If you experience burning in your chest after eating, you may have heartburn. A number of conditions can lead to heartburn or make it worse.
7 most common cause(s)
Symptoms of heartburn
You've just turned in for the night and are starting to relax, but then you feel a burning sensation in your chest. You sit up, and it seems to get better. But as soon as you lay back down, the pain comes back. If you've experienced this before, you can credit the burning and discomfort to heartburn. Heartburn occurs when stomach acid travels up into your esophagus and burns its lining.
Common accompanying symptoms
If you're experiencing heartburn, it's also likely to experience:
- Burning sensation in the chest: Located behind the breastbone
- Discomfort that typically presents itself after eating
- Chest pain or pressure: Often behind the breastbone
- Burning in the throat
- Strange taste(s): Such as sour, acidic, or salty fluid toward the throat
- Feeling as if food is stuck in your throat
- Regurgitating food or frequent burping
If you only occasionally experience heartburn symptoms, you aren't alone, and probably don't need to worry about an underlying medical issue. If you're battling heartburn daily or close to it, you should see a physician.
Causes of heartburn
The following details may help you better understand your heartburn symptoms. You should see a physician for persistent or worsening heartburn and a proper diagnosis.
Environmental causes
You may be experiencing heartburn due to lifestyle habits or certain events.
- Stress: If you find yourself under tremendous amounts of stress on a regular basis, heartburn can begin to occur frequently, even if you've never experienced it before.
- Eating habits: Eating spicy food, garlic, citrus, deep-fried or fatty foods, onions, tomatoes, tomato sauce, pizza, or chocolate can cause heartburn. Drinking tomato juice, citrus juice, caffeinated beverages, carbonated beverages, or alcohol can also lead to heartburn. Heartburn is more likely if you eat right before bed, have midnight snacks, or eat after drinking alcohol.
- Being overweight: Obesity causes a variety of issues, including heartburn.
- Smoking: This is a huge cause of frequent heartburn symptoms.
Medical causes
Heartburn may be related to other medical conditions, such as the following.
- Acid reflux disease: Acid reflux can be caused by anatomic issues in the stomach and esophagus, such as a hiatal hernia. This happens when the upper portion of the stomach moves up into the chest and allows stomach acid to easily enter the esophagus. This is usually caused by dysfunction in the sphincter, or muscle that prevents the contents of the stomach from moving back into the esophagus.
- Peptic ulcer disease: Heartburn is a common issue in people with ulcers.
- Pregnancy: Heartburn is a common symptom of pregnancy. Though annoying, it usually disappears immediately after giving birth.
- Heart disease or heart attack: Sometimes people feel they have heartburn, when in fact its a heart attack. If you are having chest pain, this needs immediate medical attention.
This list does not constitute medical advice and may not accurately represent what you have.
Indigestion (dyspepsia)
Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.
Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.
The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.
Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.
Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.
For functional dyspepsia – "ordinary" indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.
Rarity: Common
Top Symptoms: nausea, stomach bloating, dyspeptic symptoms, bloating after meals, vomiting
Symptoms that always occur with indigestion (dyspepsia): dyspeptic symptoms
Symptoms that never occur with indigestion (dyspepsia): vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever
Urgency: Self-treatment
Stomach ulcer
A peptic ulcer or gastric ulcer is an open sore that forms when inflammation occurs in the stomach lining.
This stomach inflammation is caused by the bacteria Helicobacter pylori (H. pylori) and by prolonged use of pain relievers such as ibuprofen or aspirin. Chronic inflammation allows acid to damage the stomach lining and an ulcer may form.
Smoking, drinking alcohol, stress, and spicy foods may aggravate ulcers, but do not cause them.
Symptoms include burning pain in the stomach; heartburn; nausea; and bloating.
The pain may be worse between meals or at night. Antacids will only work for a short time. There may be dark red blood in the vomit or stools.
Left untreated, ulcers may bleed and cause anemia. They may perforate the stomach and cause peritonitis (serious infection of the abdominal cavity.)
Diagnosis is made through physical examination and by testing breath and stool for H. pylori. Endoscopy is sometimes used.
Treatment involves a course of antibiotics to kill the bacteria, and medication to block excess acid and heal the stomach.
Spasm of the esophagus
The esophagus is the muscular tube that passes behind the heart, and carries food, liquid, and saliva from the mouth to the stomach. In a condition called diffuse esophageal spasm (DES), the tube contracts uncontrollably, causing trouble swallowing and chest pain.
You should visit your primary care physician if the pain you are experiencing is severe. Some prescription medications (such as trazodone and calcium channel blockers) may help.
Rarity: Ultra rare
Top Symptoms: dry cough, deep chest pain, behind the breast bone, heartburn, trouble swallowing, burning chest pain
Symptoms that never occur with spasm of the esophagus: shortness of breath
Urgency: Primary care doctor
Normal abdominal pain
The complaint of abdominal pain and discomfort, with no apparent cause, is one of the most common in medicine. It is a primary reason for patients to visit a medical provider or the emergency room.
The cause of abdominal pain can be difficult to find, because it can just be a completely normal abdominal pain or come from many different sources: the digestive tract, the urinary tract, the pancreas, the gall bladder, or the gynecologic organs.
The pain may simply be caused by overly sensitive nerves in the gut. This hypersensitivity can occur after repeated abdominal injury and/or it may have an emotional cause due to fear of the pain itself.
Diagnosis is made through physical examination, patient history, and simply ruling out any other condition. CT scan is often requested, but can rarely find a specific cause. The benefits must be weighed against the risks of radiation.
Treatment first involves making any needed lifestyle improvements regarding diet, exercise, work, and sleep, in order to reduce stress. In some cases, counseling, hypnosis, mild pain relievers, and antidepressants are helpful.
Irritable bowel syndrome (IBS)
Irritable bowel syndrome is commonly known as IBS. Normally, the muscles of the colon, or large intestine, contract and relax to push food along. It's thought that in IBS, the muscles randomly contract either too strongly or too weakly and therefore cause alternating bouts of diarrhea or constipation.
The exact cause is not known. Food allergy/intolerance; stress; hormonal imbalance; and infection or bacterial overgrowth in the colon may play a role, as well as an overly sensitive gastrointestinal nervous system.
Pre-menopausal women who suffer from depression or lead very stressful lives may be most susceptible.
Symptoms vary among individuals, and often come and go. These include abdominal pain and cramping; bloating; gas; diarrhea; and constipation. IBS is not associated with serious illness such as cancer, but symptoms may interfere with quality of life.
Diagnosis is made through patient history, physical examination, and ruling out any other cause. Imaging may also be done.
Treatment begins with improved diet and stress management. Antibiotics, antidepressants, and other medications may be attempted.
Functional dyspepsia/indigestion
Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.
Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.
The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.
Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.
Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.
For functional dyspepsia – "ordinary" indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.
Rarity: Common
Top Symptoms: stomach bloating, nausea, dyspeptic symptoms, bloating after meals, vomiting
Symptoms that always occur with functional dyspepsia/indigestion: dyspeptic symptoms
Symptoms that never occur with functional dyspepsia/indigestion: vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever
Urgency: Primary care doctor
Barrett's esophagus
Barrett esophagus is a condition in which the tissue lining the esophagus changes. These changes occur after longstanding gastro-esophageal reflux. Symptoms of gastro-esophageal reflux can be regurgitation, heartburn. Barretts esophagus is associated with a risk of developing malignant esophageal disease.
You should visit your primary care physician to discuss these symptoms and if screening for this condition is useful. Your doctor will likely advise you to start preventive actions if you are at risk of developing Barretts esophagus. These actions usually include life style adjustments and medications.
Rarity: Common
Top Symptoms: nausea, regurgitation, heartburn, sore throat, dry cough
Urgency: Primary care doctor
Autoimmune inflammation of the esophagus
This condition, officially known as eosinophilic esophagitis, occurs when a certain type of white blood cell (eosinophil) builds up in the lining of the tube that connects the mouth to the stomach. The buildup leads to inflammation of the tissue, causing pain and difficulty swallowing.
You should visit your primary care physician to treat this condition. This is an immune disorder and is commonly treated with corticosteroids.
Acid reflux disease (GERD)
Gastroesophageal reflux disease is also called GERD, acid reflux disease, and heartburn. It is caused by a weakening in the muscle at the end of esophagus. This allows stomach acid to flow backward, or reflux, up into the esophagus.
Risks factors for GERD include obesity, smoking, diabetes, hiatal hernia, and pregnancy.
Symptoms include a painful burning sensation in the chest and throat, and sometimes difficulty swallowing.
If heartburn occurs more than twice a week, a doctor should be consulted. If symptoms are accompanied by jaw or arm pain, and/or shortness of breath, these may be signs of a heart attack and constitute a medical emergency.
Repeated exposure to stomach acid damages the lining of the esophagus, causing bleeding, pain, and scar tissue.
Diagnosis is made by patient history and sometimes by x-ray, upper endoscopy, or other tests to measure refluxed acid.
Treatment begins with over-the-counter antacids and lifestyle changes. Medication may be used to reduce stomach acid, and surgery may be done to strengthen the sphincter muscle at the lower end of the esophagus.
Achalasia
Achalasia is a disorder of the esophagus, the tube that carries food from the mouth to the stomach. This condition affects the ability of the esophagus to move food into the stomach.
You should visit your primary care physician within the next 24 hours, where imaging and exploration of your swallowing issues can be fully worked up. With diagnosis, treatment is typically surgical and outcomes are good.
Rarity: Ultra rare
Top Symptoms: pain below the ribs, regurgitation, unintentional weight loss, heartburn, deep chest pain, behind the breast bone
Urgency: Primary care doctor
Heartburn treatments and relief
At-home treatments
You can try the following lifestyle changes to help combat heartburn symptoms.
- Eat smarter: Avoid eating at least three hours before bed, decrease the size of your portions or eat smaller portions throughout the day, and don't eat too quickly. Limit or remove acidic foods and drinks from your diet, especially alcohol.
- Lose weight: This will help your health and lessen heartburn.
- Quit smoking: This helps a variety of health issues, including heartburn.
- Raise the head of your bed: Try sleeping on your left side or with your head elevated. You can either raise the edge of your bed on cinder blocks or use pillows.
- Medication: There are both prescription and over-the-counter medications that can help prevent heartburn. Antacids can provide almost immediate relief. Proton pump inhibitors and H2 blockers are for more chronic symptoms.
- Baking soda: Baking soda can neutralize stomach acid. Try mixing a teaspoon of baking soda in a glass of water and drinking it as soon as symptoms begin.
When to see a doctor
If you're experiencing any of the following heartburn symptoms, it's time to schedule an appointment with your doctor.
- Your heartburn symptoms increase in frequency and severity
- You have trouble swallowing liquids or solids
- Your heartburn sometimes causes you to vomit
- You begin to lose weight unintentionally
- You rely on antacids for more than two weeks on a consistent basis
- Heartburn medication does not seem to help
FAQs about heartburn
Can stress cause heartburn?
Stress is one of the major risk factors for heartburn and can actually make heartburn worse. Some believe that daily stress can alter your threshold for pain, making you more sensitive. Some studies also show that stress can exacerbate the damage acid does to the esophagus.
How to know if you have heartburn?
Heartburn often presents in the form of chest pain, regurgitation (acidic material mixed with small amounts of undigested food), and difficulty swallowing. Sometimes it also triggers cough and the sensation of having a lump in the throat.
What causes frequent heartburn?
One common cause of frequent heartburn is a weak or relaxed lower esophageal sphincter (LES), a circular ring of muscle of the esophagus that prevents the backup of stomach content into the esophagus. If the diaphragm muscle is too weak, the stomach can also partially slip through the diaphragm into the chest (hiatus hernia), making acid reflux more likely. Obesity and pregnancy are common contributing factors.
What does heartburn look like?
Acid reflux is when the acid that is normally in the stomach backs up into the esophagus, the tube that carries food from the mouth to the stomach. A small amount of acid reflux is normal. If the reflux happens frequently, it can give the sensation of heartburn as a result of irritation to the esophageal lining.
What does heartburn feel like when pregnant?
Heartburn occurs in 30–50% of pregnancies as the esophageal sphincter become more lax than usual. It can present as a burning sensation in the chest and/or throat, an acid taste in the mouth, stomach or chest pain, nausea/vomiting, trouble swallowing, a raspy voice or sore throat, or a cough.
Questions your doctor may ask about heartburn
- Do you burp up food or liquids after a meal?
- Have you experienced any nausea?
- Do you currently smoke?
- What is your body mass?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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References
- Heartburn. U.S. National Library of Medicine: MedlinePlus. Updated December 6, 2018. MedlinePlus Link.
- Naliboff BD, Mayer M, Fass R, et al. The effect of life stress on symptoms of heartburn. Psychosom Med. 2004;66(3):426-434. NCBI Link.
- Diet changes for GERD. IFFGD. Updated November 7, 2017. IFFGD Link.
- Smoking and the digestive system. National Institute of Diabetes and Digestive and Kidney Diseases. Published September 2013.
- Hiatal hernia. U.S. National Library of Medicine: MedlinePlus. Updated April 30, 2018. MedlinePlus Link.
- Warning signs of a heart attack. American Heart Association. Updated June 30, 2016. AHA Link.
- Gerson LB. Treatment of gastroesophageal reflux disease during pregnancy. Gastroenterol Hepatol (N Y). 2012;8(11):763-4. NCBI Link.