Heartburn is a painful burning feeling in your chest or throat. It happens when stomach acid backs up into your esophagus, the tube that carries food from your mouth to your stomach.

If you have heartburn more than twice a week, you may have GERD. But you can have GERD without having heartburn.

Pregnancy, certain foods, alcohol, and some medications can bring on heartburn. Treating heartburn is important because over time reflux can damage the esophagus.

Over-the-counter medicines may help. If the heartburn continues, you may need prescription medicines or surgery.

If you have other symptoms such as crushing chest pain, it could be a heart attack. Get help immediately.

There are several conditions that can cause heartburn, but most often it's caused by acid reflux or a more chronic form of acid reflux called GERD, or gastroesophageal reflux disease.

Eating certain foods, drinking alcohol, and some medications can make heartburn more likely.

What is acid reflux?

When you swallow food, it passes from your throat, through your esophagus, and then through an opening in your stomach.

This opening usually closes once the food passes through. If it doesn't, acid from your stomach may enter through the opening and travel the wrong way—back into your esophagus and to your throat. This is called acid reflux. The opening can occur sporadically after a meal leading to multiple reflux events.

Being pregnant or overweight can make you more likely to have heartburn. There are also certain foods and drinks that can trigger heartburn including:

• Spicy foods
• Acidic foods, like those with citrus (oranges or lemons) or those with tomatoes (marinara sauce)
• Alcohol
• Caffeinated beverages, like coffee and tea

You feel something rising in your throat. It burns and tastes acidic. Now you feel it behind your breastbone.

Is it heartburn? Is it GERD? Is it acid reflux? Are they all the same?

We've compiled a simple overview to help you navigate this often tricky area of digestive conditions.

Acid reflux: The cause

Acid reflux is when the contents of your stomach—like food or acids—go in the wrong direction. They travel from your stomach back to your throat through the tube connecting them, your esophagus.

When you have acid reflux, you may taste food or stomach acid in the back of your mouth. This can be uncomfortable and make you feel sick. Acid reflux is also referred to as GER (gastroesophageal reflux).

Heartburn: The symptom

Acid reflux causes heartburn, which is a burning feeling behind your breastbone, in your neck, or in your throat. This feeling is often worse after eating, in the evening, or when lying down or bending over. Being pregnant or overweight can make heartburn more likely.

GERD: The more serious cause

GERD stands for gastroesophageal reflux disease (GERD).

Like its name suggests, GERD is a more serious version of acid reflux. They can both cause heartburn. Often people who experience heartburn more than twice a week have GERD.

GERD happens when the closure in your lower esophagus—which is near your stomach—becomes weak or relaxes when it should not. Symptoms include heartburn, regurgitation, chest pain, dry cough, shortness of breath, or trouble swallowing.

Treating GERD may require prescription medications. Occasionally, surgery or other procedures may be necessary.

If you suspect you have GERD, make sure to see your provider or a gastroenterologist, a doctor who focuses on the digestive system. This can help prevent future damage to your esophagus, or cancer.

You’ve probably felt it. After a meal, a burning sensation rises through your chest, or up to your throat. This feeling can come from reflux: when acid and food rise up from the stomach into the esophagus, which is the tube that connects your stomach to your throat.

Occasional reflux is normal. Most people may not even feel it. Sometimes it’s mild, with occasional heartburn after large meals. Reflux can also cause coughing, wheezing, or problems swallowing.

Anyone can experience reflux. But reflux two or more times a week for a few weeks may be gastrointestinal reflux disease (GERD). GERD affects around 20% of people in the U.S. at some point in their lives.

“Reflux becomes GERD when the symptoms start to negatively affect someone’s daily quality of life,” says Dr. John Pandolfino, an expert on reflux at Northwestern University.

GERD usually isn’t dangerous. But it can cause discomfort, pain, and fear of eating, Pandolfino explains. Severe GERD can damage the lining of the esophagus, which can raise the risk of esophageal cancer. Although that risk is low, people should discuss reflux symptoms with their doctor.

Fortunately, there are many options for treating reflux and GERD. Some lifestyle choices may simply prevent it. For example, certain foods can trigger reflux in some people. See the Wise Choices box for tips to reduce reflux.

One of the most effective treatments for GERD is weight loss. In Pandolfino’s clinic, people with GERD are automatically assigned a health coach who helps them with diet and lifestyle changes.

“We help them lose about 10 to 15 pounds, and then see if we can get them off their medication,” he says. “Our success rate has been very good. We can get about a third of people off medication when they lose a little bit of weight. And about 50% experience a dramatic improvement in their symptoms.”

But medications can still help many people with GERD. They work in different ways, and you may need a combination to control your symptoms.

Doctors often first recommend antacids to relieve heartburn and other mild symptoms. Drugs called H2 blockers may provide relief if an antacid alone isn’t enough. These can stop your stomach from making acid in the short-term.

A type of drug called proton pump inhibitors (PPIs) may be recommended if other drugs don’t help control your reflux. PPIs reduce the amount of acid the stomach makes. They’re very effective. But people who take PPIs for a long time or in high doses may be more likely to have side effects. Sometimes, the benefits of these medications can outweigh the side effects. Talk with your doctor about the long-term use of medications for GERD.

If GERD persists despite drugs and lifestyle changes, surgery to strengthen the opening between the stomach and esophagus may be an option. This is especially useful when reflux is caused by a physical problem, like a hernia. A hernia happens when an organ squeezes through a weak muscle in your body.

Researchers are working on developing less-invasive procedures for people who need surgery. Pandolfino and other researchers are also looking for better ways to use existing tests to choose treatments.

“Reflux is such a mixed bag of symptoms and complications. We’d like to be able to better tailor therapy based on these studies,” he says.

Ways to Reduce Reflux

• Maintain a healthy weight. Even a bit of weight loss can help reduce reflux.
• Avoid your personal trigger foods. Some people have foods that make their reflux worse. These can include acidic foods, chocolate, or alcohol.
• Don’t smoke. Smoking can cause more acid to enter the esophagus.
• Manage stress. Stress and anxiety can make reflux feel worse.
• Stay upright. Don’t lie down for 2 or 3 hours after a meal.
• Raise the head of your bed. If you have reflux at night, raise the head of your bed by 6 to 8 inches.
• Talk to your doctor, if you have reflux twice or more per week.

What is heartburn?

Heartburn occurs when stomach contents flow back up into the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach. Also called acid indigestion, heartburn is an uncomfortable, burning feeling in the mid-chest, behind the breastbone, or in the upper part of the abdomen—the area between the chest and the hips. This feeling occurs because the stomach’s digestive juices contain acid. Sometimes people with this problem can taste food or acidic fluid in the back of the mouth.

What are my OTC treatment options?

There are three classes of OTC medications for the treatment of heartburn.

Antacids

Antacids relieve heartburn (indigestion). They work by changing the stomach acid that causes heartburn. Common OTC antacids include:

• Mylanta
• Rolaids
• Tums

Histamine-2 (H2) blockers

H2 blockers relieve and prevent heartburn and work by reducing the amount of acid produced by the stomach. Typically, they start to work within one to three hours and provide acid-suppression for several hours. Because acid reducers may interact with certain other medicines, ask your doctor or pharmacist before use if you are taking a prescription drug.  Common OTC H2-blockers include:  

• Tagamet HB (cimetidine)
• Pepcid Complete or Pepcid AC (famotidine)
• Axid AR (nizatidine)

Proton pump inhibitors (PPIs)

OTC PPIs treat frequent heartburn (occurs 2 or more days a week) and are not intended for immediate relief of heartburn, as they may take one to four days for full effect. In contrast, prescription PPIs are used to treat conditions like gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. PPIs work by reducing the amount of acid produced by the stomach. Because acid reducers may interact with certain other medicines, ask your doctor or pharmacist before use if you are taking a prescription drug.  OTC PPIs are only intended for a 14-day course of treatment and can be used up to three times per year.

• Prevacid 24HR (lansoprazole)
• Nexium 24HR (esomeprazole)
• Prilosec OTC (omeprazole magnesium)
• Zegerid OTC (omeprazole and sodium bicarbonate)

How do I use these drugs safely and effectively?

1. Read the label.
2. Do not take more than directed or use for longer than directed on the label.
3. If your heartburn symptoms persist even after taking these drugs, then talk to a health care professional.

Hormones and the pressure of the growing uterus cause indigestion and heartburn. Pregnancy hormones slow down the muscles of the digestive tract. So food tends to move more slowly and digestion is sluggish. This causes many pregnant women to feel bloated.

Hormones also relax the valve that separates the esophagus from the stomach. This allows food and acids to come back up from the stomach to the esophagus. The food and acid causes the burning feeling of heartburn. As your baby gets bigger, the uterus pushes on the stomach making heartburn more common in later pregnancy.

What might help:

• Eat several small meals instead of three large meals — eat slowly.
• Drink fluids between meals — not with meals.
• Don't eat greasy and fried foods.
• Avoid citrus fruits or juices and spicy foods.
• Do not eat or drink within a few hours of bedtime.
• Do not lie down right after meals.

Call your doctor if symptoms don't improve after trying these suggestions. Ask your doctor about using an antacid.

Despite what it's called, heartburn—or that burning feeling in your chest—has nothing to do with your heart.

Here are four key facts about heartburn from John Pandolfino, M.D., of Northwestern University.

1. Many diseases can cause heartburn.

Acid reflux is not always the cause. One disease that can cause heartburn is achalasia, a rare disorder that makes it difficult for food and liquid to pass into your stomach. Another is eosinophilic esophagitis. That's an allergic inflammatory disease of the esophagus.

2. Regular heartburn does not lead to cancer.

Most people who experience occasional, mild heartburn will not develop esophageal cancer. If you have heartburn regularly for 10 or 15 years, for example, there is a very small chance that it could lead to cancer. Always talk to your doctor if you experience regular symptoms and please don't wait, as endoscopy can assess your risk.

3. Not all foods trigger heartburn.

There's a difference between what makes you more likely to experience heartburn and what triggers heartburn. Fatty foods, for example, lower your anti-reflux barrier, which can increase your chances of heartburn. Acidic foods may trigger heartburn the moment they hit your esophagus. Avoiding heartburn triggers will help stop heartburn.

4. Significant weight loss is not necessary to ease heartburn.

Some people experience heartburn after gaining weight. However, significant weight loss—such as 50 or 60 pounds—isn't necessary to stop heartburn. Losing the 5 or 10 pounds you gained and returning to your baseline weight will help heartburn disappear.

Heartburn is a burning feeling in your chest or throat. Despite its name, heartburn actually has nothing to do with your heart.

Who gets it?

More than 60 million Americans experience heartburn at least once a month. Some studies suggest that more than 15 million Americans experience heartburn symptoms each day.

Is heartburn serious?

Occasional heartburn isn't a cause for concern. But if heartburn occurs regularly, interferes with your daily routine, or is caused by GERD, it could damage your esophagus or lead to cancer.

When heartburn is frequent or it leads to complications, it is categorized as GERD.

What are the symptoms?

• Burning in the chest after eating or at night
• Pain that worsens when lying down or bending over
• Bitter or acidic taste in the mouth

How is it diagnosed?

If you're experiencing heartburn, make sure to track your symptoms. For example, how often does it happen in a day? Does it happen after eating? You can bring this list to your provider to help make a faster and better diagnosis.

After discussing your symptoms and medical history with you, your provider can usually diagnose heartburn easily.

What are the treatment options?

If you have heartburn, your provider may prescribe over-the-counter antacids, which may come in a chewable tablet. They might also recommend prescription drugs such as H2 blockers or proton pump inhibitors, which reduce how much acid your stomach makes.

Providers may also recommend lifestyle changes, like losing weight and quitting smoking, which can increase stomach acid production. Other changes often include reducing stress, exercising more, avoiding food around bedtime, raising the head of the bed about 6 inches, and eating more high-protein, low-fat meals.

What if medication or lifestyle changes don't help?

Your provider may request more testing if lifestyle changes and medication did not help. These tests include a pH test to check for acid in your esophagus or an endoscopy. This test uses a small tube with a camera and light to see inside of your digestive tract and spot any issues.