidine, nizatidine and ranitidine (eg, Zantac®). Proton pump inhibitors include esomeprazole (eg, Emozul®, Nexium®), lansoprazole (eg, Zoton FasTab®), omeprazole (eg, Losec®), pantoprazole and rabeprazole (Pariet®)

Surgery is only needed if the valve mechanism is damaged and treatment has not stopped the symptoms.

Help yourself

  • If you smoke, try to stop - cutting down is not enough
  • If you are overweight, try to reach your ideal body weight. Heartburn often stops when your weight is back to normal
  • Avoid very large meals and do not drink more than the recommended amount of alcohol (14 units per week [spread over three or more days] with two or more drink-free days each week. One unit = 1/2 pint of average-strength beer [approximately 250mL]; 1/2 glass of wine [76mL]; 1 standard pub measure of spirits [25mL]).
  • Avoid spicy foods, hot drinks and fruit juice
  • Drink low-fat milky drinks
  • Avoid aspirin and drugs like ibuprofen if possible, as they may aggravate heartburn
  • Sit upright for about an hour after eating. Try to eat a few hours before going to bed
  • Raise your bed-head by four to six inches (use bricks, books, or blocks) or sleep with three pillows
  • Avoid tight clothing or belts around your stomach
  • Squat or kneel to avoid bending and stooping

Further information available from:

CORE
3 St Andrews Place
London NW1 4LB
Tel: 020 7486 0341
Email: info@corecharity.org.uk  
Internet: www.corecharity.org.uk


Fact sheet provided by MIMS


Date last reviewed: October 2014


MIMS Clinics

Prescribing news and resources for key therapeutic areas, collated by the MIMS editors.

Register or Subscribe to MIMS

GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! If you're not a GP, you can subscribe to MIMS for full access.

Register or subscribe

MIMS bulletins

News and updates straight to your inbox.

Prescribing Update: Fortnightly news bulletin
Alert:
Urgent prescribing updates
Spotlight: Disease-themed monthly round-up

Sign me up

MIMS Dermatology

Read the latest issue online exclusively on MIMS Learning.

Read MIMS Dermatology

Mobile apps

MIMS: access the full drug database and quick-reference tables on the go

MIMS Diagnosis and Management: concise information on signs and symptoms, investigations and diseases

Promo Image

Clinical calculators

Handy calculators and conversions for primary care.