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Gastro-intestinal system
Heartburn is a form of indigestion, which is felt as a burning discomfort in the oesophagus (the tube leading from the mouth to the stomach), just below the breastbone. Heartburn has nothing to do with the heart. The name 'heartburn' simply comes from the fact that the discomfort or pain is felt in the area of the chest above the heart. Heartburn is a very common complaint and will affect most people at some time during their life. It is not usually serious, but if it does occur frequently it may progress to a condition called gastro-oesophageal reflux disease (GORD).
The pain of heartburn is caused by acid that irritates the delicate lining of the oesophagus. The oesophagus is separated from the stomach by a circular band of muscle called a sphincter. When food passes down the oesophagus, the sphincter relaxes allowing food to pass into the stomach. The sphincter then contracts, preventing the contents of the stomach returning to the oesophagus. Within the stomach, the food is digested or broken down by the action of gastric acid (hydrochloric acid produced by special cells in the stomach). If the sphincter relaxes or is forced open, partially digested food mixed with gastric acid escapes from the stomach into the oesophagus. The return of the stomach contents is known as acid reflux or gastro-oesophageal reflux. The acid irritates the sensitive lining of the oesophagus and produces the symptoms of heartburn.

Acid reflux leading to heartburn is mainly related to eating habits and to posture. When large meals are eaten, particularly those with a high fat content, the stomach produces more gastric acid and remains full for a long period of time to allow digestion to take place. A full stomach puts a lot of pressure on the sphincter, sometimes causing it to open and allowing acid reflux to occur. Lying down soon after eating a large meal can have the same effect. The stomach content, instead of remaining at the bottom of the stomach as it would do when sitting or standing, moves up towards and through the sphincter when lying down.

Increased pressure on the sphincter can also be caused by being overweight, by being pregnant or by wearing clothes that are tight around the waist. All of these put pressure on the stomach which, in turn, puts pressure on the sphincter causing it to open.

Foods that may cause heartburn include alcohol, caffeinated drinks such as tea, coffee and cola, chocolate, citrus fruits, tomatoes, peppers, curries and other spicy foods. These foods either stimulate an increased secretion of gastric acid, which is subsequently refluxed, or they have a direct irritant action on the lining of the oesophagus.

Peppermints and smoking may cause heartburn by relaxing the sphincter.
There are a large number of medicines that can help relieve the symptoms of heartburn.

Alginates, taken in the form of a suspension, react with the gastric acid to form a thick layer of non-acidic gel that floats on the stomach contents and restricts reflux. If reflux does occur, the gel has a soothing effect on the lining of the oesophagus.

Antacids such as aluminium hydroxide, calcium carbonate or magnesium hydroxide neutralise gastric acid, so even if reflux takes place, it will cause less irritation of the oesophagus.

H2-receptor antagonists, such as cimetidine, famotidine, nizatidine and ranitidine, and proton pump inhibitors (PPIs), such as esomeprazole, omeprazole, lansoprazole, pantoprazole and rabeprazole, inhibit the formation of gastric acid in the stomach and so help reduce irritation if reflux should occur.
When to consult your pharmacist
If you are troubled by heartburn, see your pharmacist. Many of the products for the relief of heartburn are available over the counter from a pharmacy without the need for a prescription. It is important that you describe your symptoms fully to your pharmacist to ensure that your heartburn is not confused with something more serious. Describe how long you have had the symptoms and when they tend to occur. Also tell your pharmacist your age, if you are pregnant, suffering from any other illnesses such as high blood pressure, and if you are taking any other medicines or healthcare supplements. It is important that you give your pharmacist this information because some heartburn medicines should not be used by people with certain illnesses or should not be taken at the same time as other medicines. If your pharmacist decides that you do have heartburn he or she will recommend a suitable product for you. If your pharmacist decides that your symptoms are too severe, it is not appropriate to treat yourself, or over the counter medicines have not worked, you will be advised to see your doctor.

Heartburn remedies containing alginates or antacids can usually be purchased quite freely over the counter from your local pharmacy. The H2-receptor antagonists, famotidine and ranitidine, and the proton pump inhibitor omeprazole are also available over the counter but their use is more tightly controlled, so your pharmacist will need to check if they are right for you.
When to see your doctor
You should see a doctor if you suffer from heartburn regularly, you have prolonged indigestion symptoms that are not relieved by antacids, you have a family history of stomach problems, or if you take regular medication such as painkillers or anti-inflammatory drugs for the treatment of arthritis. You should see your doctor urgently if you experience bloody and recurrent vomiting, black stools, difficulty swallowing and rapid weight loss.

Heartburn can be confused with pain resulting from angina or a heart attack. Angina should be suspected if the chest pain is brought on by exercise and relieved by rest. A heart attack should be suspected if the pain is intense and in the centre of the chest, spreading sometimes to one or both arms and the lower jaw, or if it feels like a heavy pressure. If you have any of these symptoms, see your doctor urgently.
Living with heartburn
Some simple changes in lifestyle will help avoid the chances of getting heartburn.

Avoid eating late at night. Eating at least 2 to 3 hours before bedtime is much better for you. Try to go for a short walk after a meal, rather than sitting down or going straight to bed. Eat small portions at regular intervals rather than large meals. Try to avoid foods that you know have caused your heartburn before.

Limit the amount of alcohol that you drink, and try switching from red wine to white wine and from gassy beers. Drinking water with meals is much better for you and it will help dilute gastric acid.

Give up smoking, or if you cannot give up, avoid smoking after meals. Lose weight if you are overweight and do not wear clothes or belts that are tight around the waist. If you suffer from heartburn at night, try propping the head of the bed up on a few books so the contents of the stomach are moved away from the sphincter.
Advice for carers and family members
If you are cooking for someone that suffers from heartburn, give thoughts to meals and to meal times. Be aware of the types of meals that cause problems and try to avoid them. Reduce the size of meals and plan meal times so that you are not eating late at night.

Keep a check on the person, if you think that their symptoms are getting worse or have changed, persuade them to see their doctor in case there is anything more serious.
Useful Tips
  • Give up smoking - see give up smoking section
  • Eat little and often
  • Do not rush meals
  • Eat and drink in moderation
  • Avoid foods that you know upset you - greasy or spicy foods and coffee are common culprits
  • If aspirin brings on indigestion, try another painkiller but check with the pharmacist first
  • Try to avoid stressful situations before eating
Further information
Based on information supplied by:
Core (the working name of the Digestive Disorders Foundation)

Telephone: 020 7486 0341