heartburn

Heartburn is a burning or uncomfortable sensation behind the breastbone that occurs when stomach acid backs up into the esophagus. It is the most common symptom of gastroesophageal reflux and can occur after meals, when bending over, or when lying down. Occasional heartburn is common, but frequent or severe symptoms may indicate gastroesophageal reflux disease (GERD).

Causes and contributing factors involve the reflux of stomach contents into the esophagus due to a temporarily or chronically relaxed lower esophageal sphincter. Triggers can include large or fatty meals, spicy or acidic foods, chocolate, caffeine, alcohol, tobacco, obesity, pregnancy, and certain medications (such as nonsteroidal anti-inflammatory drugs or some blood pressure drugs). Hiatal hernia and stress may also play a role. Symptoms may include a burning sensation in the chest, regurgitation of sour liquid or bitter taste, chest discomfort, and sometimes coughing, hoarseness, or difficulty swallowing.

Diagnosis is usually based on symptom history. Further testing, such as endoscopy, pH monitoring, or esophageal manometry, may be used if symptoms are persistent, severe, or associated with complications or red flags.

Treatment emphasizes lifestyle changes and medications. Lifestyle measures include avoiding trigger foods, eating smaller meals, not lying down soon after eating, weight management, and elevating the head of the bed. Over-the-counter antacids, H2 receptor antagonists, and proton pump inhibitors are commonly used. In resistant cases, surgical interventions such as fundoplication may be considered.

Seek medical attention for chest pain with other heart attack symptoms, vomiting blood, unintended weight loss, trouble swallowing, or symptoms persisting despite appropriate therapy.