Approved factsheet on heartburn @ 17 April 2001 with Dr. Butt comments

What is heartburn?
Heartburn is a type of indigestion that occurs when acid from the stomach passes up into the oesophagus (the tube that leads from the mouth to the stomach - sometimes called food pipe or gullet). This is also known as acid reflux. Most people will experience acid reflux at some point in their lives.

What causes heartburn?
Heartburn typically comes on after eating a large or spicy meal or drinking a lot of alcohol or fizzy drinks. Some people get heartburn when they bend over or lie down. Stress can also be a trigger. The frequency of acid reflux or heartburn varies from one person to another.

What are the symptoms of heartburn?
The typical symptoms of heartburn may be a burning pain in the chest, bitter acid taste in the back of the throat, or a feeling like you need to burp or swallow.

How does stomach acid get into the oesophagus?
At the lowest part of the oesophagus where it joins the stomach, there is a ring of muscle (sphincter). This muscle acts as a one-way valve, so food and drink can flow down into the stomach, but should not be able to flow back up.

If this one-way valve does not work properly, the acid from the stomach will be able to pass up into the oesophagus. This is more likely if the stomach contains large amounts of food or fluids - especially if they are spicy, fatty or alcoholic - or if there is something pressing on the stomach. Smoking also reduces the tightness of this muscle.

What are the triggers for heartburn?
There are many potential triggers for heartburn including:

• Large meals
• Exercise soon after eating
• Alcohol
• Being overweight
• Caffeine in tea or coffee
• Pregnancy
• Smoking
• Constipation
• Fizzy drinks
• Hiatus hernia
• Stress
• Fatty or spicy foods, e.g. fried food, curries
• Lying down or bending down
• Acidic drinks or food, such as oranges, lemons or tomatoes
  

What can you do to help yourself when you have heartburn?

• Avoid spicy, fatty and/or large meals, especially near bedtime
• Try to cut down on tea, coffee & fizzy drinks
• Avoid drinking too much alcohol
• Stop smoking
• Try eating in a calm, unhurried environment, allowing time to enjoy meals
• If you get heartburn at night, try using an extra pillow, or putting a couple of books under the legs at the head of the bed (it's harder for the acid to flow uphill)
• There are many medicines available over-the-counter, which work very effectively for the relief of heartburn. You should ask their pharmacist for advice.

When should further advice be sought?
Heartburn is common and is generally nothing to worry about, but in some situations you should make sure your symptoms are not something more serious. If you have heartburn, you should ask your pharmacist for further advice if you:

• are over 45 or under 16;
• are pregnant (there are products specifically designed for heartburn during pregnancy);
• symptoms last for more than a week;
• symptoms occur more than twice a week;
• symptoms don't disappear with medication, or reappear when you stop taking medication;
• have difficulty swallowing or a feeling of food sticking in your throat when you swallow;
• have shortness of breath, wheezing or coughing;
• have a bitter taste in your mouth;
• have a persistent sore throat or ear ache;
• have severe pain in your back, chest or neck;
• are vomiting or passing blood;
• are experiencing unexpected weight loss;
• symptoms suddenly change - become more painful, spread across your chest or become more frequent;
• have previously had gastric surgery, a gastric ulcer, gastro-intestinal bleeding, or you have anaemia;
• have been taking other medication, especially non-steroidal anti-inflammatory drugs (sometimes called NSAIDs for short) such as aspirin or ibuprofen; or
• are worried about your symptoms.