Digestive Health Heartburn Causes & Risk Factors Heartburn Guide Heartburn Guide Symptoms Causes Diagnosis Treatment Prevention Heartburn By Sharon Gillson Sharon Gillson Sharon Gillson is a writer living with and covering GERD and other digestive issues. Learn about our editorial process Updated on August 10, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Robert Burakoff, MD, MPH Medically reviewed by Robert Burakoff, MD, MPH LinkedIn Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms of Heartburn Understanding Heartburn Causes of Heartburn Genetic Factors Lifestyle Risk Factors How to Treat Heartburn When to Call Your Healthcare Provider A Word From Verywell Health Frequently Asked Questions Next in Heartburn Guide How to Diagnose Heartburn Heartburn can have several different causes, including the foods you eat or a more serious underlying medical condition like hiatal hernia or esophagitis. Understanding the causes of heartburn can help you identify what kind of treatment you need and why you're experiencing your symptoms. This article discusses the symptoms and causes of heartburn. It also covers how treatments may help to treat gastroesophageal reflux disease (GERD). Symptoms of Heartburn While heartburn will have many symptoms, depending on its causes, some of the more common symptoms include: Intense burning sensation in the chestChest pain while laying down or bending overSour or acidic taste in the mouthPain or difficulty when swallowing While heartburn is generally related to lifestyle factors, such as food, it can also indicate a more serious medical condition, such as esophageal cancer. If your symptoms persist or intensify, contact your healthcare provider. Some of the mechanisms that can contribute to heartburn include: Direct irritation of the esophagusWeakness of the lower esophageal sphincter (LES)Motility disorders of the digestive tract that result in delayed gastric emptyingHiatal hernia Often, more than one of these factors contributes to bouts of heartburn. © Verywell, 2018 Understanding Heartburn Knowing how your digestive system functions can help you better understand heartburn. Your digestive tract starts with your mouth, where food is chewed and mixed with saliva, starting the process of digestion. From here, food travels to the esophagus. This muscular tube makes tiny contractions, called peristalsis, to move the food to the stomach. The esophagus and stomach are connected by a band of muscle fibers called the lower esophageal sphincter (LES). Normally, the LES works like a valve, opening to allow food to pass into the stomach and closing to keep food and digestive juices from flowing back into the esophagus. But if the sphincter relaxes when it shouldn't, or becomes weak, stomach acid can flow backward into the esophagus causing the burning sensation known as heartburn. Causes of Heartburn The underlying mechanisms that can cause heartburn can also lead to the development of gastroesophageal reflux disease (GERD) if heartburn is frequent enough. GERD has multiple stages, from mild to precancerous, and it's possible to experience flare-ups many times per week. Some of the most common causes of heartburn include: Esophageal Irritation Some types of food, drink, smoking, and medications can directly irritate the lining of the esophagus and cause heartburn. In the case of medications, it may help to stay upright for at least 20 to 30 minutes after taking the medication and to take the pill with a full glass of water. You may also want to speak with your healthcare provider about making changes to your diet in order to support esophageal health. Lower Esophageal Sphincter (LES) Dysfunction If the lower esophageal sphincter is weak or loses tone, it will not close completely after food passes into the stomach. Stomach acid can then back up into the esophagus. Certain foods and beverages, alcohol, drugs, and nervous system factors can weaken LES and impair its function. Motility Disorders (Slow Stomach Emptying) In normal digestion, food is moved through the digestive tract by rhythmic contractions called peristalsis. When someone has a digestive motility disorder, these contractions are abnormal. This abnormality can be due to one of two causes—a problem within the muscle itself, or a problem with the nerves or hormones that control the muscle's contractions. Some people with gastrointestinal reflux disorder (GERD) have abnormal nerve or muscle function in their stomachs that could result in impaired motility. When the muscles in the stomach do not contract normally, the stomach does not empty into the small intestine as fast as it normally would. The combination of more food left in the stomach plus increased pressure in the stomach due to the delayed emptying increases the risk for stomach acid to leak back up into the esophagus. Gastrointestinal Motility Disorder Hiatal Hernia Hiatal hernia is often found in patients with GERD. A hiatal hernia occurs when the upper part of the stomach is pushed upward into the chest through an opening in the diaphragm. This may occur due to a weakening in the diaphragm or because of increased abdominal pressure. This opening is called the esophageal hiatus or diaphragmatic hiatus. It is believed that a hiatal hernia can weaken the LES and cause reflux. Hiatal Hernia Pressure on the Abdomen Excessive pressure on the abdomen can put pressure on the LES, allowing stomach acid to enter the esophagus or even the mouth. Pregnant women and overweight people are especially prone to heartburn for this reason. Other Medical Conditions Other medical conditions that may contribute to GERD include asthma and diabetes. Genetic Factors Studies have suggested there is an inherited risk for GERD. This could be because of inherited muscular or structural problems in the esophagus or stomach. Genetic factors may also be an important aspect in a patient's susceptibility to Barrett's esophagus, a precancerous condition caused by severe GERD. Lifestyle Risk Factors Some people have a naturally weak LES that is unable to withstand normal pressure from the contents of the stomach. But other factors also can contribute to this weakening and lead to heartburn episodes. Alcohol Alcohol relaxes the LES, allowing the reflux of stomach contents into the esophagus. It also increases the production of stomach acid and makes your esophagus more sensitive to stomach acid. Drinking alcohol can also lead to making less healthy food choices and eating foods you know can trigger your heartburn. Smoking Tobacco The chemicals in cigarette smoke weaken the LES as they pass from the lungs into the blood. Cigarette smoking slows the production of saliva, which is one of your body's defenses against damage to the esophagus. Smokers also produce fewer acid-neutralizing chemicals in saliva, called bicarbonates. Also, smoking stimulates the production of stomach acid and changes stomach acid by promoting the movement of bile salts from the intestine into the stomach. Digestion is slowed while you are smoking and the stomach takes longer to empty. Foods People differ as to which foods trigger heartburn. These are the most common: Coffee, tea, and other caffeinated drinks: Caffeine can relax the (LES), allowing stomach contents to reflux into the esophagus. Caffeinated beverages may also stimulate acid production. Chocolate: Chocolate contains concentrations of theobromine, a compound that occurs naturally in many plants such as cocoa, tea, and coffee plants. This relaxes the esophageal sphincter muscle, letting stomach acid squirt up into the esophagus. Fried, greasy, or fatty foods: These foods tend to slow down digestion and keep food in your stomach longer. This can result in increased pressure in the stomach, which in turn puts more pressure on a weakened LES. All of this allows reflux of what's in your stomach. Peppermint is often a heartburn trigger. Tomatoes and tomato-based products: Any foods that contain tomatoes stimulate stomach acid production. Spicy foods and black pepper stimulate stomach acid production. Citrus fruits and juices: Oranges, lemons, limes, and other citrus fruits stimulate stomach acid production. Eating Habits How you eat can also trigger heartburn episodes: Large meals: A full stomach can put extra pressure on the LES, which will increase the chance that some of this food will reflux into the esophagus.Eating two to three hours prior to bedtime: Lying down with a full stomach can cause stomach contents to press harder against the LES. This increases the chances of refluxed food. Abdominal Pressure Excess weight can put pressure on the abdomen that can trigger heartburn, in which case your healthcare provider may recommend weight loss. Even wearing tight-fitting clothes can cause pressure in the abdomen. This forces food up against the LES and causes it to reflux into the esophagus. Tight-fitting belts and slenderizing undergarments are two common culprits. You can also feel increased symptoms when you lie down or have a full stomach. Some people find certain types of exercise trigger heartburn. High-impact exercises that involve jumping, as well as exercises such as crunches that place pressure on the abdomen, are the most likely to be triggers. What Medications Can Cause Heartburn? Nearly any medication may cause heartburn; however, some render patients more vulnerable than others. Medications can cause heartburn in multiple ways. If the medication you're taking is causing you heartburn, you may want to talk to your healthcare provider about possible remedies. Heartburn Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Medications that have been known to cause heartburn include: Antianxiety medications, such as Valium (diazepam), may not only relax your mood but your LES as well. Some antibiotics, such as tetracycline, can directly irritate the esophagus. Anticholinergics such as Compazine (prochlorperazine) and Phenergan (promethazine) can relax the LES. Aspirin. For some people unable to tolerate aspirin due to heartburn, enteric-coated aspirin may be an option. Never stop aspirin before talking with your healthcare provider. Bisphosphonates such as Fosamax (alendronate), Actonel (risedronate), and Boniva (ibandronate) can cause heartburn by directly irritating the esophagus. If your medication is causing heartburn, there are options for preparations that are given as an injection which is less likely to cause this symptom. Calcium channel blockers for high blood pressure, such as Procardia (nifedipine), and Cardizem (diltiazem) can result in a weakening of the LES and also slow gastric emptying. Thankfully, there are many different classes of blood pressure medications available, and switching to another class may be helpful if your symptoms persist. Asthma medications such as Proventil (albuterol) and theophylline Chemotherapy drugs Corticosteroids (steroids) such as Deltasone (prednisone) and Medrol (methylprednisolone) can cause heartburn as well as other significant digestive concerns. Hormone replacement therapy (HRT), which is a combination of estrogen and progesterone Narcotics can cause heartburn by delaying gastric emptying. NSAIDs (nonsteroidal anti-inflammatory drugs) such as Advil (ibuprofen) and Aleve (naproxen) can increase acidity in the stomach by inhibiting prostaglandins. Options for pain control such as Tylenol (acetaminophen) or even narcotic medications may be needed when NSAIDS cause significant heartburn or digestive tract upset. In some cases, making sure to take NSAIDs on a full stomach can be helpful. Tricyclic antidepressants, such as Tofranil (imipramine), Sinequan (doxepin), Norpramin (desipramine), and Pamelor (nortriptyline) slow gastric emptying. Many of the newer anti-depressants are less likely to cause this symptom. Potassium can cause heartburn by directly irritating the esophagus. Iron supplements can directly irritate the stomach. Some people find relief by taking these supplements with food or by using them early in the day. Vitamin C How to Treat Heartburn There are multiple ways you can treat or manage your heartburn to decrease symptoms and maximize your quality of life. For heartburn that indicates a more serious condition, please work with your healthcare provider to undergo the appropriate test and treatment plans. Some of the more common ways to treat heartburn include: Prescription and Over-the-Counter (OTC) Medications Depending on the frequency and severity of your heartburn, your healthcare provider may recommend prescription or OTC antacids, such as: Prilosec (omeprazole)Prevacid (lansoprazole)Nexium (esomeprazole) Common OTC medications include sodium bicarbonate, antacids (Rolaids, Tums, Mylanta), Prilosec OTC, and Nexium 24HR (esomeprazole). Diet and Lifestyle Changes Limiting or avoiding spicy or acidic foodsStopping eating or snacking three hours before bedtimeEating smaller and more frequent meals Limiting alcohol consumption When to Call Your Healthcare Provider Consider making an appointment with your healthcare provider if you: Experience intense heartburn two or more times per week.Have trouble sleeping due to heartburn.Experience nausea and severe stomach cramps.Have trouble swallowing.Taste an unusual taste (bitter, sour, acidic) during heartburn.Have trouble breathing.Experience no relief with OTC or medications. A Word From Verywell Health Heartburn can emerge from a variety of causes, some of which are more serious than others. It's important to know the causes of your heartburn so you can develop a treatment plan, reduce frequency and severity, and maximize your quality of life. Even though heartburn is common, it's not inevitable and it shouldn't be ignored. If you think you're heartburn may be linked to a more serious medical condition, work with your care provider to identify the causes and create a plan for treatment. Frequently Asked Questions What causes heartburn? Heartburn occurs when stomach acid backs up into the esophagus (the tube that carries food from the mouth to the stomach). Normally, a band of muscles at the bottom of the esophagus, called the lower esophageal sphincter (LES), will prevent backflow of stomach contents. With heartburn, this doesn’t occur as it should, leading to acid reflux. What causes chronic heartburn? Chronic heartburn, defined as ongoing or episodic bouts lasting six months or more, may be the result of gastroesophageal reflux disease (GERD), a condition affecting 15% to 20% of people in Western countries. It may also be the result of chronic gastritis, motility disorders, or a hiatal hernia. Which foods cause heartburn? Certain food can trigger excess stomach acid in some people, which can leak through the lower esophageal sphincter and cause heartburn. These include:Spicy foodsFatty or fried foodsCaffeinated foods, like coffee and chocolateAcidic foods, including citrus and pickled foodsProcessed foodsCarbonated beveragesAlcohol, particularly beer and wine What causes heartburn during pregnancy? The hormone progesterone, which increases throughout the course of a pregnancy, can relax the lower esophageal sphincter so that it doesn’t close as it should. At the same time, the growing uterus can place increasing pressure on the intestines and stomach, which also promotes reflux. What causes heartburn at night? The position of your body during sleep can play a role in heartburn symptoms. If you have chronic heartburn, lying flat on your back allows acid to creep up the esophagus. Elevating your head can keep these acids down. Avoiding food before bedtime and sleeping on your left side can also help. Can heartburn be a sign of something serious? While you may assume that heartburn is simply the result of “something you ate,” it may be the sign of something more serious—particularly if the symptoms are severe and ongoing. In addition to GERD, chronic heartburn may be the result of:AchalasiaCoronary artery atherosclerosisEsophageal cancerGallstonesHiatal herniaH. pylori infectionIrritable bowel syndrome (IBS)Motility disordersPeptic ulcer disease How to Diagnose Heartburn 13 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American College of Gastroenterology. What causes heartburn and GERD? Gastroesophageal Reflux Disease | The University of Kansas Health System. What to eat when you have chronic heartburn. Harvard Health. Peristalsis - health video: medlineplus medical encyclopedia. Argyrou A, Legaki E, Koutserimpas C, et al. Risk factors for gastroesophageal reflux disease and analysis of genetic contributors. World J Clin Cases. 2018;6(8):176-182. doi:10.12998/wjcc.v6.i8.176 National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of GER & GERD American College of Gastroenterology. What are the treatments for GERD? Lifestyle Modification National Institute of Diabetes and Digestive and Kidney Diseases. Eating, Diet, & Nutrition for GER & GERD Over-the-counter (OTC) heartburn treatment. FDA. Published online March 12, 2021. Clarrett DM, Hachem C. Gastroesophageal reflux disease (GERD). Mo Med; 115(3):214-8. Badillo R. Diagnosis and treatment of gastroesophageal reflux disease. WJGPT; 5(3):105. American Pregnancy Association. Heartburn and pregnancy. Gaddam S, Maddur H, Wani S, et al. Risk factors for nocturnal reflux in a large GERD cohort. J Clin Gastroenterol. 2011;45(9):764-8. doi:10.1097/MCG.0b013e318205e164 Editorial Process Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit