Heartburn is stomach acid washing back up into the esophagus. Common triggers, simple changes that help, antacids vs omeprazole, and the chest pain you should never ignore.
What is heartburn?
Heartburn is a burning feeling behind the breastbone, often after eating or when lying down. It happens when stomach acid flows back up into the esophagus – the tube between your mouth and stomach. This is called acid reflux.
Occasional heartburn is very common. If you have it twice a week or more, or it damages the esophagus, it may be gastroesophageal reflux disease (GERD), which is worth discussing with a doctor.
Symptoms
- A burning pain in the chest, usually after meals or at night
- A sour or bitter taste, or food or liquid coming back up into your mouth
- Trouble swallowing, or a feeling of a lump in your throat
- A long-lasting cough, hoarse voice or sore throat
- Asthma that gets worse at night
Common triggers
- Large or fatty meals, and fried or spicy food
- Chocolate, peppermint, citrus fruits and tomatoes
- Coffee, alcohol and fizzy drinks
- Eating within 2–3 hours of bedtime
- Smoking, being overweight and pregnancy
- Some medicines, including anti-inflammatory pain relievers such as ibuprofen
Not everyone reacts to the same foods. Noting what you ate when heartburn strikes helps you find your own triggers.
What helps
Simple changes:
- Eat smaller meals, and don't lie down for 3 hours after eating.
- Raise the head of your bed by 6–8 inches (extra pillows alone don't work as well).
- Lose weight if you're overweight, and stop smoking.
- Wear clothes that are loose around your waist.
Over-the-counter medicines:
| Type | Example | How fast it works | Best for |
|---|---|---|---|
| Antacids | Calcium carbonate chewables | Within minutes | Occasional heartburn; relief is short-lived |
| H2 blockers | Famotidine | Within about an hour, lasting up to 12 hours | Preventing heartburn before a meal you know triggers it |
| Proton pump inhibitors (PPIs) | Omeprazole 20 mg | 1–4 days for the full effect | Frequent heartburn on 2 or more days a week |
Over-the-counter omeprazole is taken once a day before breakfast for 14 days. Don't take more than one 14-day course every 4 months unless your doctor tells you to. It isn't meant for immediate relief.
When to see a doctor
See a doctor if:
- You have heartburn more than twice a week despite over-the-counter treatment
- You need omeprazole more often than every 4 months
- It's hard or painful to swallow, or food gets stuck
- You're losing weight without trying, or keep vomiting
- You have black, tarry stools, or vomit blood or something that looks like coffee grounds
- Your symptoms are new and you're over 60
Don't assume chest pain is heartburn. Call 911 if chest pain or pressure spreads to your arm, jaw, neck or back, or comes with shortness of breath, a cold sweat, nausea or lightheadedness. These can be signs of a heart attack.