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What Causes Heartburn?

Heart Burn

Overview

Heartburn is a common digestive symptom that causes a burning sensation in the chest. Despite its name, heartburn is not related to the heart. It occurs when stomach acid flows back into the esophagus—the tube that carries food from the mouth to the stomach—irritating its lining.

Occasional heartburn is common and usually not serious. However, frequent or persistent symptoms may indicate an underlying condition such as gastroesophageal reflux disease (GERD).

Key Takeaways

  • Heartburn is caused by stomach acid flowing back into the esophagus.
  • It commonly produces a burning sensation behind the breastbone.
  • Certain foods, eating habits, and body positions can trigger symptoms.
  • Frequent or persistent heartburn may require medical evaluation.
  • Chest pain that is severe or unusual should be evaluated urgently.

What Is Heartburn?

Heartburn is a burning pain behind the breastbone, sometimes rising toward the throat. It often occurs after eating and may be accompanied by a bitter or acidic taste in the mouth. Symptoms commonly worsen when lying down or bending over.

Heartburn, Acid Reflux, and GERD

  • Acid reflux refers to stomach acid flowing backward into the esophagus.
  • Heartburn is the burning sensation many people feel as a result of acid reflux.
  • GERD is a chronic condition in which reflux occurs frequently or leads to complications such as esophageal inflammation or damage.

Frequent reflux—commonly defined as occurring two or more times per week—may indicate GERD.

What Causes Heartburn

Lower Esophageal Sphincter (LES) Dysfunction

Heartburn occurs when the lower esophageal sphincter (LES)—a ring of muscle at the bottom of the esophagus—does not function properly. When the LES fails to close tightly, stomach acid can flow back into the esophagus and cause irritation.

Common Triggers

Foods and Beverages

Certain foods and drinks are known to trigger or worsen heartburn in some people:

  • Spicy foods
  • Fatty or fried foods
  • Citrus products
  • Tomato-based foods
  • Chocolate
  • Peppermint
  • Coffee and other caffeinated beverages
  • Alcohol
  • Carbonated beverages
  • Large or high-fat meals

Lifestyle Factors

Daily habits can also contribute to heartburn:

  • Eating large meals
  • Eating late at night
  • Lying down or bending over soon after eating
  • Smoking
  • Wearing tight clothing that increases abdominal pressure

Medical and Physical Risk Factors

Certain conditions increase the likelihood of heartburn:

  • Pregnancy
  • Overweight or obesity

Hiatal hernia has been identified as a risk factor for reflux-related symptoms, but competitor sources alone were insufficient, and this association required external authoritative verification.

Symptoms of Heartburn

Common symptoms include:

  • Burning pain in the chest, often after eating or at night
  • Pain that worsens when lying down or bending over
  • Bitter or acidic taste in the mouth
  • Sensation of acid or food backing up into the throat

Symptoms such as coughing, hoarseness, or throat irritation lack high-quality evidence directly linking them to heartburn alone.

When Is Heartburn Serious?

Medical evaluation is recommended if heartburn:

  • Occurs frequently or interferes with daily life
  • Does not improve with nonprescription treatments
  • Is accompanied by difficulty swallowing
  • Occurs with persistent nausea or vomiting
  • Is associated with unexplained weight loss

Long-term, untreated reflux can lead to inflammation or damage of the esophagus.

Heartburn vs. Heart Attack

Heartburn-related chest pain can feel similar to heart-related pain. Seek immediate medical attention for chest pain that is new, severe, or unexplained—especially if it occurs with:

  • Shortness of breath
  • Sweating
  • Dizziness
  • Pain spreading to the arm or jaw

How Heartburn Is Diagnosed

Diagnosis usually begins with a review of symptoms and medical history. Healthcare professionals may ask:

  • How often symptoms occur
  • What triggers symptoms
  • Whether symptoms improve with medications

If symptoms are persistent or unclear, tests such as upper endoscopy or esophageal pH monitoring may be recommended.

Treatment Options

Self-Care and Lifestyle Measures

For many people, symptoms improve with:

  • Staying upright after meals
  • Avoiding known trigger foods
  • Eating smaller meals
  • Avoiding lying down for several hours after eating
  • Elevating the head of the bed
  • Maintaining a healthy weight
  • Quitting smoking

Medications

Several nonprescription and prescription options are used:

  • Antacids to neutralize stomach acid
  • H2 blockers to reduce acid production
  • Proton pump inhibitors (PPIs), which reduce acid more strongly

Persistent symptoms despite these measures may require prescription treatment or specialist evaluation.

Special Situations

Heartburn During Pregnancy

Heartburn is common during pregnancy. Lifestyle changes are usually recommended first, and any medication use should be discussed with a healthcare professional.

Nighttime Heartburn

Symptoms may worsen at night due to lying flat. Helpful strategies include:

  • Avoiding meals close to bedtime
  • Elevating the head of the bed
  • Sleeping on the left side

Frequently Asked Questions

What causes heartburn?

Heartburn is caused by stomach acid flowing back into the esophagus, usually due to dysfunction of the lower esophageal sphincter.

What triggers heartburn?

Common triggers include certain foods, large meals, lying down after eating, smoking, and alcohol use.

What causes frequent or severe heartburn?

Frequent or severe heartburn may be linked to GERD and should be evaluated by a healthcare professional.

What are the symptoms of heartburn?

Typical symptoms include a burning sensation in the chest, a bitter or acidic taste in the mouth, and discomfort that worsens after eating or when lying down.

What drinks help heartburn?

There is no high-quality evidence supporting specific drinks for heartburn relief.

Why do I get heartburn after drinking water?

There is no high-quality evidence supporting this explanation.

When should I see a doctor for heartburn?

Medical advice is recommended if symptoms are frequent, persistent, severe, or associated with warning signs such as difficulty swallowing, vomiting, or weight loss.

APA Reference List

Cedars-Sinai Staff. (2018, February 17). Heartburn and acid reflux: What you need to know. Cedars-Sinai. https://www.cedars-sinai.org/stories-and-insights/expert-advice/what-causes-heartburn-and-acid-reflux

Cleveland Clinic. (n.d.). Heartburn: What it feels like, causes & treatment. https://my.clevelandclinic.org/health/diseases/9617-heartburn-overview

Mayo Clinic Staff. (2025, September 20). Heartburn: Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heartburn/symptoms-causes/syc-20373223

Mayo Clinic Staff. (2025). Heartburn: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heartburn/diagnosis-treatment/drc-20373229

MedlinePlus. (2025, January 24). Gastroesophageal reflux disease. MedlinePlus Medical Encyclopedia. National Library of Medicine. https://medlineplus.gov/ency/article/000265.htm

MedlinePlus. (2025, January 24). Heartburn. MedlinePlus Medical Encyclopedia. National Library of Medicine. https://medlineplus.gov/ency/article/003114.htm

MedlinePlus. (2025, April 21). Hiatal hernia. MedlinePlus Medical Encyclopedia. National Library of Medicine. https://medlineplus.gov/ency/article/001137.htm

National Health Service. (2023, November 14). Indigestion and heartburn in pregnancy. NHS. https://www.nhs.uk/pregnancy/common-symptoms/indigestion-and-heartburn/

National Institute of Diabetes and Digestive and Kidney Diseases. (2020, July). Symptoms & causes of GER & GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes