Most people recognise heartburn because they have occasionally experienced it, usually after a heavy or rich meal or an excess of alcohol. It is a burning discomfort felt behind the breast-bone; often seeming to rise up from the stomach to the throat.

Is heartburn a disease?

No. It is a discomfort that can be ignored or treated with simple indigestion medicines if it occurs occasionally. If it happens more frequently then further investigation may be advised.

Does heartburn have anything to do with the heart?

No, the name is misleading. Pain caused by heart disease is quite different from the burning in the chest called heartburn. The discomfort of heartburn actually arises in the gullet (oesophagus) which carries food from our mouth to the stomach.

What causes heartburn?

Heartburn occurs when digestive juices (containing add and chemical enzymes) rise into the gullet (oesophagus) from the stomach. This process is called reflux. If this happens a lot, the oesophagus becomes inflamed; this is called oesophagitis. There is a valve (sphincter) at the lower end of the oesophagus, where it joins the stomach, which normally prevents reflux. Sometimes the valve becomes weak or a normal valve is overcome by extra strain such as an overfilled stomach, or a lot of bending or lifting.

Why should the valve (sphincter) become weak?

We do not always understand the reason, but there are some known causes

Can anything else cause heartburn?

Sometimes heartburn is a symptom of other diseases. A peptic ulcer (gastric or duodenal ulcer) sometimes causes heartburn, though usually there are other symptoms such as pain in the stomach. Some people with gallbladder disease have heartburn (though removing the gallbladder may not cure the heartburn). Occasionally, narrowing of the stomach outlet (pyloric stenosis) causes back-flow and leads to heartburn. One of the reasons for doing tests on patients with heartburn is to discover any of these possible causes.

What is a hiatus hernia?

If a portion of the stomach rises through the hole (hiatus) in the diaphragm through which the oesophagus (gullet) usually passes, it is called a hiatus hernia. A small hiatus hernia is often found in patients with frequent heartburn, hut by no means always Conversely, hiatus hernia can sometimes be seen on x-rays in people who have no heartburn. So, although patients with heartburn are often told that the diagnosis Is a hiatus hernia", the hernia is not the most important thing.

If I have a hiatus hernia, will it develop complications?

Almost certainly not. The sort of hiatus hernia associated with heartburn is not subject to strangulation and other complications which can affect hernias in the groin An uncommon sort of hiatus hernia may cause problems, but these are rare and do not usually cause heartburn. Most hiatus hernias never need surgical treatment.

Can medicines or drugs I take cause heartburn?

Many medications may irritate the gullet (oesophagus) if they do not pass through quickly into the stomach, so all tablets should be taken with a good gulp of water while sitting or standing upright. However, some drugs are particularly inclined to do this. Many of them are pain-relievers (including aspirin) taken for arthritis or back-ache. People prone to heartburn should be cautious about what they take.

Can the inflammation of the oesophagus interfere with swallowing?

Everything we swallow goes down the oesophagus into the stomach. if the oesophagus is inflamed (oesophagitis), swallowed material may hurt as it passes down. Hot dishes or alcoholic spirits are particularly likely to do this. Occasionally, large pieces of food, meat for example, may seem to stick for a moment. If such "sticking' happens at all frequently, it suggests that the inflammation is severe, and may have led to narrowing of the oesophagus (a stricture).

Can there be complications?

Heartburn due to reflux oesophagitis is not usually a serious disease, though if it is frequent or interferes with normal activities (such as eating, gardening, housework, sexual intercourse) then it should be investigated and treated. Complications are rare, the only important one being a stricture. This always needs investigation and may require special treatment

What treatment can be given?

The most important and helpful aspects of treatment are things that you can do for yourself.

If the symptoms are troublesome it may help to sleep with the head of the bed raised on bricks or blocks to reduce the likelihood of reflux occurring during the night.

What medicines can the doctor give me to help?

What you can do