Heartburn Handbook: Your Go-To Guide for Relief!

Medically reviewed by Mary Ahern MS, RDN, RYT April 22, 2024| Written by Zenda Nel

Heartburn Handbook: Your Go-To Guide for Relief!

Heartburn is the most common symptom of a chronic medical condition called gastroesophageal reflux disease (GERD). However, if you experience heartburn, you don't necessarily have GERD. The extreme discomfort you experience may simply be a sign of indigestion.

Heartburn is a verycommon condition. In the United States, more than 60 million people experience heartburn at least once a month, and as many as 15 million have heartburn symptoms every day.

Distinguishing between Acid Reflux, GERD and Heartburn

GERD is a common gastrointestinal disease. It is caused when the acidic contents of the stomach flow from the stomach up into the esophagus - the tube that connects the stomach to the pharynx at the back of the mouth. In normal conditions, the food moves down this tube to the stomach.

GERD is characterized by acid reflux and acid regurgitation. Acid regurgitation happens when stomach content flushes up through the esophagus into the mouth.

Normally, this is prevented by the esophageal sphincter – a kind of valve that lets food pass into the stomach and then cinches shut to block it from coming back up the esophagus. When this valve doesn't close properly, food can push up back into the esophagus, causing acid reflux.

Another common symptom of GERD is heartburn. Heartburn is the burning sensation in the chest behind the breastbone caused by acid reflux. If heartburn keeps happening, it becomes GERD.

The American College of Gastroenterology estimates that up to20% of the US population has GERD

Symptoms of Heartburn

Since heartburn is so common, most of us have experienced it and know it as an unpleasant, persistent burning sensation in the chest and throat.

The burning sensation may be accompanied by:

  • Pressure or pain behind the breastbone
  • An acidic, sour, or bitter taste in the mouth
  • Difficulty with swallowing and coughing
  • A hoarse voice 

What Causes Heartburn?

In addition to acid reflux, heartburn can be caused by several other factors.

1. Excessive Intake of Certain Foods

Foods that are high in fat, spice, caffeine, or acidity can trigger heartburn. This includes fried, spicy, and, fast foods as well as fatty meats such as bacon and sausage. Cheese, white flour, tomato sauces, citrus fruits, chocolate, peppermint, and tea can also contribute.

We’ll discuss these foods in detail, later in the article.

2. Unhealthy Weight 

Research shows that beingoverweight is a significant risk factor for developing GERD and accompanying heartburn. There is also growing evidence linking obesity to complications from persistent reflux.

3. Smoking

The esophageal sphincter protects the esophagus from stomach acids by keeping fluids in the stomach. Smoking weakens this sphincter, allowing stomach acid to flow backward into the esophagus, causing heartburn. 

In one study, cigarette smoking increasedthe rateat which acid reflux events occurred. Another study showed how GERD sufferers whostopped smoking got rid of the condition. 

4. Pregnancy

Indigestion and heartburn are common during pregnancy due to the pressure of the baby on the stomach. Lifestyle changes like eating small meals rather than three big meals, not eating shortly before bed, and avoiding drinks containing caffeine, and rich and spicy foods can help to ease heartburn.

5. Stress and Anxiety

Stress and anxiety can cause reflux symptoms to worsen. Emotional stress can increase acid production in the stomach, aggravating acid reflux. Stressful events like a job interview or having to arrange an exhibition may trigger acid reflux.

A 2009 study in Norway found that work-related stress made people more vulnerable to GERD symptoms. Survey participants who reported low job satisfaction were found to be twice as likely to have GERD compared to those who experienced high job satisfaction.

However, scientists are not entirely convinced that stress increases the production of stomach acid. 

Research seems to indicate thatwhen people with GERD are stressed, they are more aware of acid in the esophagus and interpret mild esophageal sensations as painful reflux symptoms. In this study, stress increased blood pressure, anxiety, and subjective reflux symptoms, but more reflux acid was not measured.

6. Gastric Ulcers

Ulcers are open sores frequently present on the lining of the stomach. They are also found in the duodenum - which is the upper part of the small intestine. Either of these two can cause severe pain, but not always. 

 Some people have no pain but experience indigestion, acid reflux, and heartburn.

7. Medications

Some medications can cause heartburn or make it worse. Medicines that cause heartburn include blood pressure drugs, aspirin, antibiotics, ibuprofen, iron supplements, potassium supplements, tricyclic antidepressants, and respiratory drugs.

What is Heartburn a Symptom of? 

Heartburn is not considered a major health issue. However, under certain conditions, it may be a sign of something else going on. Your heartburn could be a symptom of a serious underlying condition, such as the ones discussed below. 


If you have heartburn symptoms most days, you may have GERD. GERD can become serious and uncomfortable if not treated. Heartburn accompanied by the following symptoms may indicate GERD:

  • A burning sensation in the chest or throat
  • A sour, bitter, or burning taste in the mouth
  • Regurgitation of stomach contents into the mouth
  • Problems with swallowing
  • A sensation that food is not moving down the esophagus
  • Nausea and or vomiting
  • Sore throat or hoarseness

The esophagus doesn't have a thick protective lining. Therefore, prolonged periods of acid reflux can damage the esophagus, leading to a complication called Barrett’s esophagus. When this happens, there may be alterations to esophageal cells due to repeated acid exposure. The altered cells could potentially develop into esophageal adenocarcinoma, a potentially life-threatening form of cancer.

GERD may also be present if your heartburn and acid reflux persist despite you taking over-the-counter antacids.

2. Gastritis

If you are experiencing some or any of the following symptoms, you may be suffering from gastritis.

  • Stomach pain
  • Heartburn
  • Belching, bloating, and hiccups
  • Abdominal bleeding
  • Nausea and vomiting
  • Vomit or stool contains blood. 
  • Loss of appetite

Gastritis is inflammation of the stomach lining. The condition can be due to bacteria, infection, and persistent vomiting. Excessive alcohol consumption and chronic use of non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen can also cause gastritis.

If left untreated, gastritis can lead to other serious conditions, including ulcers and even stomach cancer. 

2. Hiatus Hernia 

Ahiatus hernia happens when the upper part of the stomach pushes through the diaphragm into the chest. It pushes through a small opening in the diaphragm called the hiatus.

This is normally not a serious condition, but it can cause discomfort and heartburn.

A minor hiatus hernia will most likely not cause any symptoms. But a larger hernia may be indicated by heartburn and other symptoms, such as 

  • Regurgitation of food or liquids from the stomach into the mouth
  • Acid reflux
  • Trouble swallowing
  • Chest pain
  • Stomach ache
  • Shortness of breath
  • Vomit or stools containing blood or black stools
  • Feeling full just as you start eating

3. Esophagitis 

If, in addition to heartburn, you find it difficult or painful to swallow, you may be suffering from esophagitis - which can be a result of GERD. With GERD, stomach acid leaks backward into the esophagus. If this happens regularly, it can cause esophagitis, an inflammation of the esophageal tissue.

Esophagitis can also be caused by chronic vomiting, certain medicines like anti-inflammatories, and medical procedures, such as radiation therapy. 

Esophagitis can have serious consequences if left untreated. If you ignore these symptoms, the condition may progress from esophagitis to Barrett’s esophagus, which is a risk factor for esophageal cancer.


Your healthcare provider will makea heartburn diagnosis based on your symptoms and medical history. Based on the findings, treatment options may include lifestyle changes, OTC medication, or prescription medication.

If the symptoms don't subside after following the suggested treatments, your heartburn might be an indication of GERD. Diagnosing GERD will require additional tests, including: 

  • Ambulatory acid (pH) probe test which involves the insertion of a small tube via the nose into the esophagus to measure the level of stomach acid in your esophagus.
  • Esophageal pH monitoring is an accurate way to measure stomach acid reflux in the esophagus. It involves either a capsule or a catheter.
  • X-ray imaging can be used after ingesting a chalky liquid to coat your upper digestive tract. This helps visualize what is going on in your esophagus, stomach, and upper intestine.
  • Endoscopy involves the insertion of a tiny camera attached to a tube into the stomach to see if there is an ulcer in the esophagus or stomach lining.
  • Esophageal manometry involves the insertion of a tube through the nose into the esophagus to measure the muscle movements of the esophagus to see if it functions properly.

Depending on your diagnosis, your doctor can provide you with treatment options to help reduce or eliminate your symptoms.

What is the Treatment for Heartburn? 

Heartburn symptoms are treated with over-the-counter (OTC) medications, and lifestyle changes can also alleviate symptoms.

1. Lifestyle changes

Lifestyle changes, if applied persistently, can reduce symptoms drastically. Doctors usually recommend that patients

  • Lose weight if they are overweight or obese. 
  • Stop smoking, as smoking is known to make heartburn worse.
  • Change what, how much, and how often they eat. 
  • Sleep with their heads higher than the rest of their body.

2. Over-the-counter and prescription medicines

There a loads of over-the-counter medications for GERD and heartburn. 

  • Antacids

  • Antacids help neutralize stomach acid and relieve pain. But it's important not to use these OTC medicines indefinitely, as they can have side effects, such as diarrhea or constipation.

    Also, OTC antacids typically contain elements like calcium, sodium, magnesium, or aluminum. Long-term use of calcium-containing antacids can lead tohypercalcemia (high blood calcium levels), which can lead to kidney failure in some people. These medications canlower calcium absorption, which might increase fracture risk, especially in older women. 

    Besides, OTC antacids are a major source of human aluminum exposure. Aluminum can beharmful to the nervous system and cause toxic effects in embryos and fetuses when exposed during pregnancy.

  • H2 blockers

  • H2 blockers help to lower the amount of acid the stomach produces. They are available without a prescription.

  • Proton pump inhibitors (PPIs)

  • PPIs also lower the amount of acid the stomach produces. PPIs areprescribed to relieve symptoms of acid reflux, treat a duodenal or gastric ulcer, and treat damage to the lower esophagus caused by acid reflux. 

    But PPIs should also be used in moderation. After all, recent research is looking at the cumulative effect of the long-term use of PPIs. The scientists found individuals aged 45 years and older who use prescribed PPIs for more than 4 years are at higher risk of beingdiagnosed with dementia.

    Scientists warn that OTC medications offer only temporary relief,potentially masking underlying issues like GERD, peptic ulcer, gastric ulcer, and hiatal hernia. They also warn about the possible interaction of antacids with other medications, especially in people who take more than one medication. 

    These medications are not toxic, but patients must use them correctly for proper relief and be aware that they can interact with other medications.

    Considering this, it may only be appropriate to try and manage heartburn through dietary changes. A good idea is to look through home remedies before picking an OTC drug:

    Home Remedies for the Treatment of Heartburn

    Here are a few home remedies for heartburn that are known to be effective:

    1. Bicarb soda 

    Bicarb soda (baking soda) is alkaline – it has a pH of 9.0. You can safely dissolve one teaspoon of baking soda in a glass of water, stir it, and drink it. In a few minutes, you will burp and immediately feel better. 

    2. Papaya

    Papaya is excellent for treating heartburn. It contains the enzyme papain, which helps to improve digestion. Eating ripe papaya or drinking papaya juice can help your digestion andreduce symptoms of GERD, including heartburn.

    3. Apple Cider Vinegar

    Some people find relief from heartburn by taking apple cider vinegar, but doctors don't recommend using it for moderate to severe acid reflux.

    4. Ginger

    Ginger is known to aid digestion and the herb can act as an anti-inflammatory in the body. Taken in small doses, ginger can help with heartburn. It is also effective against nausea. You can grate some fresh ginger and steep it in boiled water. Use only a little bit. 

    Fresh ginger is better than the powdered form, which cancause side effects.

    5. Chewing Gum

    Chewing gum works for heartburn because chewing promotes salivation, which neutralizes acid, cleans the gut, and sends acid back down to the stomach. 

    6. High-fiber foods

    Food high in fiber helps to prevent heartburn. The fiber in these foods makes them filling, so one is less likely to overeat, which is one of the causes of heartburn. Nuts, legumes, fruit, vegetables, and whole grains are all high in fiber.

    7. Alkaline foods

    If you have a lot of stomach acid, make a point of eating foods with ahigher pH. They are alkaline and are less likely to cause acid reflux. Alkaline foods include: 

    • Celery
    • Papaya 
    • Bananas
    • Melons
    • Cauliflower
    • Carrots 
    • Fennel
    • Nuts

    8. Hydrating Foods 

    You can consider eating foods that have a high percentage of water. Scientists at Johns Hopkins suggest foods that contain a lot of water can dilute stomach acid and help prevent acid reflux. These include celery, cucumber, lettuce, watermelon, and broth-based soups.

    9. Milk and Yogurt

    Milk or yogurt, provided it is low-fat or fat-free can provide immediate relief of heartburn. The effect may be short-lived, though. Milk will only temporarily relieve a mild case of heartburn.

    Foods and Drinks that Can Cause Acid Reflux and Heartburn

    1. Baked Goods Made with Refined White Flour

    Avoid breads and pastries baked with refined flour. Experts advise people with acid reflux to incorporatewhole grains into their diet.

    Research has found that incorporatingmore fiber into the diet strengthens the lower esophageal sphincter and keeps it more effective at keeping food from spilling into the esophagus. 

    2. High-Fat Foods

    Foods high in fat, like French fries and fatty meats, take longer to digest and tend to decrease lower esophageal sphincter efficacy, creating the ideal condition for acid reflux and heartburn.

    3. Citrus Fruits

    People prone to heartburn are advised to avoid citrus fruits like oranges, grapefruits, lemons, and limes as well as most fruit juices. These foods are highly acidic and can trigger acid reflux symptoms. 

    4. Tomatoes and Tomato-Based Products

    Tomatoes are also highly acidic and can aggravate the digestive system of people prone to heartburn. Avoid fresh and cooked tomatoes and tomato-based sauces like ketchup and salsa.

    5. Chocolate 

    Chocolate contributes to heartburn in two ways: cacao is naturally acidic, and chocolate products are made with full cream milk, which is high in fat. Fat slows down digestion and affects the pressure of the lower esophageal sphincter.

    6. Spicy Food

    Spicy food canworsen the reflux symptoms in people who have GERD. People who suffer from GERD are advised to avoid spicy food. Spicy food contains a compound called capsaicin, which slows down digestion, increasing the likelihood that food will reflux into the esophagus.

    7. Alcohol

    Alcohol is known to trigger GERD symptoms like heartburn. The worst culprit is probably white wine, which is very acidic. Alcohol precipitates heartburn because itrelaxes the lower esophageal sphincter, allowing acidic stomach content to escape into the esophagus.

    8. Coffee

    Coffee can lead to heartburn in some people. Coffee also relaxes the lower esophageal sphincter, which can increase the risk of acid reflux. However, this effect differs between individuals. 

    Some research studieshave not found a link between acid reflux and coffee consumption.

    9. Sodas and Carbonated Beverages

    Sodas and carbonated beverages can cause heartburn in some people. AKorean study found that in addition to noodles, spicy foods, fatty meals, sweets, alcohol, breads, and caffeinated drinks, sodas were associated with reflux-related symptoms.

    Lifestyle Changes to Relieve Heartburn

    In addition to watching what you drink and eat, adjusting a few daily habits can make all the difference to how you feel after a meal. 

    a) Pay Attention to How Much and When You Eat

    Eat smaller meals and don't eat shortly before you go to bed. In addition, As a general rule, don't overeat. An overfull stomach is in itself uncomfortable and can worsen things by putting pressure on the lower esophageal sphincter, increasing the risk of acid reflux.

    Eat slowly, with as little distractions as possible, and in company, if possible. Meals should be a happy, relaxed time.

    b) Focus on Keeping a Healthy Body Weight

    Lose weight if you carry excess weight. This is the best thing you can do to reduce your reflux symptoms. Obesity has been identified as an importantrisk factor for acid reflux, the leading cause of frequent heartburn. One factor is the abdominal pressure caused by excess weight.

    c) Don't Lie Down Immediately After a Meal

    Eating a meal increases the amount of gastric acid in the stomach as the food digests. Lying down after a meal weakens the effectiveness of the lower esophageal sphincter. Together, these two factors create the ideal condition for acid reflux. 

    Give food three to four hours to digest before going to bed.

    d) Quit Smoking

    Ditching this habit is a lifestyle change that will benefit your health in general. In terms of digestive health,smoking contributes to heartburn by

    • Reducing the amount of saliva in the mouth
    • Reducing the amount of acid-neutralizing bicarbonate in the saliva
    • Lowering esophageal sphincter pressure 


    Heartburn is a common condition that most of us experience at some point in our lives. It is not a life-threatening condition, but if it is a symptom of GERD, it can have serious consequences. GERD and its unpleasant symptoms can be avoided by making a few changes to your diet and lifestyle.