Heartburn is a burning feeling behind the breastbone. Stomach acid and food back up from the stomach into the esophagus. It irritates the lining of the esophagus. The pain is often worse after eating, in the evening, or when lying down or bending over.
Heartburn that occurs often and gets in the way of day-to-day life may be gastroesophageal reflux disease (GERD). It can damage your esophagus. GERD can also cause Barretts esophagus, a change in the cells that can lead to cancer.
A muscular ring controls the opening between the esophagus and the stomach. It relaxes to let food pass into the stomach. Then it closes shut to keep stomach acid and food in the stomach. If the ring does not close completely, stomach acids can escape up into the esophagus. The acid irritates the esophagus and causes heartburn. There are a number of reasons that the ring may not close tightly including:
Problems with the nerves that control the muscles of the ring
Problems with muscle tone of the ring
Muscles that move food down into the stomach are weak
Abnormal pressure on the area
Increased relaxation of the muscles
Increased pressure within the abdomen—pushes up against the stomach
Make an appointment to see your doctor if you have heartburn 2 or more times a week, every week.
The doctor will ask about symptoms and past health. Heartburn or GERD will be suspected based on your symptoms. Your doctor may do a trial with medicine. If your symptoms are managed with medicine it will confirm GERD.
Further testing is not always needed.
Your doctor may order the following to better plan treatment:
Elevate head of bed 6 to 8 inches. It may relieve heartburn at night.
Medicine may help relieve symptoms. Some can also help to repair damage. They can treat heartburn that has started or may help stop heartburn from starting. Many heartburn medicines are available over-the-counter such as:
Talk to your doctor about which ones may be best for you. Some should only be used for short periods of time.
Heartburn that is severe or does not respond to treatment may need surgery. Options include:
The most common surgery for GERD is
fundoplication. The doctor wraps the stomach around the esophagus. This helps to keep the opening to the stomach closed.
Endoscopic Antireflux Procedures
There are a number of procedures that can be done with an endoscope. The scope passes through the mouth to the stomach to complete procedures. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach. It will help to tighten the opening to the stomach.
LINX Reflux Management System
LINX is a small band with magnetic beads. A surgeon places the band around the end of the esophagus where it meets the stomach. The magnets pull together to help close the opening. Swallowed food or drink push apart the beads so that it can move into the stomach.
Some people will be able to stop or reduce medicine after surgery.
Acid reflux (GER & GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults. Accessed January 26, 2021.
Gastroesophageal reflux disease (GERD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Accessed January 26, 2021.
Heartburn. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/heartburn/. Accessed January 26, 2021.
Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp#.WsUYIy7wZQJ. Accessed January 26, 2021.
4/25/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD: Shimamoto T, Yamamichi N. No association of coffee consumption with gastric ulcer, duodenal ulcer, reflux esophagitis, and non-erosive reflux disease: A cross-sectional study of 8,013 healthy subjects in Japan. PLoS One. 2013;8(6):e65996.
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