Heartburn is a burning discomfort in the chest or throat that results when harsh stomach acid comes into contact with and irritates the delicate lining of the esophagus , the tube-like structure that connects the mouth to the stomach. The exact symptoms and sensations of heartburn vary from person to person, but its most common symptom is often described as a burning or vague feeling of discomfort in the chest just behind the breastbone.

What does heartburn feel like?

The symptoms of heartburn vary widely and can be difficult to describe. However, people with heartburn generally describe one or more of the following symptoms:

What causes heartburn?

Juices that are produced by the stomach to help the body break down food contain an acid called hydrochloric acid . While the stomach is naturally protected from this potent acid, the esophagus does not share the same protective qualities as the stomach.

Heartburn is caused when this stomach acid refluxes —or flows backward—into the esophagus. This generally occurs when the lower esophageal sphincter ( or the LES )—the natural valve that keeps stomach acid in the stomach and out of the esophagus —does not do its job properly.

When functioning normally, the LES opens like a door that allows food into the stomach but not back up the same way. However, at times the LES relaxes and allows stomach acid flow upward into the esophagus. This relaxation exposes the esophagus to the acid from the stomach and often results in the sensation known as heartburn.

Various lifestyle and dietary factors as well as certain medications can contribute to heartburn by increasing the relaxation of the LES, increasing the amount of acid produced in the stomach, increasing stomach pressure, or making the esophagus more sensitive to acid. These triggers vary from person to person. The most common contributing factors include the following:

Eating/Dietary Habits

• Eating foods such as citrus fruits, chocolate, peppermint, spearmint, tomatoes or tomato-based products, raw onions, garlic, black pepper, vinegar and fatty or spicy foods. Foods that are fatty or greasy slow down digestion, which means that acid and food are in the stomach longer. This gives the acid a greater opportunity to move backwards into the esophagus. In addition, some foods, such as peppermint, spearmint and chocolate cause the LES to loosen or relax thus allowing acid to enter the esophagus.
• Drinking beverages such as coffee, citrus juices, and caffeinated, carbonated or alcoholic beverages. Beer and beverages with caffeine such as coffee, tea and cola raise the level of acidity in the stomach, making stomach juices even more irritating. Citrus juices, spicy foods and tomato products directly irritate the esophagus.
• Eating large portions — your stomach responds to large portions by producing large amounts of acid at one time. More stomach acid means a greater chance of acid reflux.
• Eating before bedtime — acid levels are high after mealtime .

Certain positions

Episodes of heartburn can also be precipitated by body position, certain movements, and/or exertion, such as lying down, bending over or strenuous exercise. One of the defense mechanisms limiting the reflux of gastric acid is gravity. In the upright position, gravity tends to prevent gastric contents from moving upward into the esophagus. When the body position is altered, the protective effect of gravity may be reduced. Lying down tends to decrease the effects of gravity. Bending over can also decrease the effects of gravity and increase abdominal pressure, increasing the potential for acid reflux.

Medical reasons Talk to your health care professional if you have any of the following conditions or if your medications may be contributing to your heartburn. Ask about alternatives, but never stop taking any prescription medication without checking with your doctor.

• Gastroesophageal reflux disease (GERD)
• Pregnancy — Hormones (progesterone) produced during the first trimester of pregnancy can loosen the LES. In addition, as the body makes room for the growing baby, organs such as the stomach become pushed up into the abdominal cavity and increase the pressure on the LES. This increased pressure often results in acid reflux. If you're pregnant, consult your physician before taking any medication.
• Hiatal Hernia — When a hiatal hernia is present, part of the stomach is located in the chest rather than in the abdomen where it belongs. A hiatal hernia does not cause symptoms itself, but is often associated with a weak LES muscle and with acid reflux.
• Taking certain medications — some prescription and over-the-counter (OTC) medications can contribute to heartburn. These commonly include high blood pressure and heart medications. Asthma medications can both lower LES pressure and stimulate acid production contributing to heartburn. Antibiotics can be irritating to the esophagus.

Lifestyle habits

• Being overweight — excess weight increases abdominal pressure and increases pressure on the LES. Studies have shown that even moderate weight loss can reduce symptoms.
• Smoking cigarettes, cigars or pipes — Smoking inhibits saliva, one of the body's natural protective barriers against damage to the esophagus. Smoking also may stimulate acid production and weaken the important valve that prevents stomach acid from entering the esophagus.
• Certain types of exercise/ body positions — certain types of exercise that increase abdominal pressure can aggravate heartburn symptoms.
• Exercises that require you to be upright and "bounce" against gravity, such as jogging, aerobics or rope jumping. Bouncing jostles the contents of your stomach and can cause acid to back up into the esophagus.
• Lifting heavy objects or performing weight-bearing exercises. Tensed (clenched) stomach muscles are likely the cause.
• Sit ups or curls increase the pressure in the abdomen and may increase reflux of acid into the esophagus.
• Wearing restrictive clothing — Tight clothing can promote reflux of acid contents. Reduce abdominal pressure by not wearing tight belts or binding clothing.

How can I tell the difference between heartburn and a heart attack?

The pain caused by heartburn and heart attack can be so severe that both patients and doctors have a difficult time distinguishing one from the other. In fact, sophisticated equipment is generally necessary to determine whether patients are suffering from a heart attack or not. To complicate matters even more, the two problems share many of the same symptoms and are more likely to occur in people over forty.

If you have any chest pain that lasts for more than a few minutes—or any warning signs of a heart attack—seek immediate medical attention. However, here are some possible differences between the two ailments.

Angina or Heart Attack

• A feeling of fullness, tightness or dull pressure or pain generally in the center of the chest
• Pain may spread to the shoulders, neck, or arms
• Often responds quickly to nitroglycerin, a heart medication (unresponsiveness to nitroglycerin in the presence of angina or heart attack symptoms should be treated as a medical emergency)
• May be accompanied by a cold sweat
• Might experience lightheadedness, weakness or dizziness
• Shortness of breath
• Nausea and possible vomiting

See your doctor if you experience any warning signs of a heart attack.

Heartburn

• A sharp, burning sensation just below the breastbone or ribs
• Pain generally does not radiate to the shoulders, neck, or arms, but it can
• Pain usually comes after meals
• Symptoms usually respond quickly to antacids
• Rarely accompanied by a cold sweat, lightheadedness or dizziness

Is heartburn serious?

If heartburn is severe or persistent and does not respond to medication, it could be a symptom of a more serious condition called gastroesophageal reflux disease or GERD . If left untreated, GERD can cause or contribute to a wide range of problems. Fortunately, many of these complications can be avoided with proper monitoring from a health care professional.

Besides medications, what might help relieve symptoms?

• Avoid common trigger foods and beverages. Foods that are fatty or greasy slow down digestion, which means that acid and food are in the stomach longer. This gives the acid a greater opportunity to move backwards into the esophagus. In addition, some foods, such as peppermint, spearmint and chocolate cause the LES to loosen or relax, thus allowing acid to enter the esophagus. Beverages containing caffeine such as coffee, tea and cola raise the level of acidity in the stomach, making stomach juices even more irritating. Alcoholic beverages, citrus juices, spicy foods and tomato products directly irritate the esophagus.
• Decrease the size of portions at mealtimes — your stomach won't need to produce as much acid as with a big meal, and less acid mean less chance of acid reflux.
• Eat meals at least 2-3 hours before lying down — the added time will give your acid levels a chance to decrease before putting your body in a position where heartburn is more likely to occur.
• Check with your doctor to see if one of the medications you are taking might be triggering your heartburn. Some prescription and over-the-counter medications can contribute to heartburn. These commonly include high blood pressure and heart medications. Asthma medications can both lower LES pressure and stimulate acid production contributing to heartburn. Some antibiotics can be irritating to the esophagus. Talk to your doctor about alternatives if you suspect one of your medications may be contributing to your heartburn, but never stop taking any prescription medication without checking with your doctor.
• Avoid exercises that require you to be upright and "bounce" against gravity, such as jogging, aerobics or rope jumping. Bouncing jostles the contents of your stomach and can cause acid to wash back up into the esophagus. Tensed or clenched stomach muscles during weight-bearing exercises can increase abdominal pressure and increase reflux of acid into the esophagus.
• Try not to eat one to two hours before, during or just after exercise.
• If you are overweight or obese, try to lose weight through a safe and realistic weight loss plan — Extra pounds can increase heartburn incidence. Some heartburn sufferers find their symptoms improve by losing weight. Studies have shown that even moderate weight loss can reduce symptoms a great deal.
• Stop or cut down on smoking — Cigarette smoking inhibits saliva, one of the body's natural protective barriers against damage to the esophagus. Smoking also may stimulate acid production and relaxes the important valve that prevents stomach acid from entering the esophagus.
• Elevate the head of your bed four to six inches using blocks — this method uses gravity to help prevent acid from creeping up the esophagus while you are lying down.
• Try sleeping on your left side — some studies indicate this helps with digestion and the removal of acid from your stomach more quickly.
• Don't wear tight belts or binding clothing — tight garments can increase abdominal pressure.
• Try to relax. Stress does not cause reflux, but it can contribute by causing heartburn sufferers to engage in other trigger behaviors (ie. turning to high-fat comfort foods, smoking cigarettes, drinking caffeine or eating late at night). In addition, stress may increase a person's sensitivity to the pain caused by a heartburn episode.
• Avoid gulping down food in a hurry. Slow down and eat less. Gulping down food in a hurry can result in eating more before you feel satisfied. Over-filling the stomach can result in reflux and heartburn.
• Suck on hard candy, but not peppermint, which can aggravate heartburn. Sucking on hard candy encourages production of saliva, which acts as a natural barrier to acid. Just be sure to avoid mint candies, which can relax the LES, the muscle between the esophagus and the stomach that helps prevent the backflow of acid.

Do I have to give up everything I love to control my heartburn?

With good advice from your health care professional, you should be able to develop a healthy eating plan to help control your heartburn. A healthy plan will let you keep eating the foods you love and keep doing your usual activities. Given the many recent advancements in our understanding and treatment of heartburn, even the most severe heartburn sufferers generally find that they can control their heartburn through heartburn medications and some simple lifestyle changes.

Sufferers of mild heartburn are often relieved to learn that they can control their heartburn without medication by making just a few of these lifestyle changes. Several of these modifications — such as stopping or cutting down on smoking or avoiding caffeine and fatty foods — have the added bonus of enhancing general physical well-being. So, while you may decide to cut back on some things you enjoy to control your heartburn, you'll also be taking steps on the road to better health.

Impact of Stress

How does stress contribute to heartburn?

Gastrointestinal symptoms have long been associated with stress, fear and anxiety. The perception of heartburn can increase during stress. Numerous clinical studies confirm the correlation between stress and heartburn. A recent heartburn survey reported that stress was associated with more than 50 percent of heartburn episodes.

Stress can contribute to reflux by causing heartburn sufferers to engage in behaviors that trigger acid production (ie. turning to high-fat comfort foods, smoking, drinking caffeine or eating late at night). Stressful life events (anxiety, tension, and stress) can increase sensitivity to refluxed acid, reducing the threshold to pain and increasing the frequency and/or severity of heartburn symptoms. In addition, stress may increase a person's sensitivity to the pain caused by a heartburn episode.

Impact of Exercise

What can I take to relieve chest pain?

Heartburn is a common cause of chest pain, but severe or chronic chest pain could also signify a more serious condition such as a heart attack. If you have any chest pain that lasts for more than a few minutes — or any warning signs of a heart attack — seek immediate medical attention. Warning signs include such things as pain occurring with exertion, pain radiating to the arms or jaw, pain associated with shortness of breath or pain associated with lightheadedness or dizziness. Risk factors for heart disease include high blood pressure, diabetes, high cholesterol and family history of heart disease.