Heartburn and its causes

It's worth exploring common triggers for heartburn and cutting them out to see if that helps but sometimes we don't find a cause. You are more likely to suffer from heartburn if you are pregnant, a smoker, overweight, drink alcohol beyond recommended limits, suffer from something called a hiatus hernia, if you take certain medications (such as anti-inflammatory painkillers) or if you are anxious or stressed.

Certain foods and drinks can be triggers, such as caffeine, alcohol, hot drinks, spicy foods and tomato-based food dishes. Acid reflux can cause symptoms other than heartburn such as an acidic or bitter taste in the mouth, halitosis (bad breath), a cough, hiccoughs, nausea, bloating, burping and pain on swallowing hot drinks.

Symptoms are often worse after bending over, when lying down or after eating.

You can make some adjustments at home which may help: eat small regular meals, don't eat for a couple of hours before bed, raise your head when you sleep either via pillows or raising the head end of the bed frame, avoid foods which may cause or worsen the symptoms and avoid wearing anything tight around your waist area. Lifestyle changes such as stopping smoking or losing weight will also help improve symptoms over time.

Your pharmacist may recommend a variety of medications, provided symptoms have only bothered you for a short time. For immediate relief, treatments fall into three main groups;

Antacids provide quick relief by neutralising excess acid in the stomach. Effects last for a couple of hours at best, which may be sufficient for most people. Examples include Rennie.

Alginates provide quick relief of symptoms, and additionally form a layer on top of the stomach contents to form a protective physical barrier or buffer zone that helps to prevent stomach acid and contents from spitting upwards to the oesophagus and causing pain. Protection lasts for hours afterwards and an example of these is Gaviscon suspension.

Proton pump inhibitors (PPIs) decrease the amount of acid produced in the stomach by turning off an acid-producing part of the stomach. This type of treatment may not provide as instant an effect and needs repeated use over days to build effect, but it gives much longer protection - for up to 24 hours. An example is Nexium control (containing the drug esomeprazole).

Natural treatment options include medications containing mastic gum or mineral mixtures that can also balance excess acidity.

You are fit for work if you have heartburn.

You should book an urgent visit with your doctor if you have pain that does not settle, difficulty swallowing, can feel a lump in your stomach area, if you have persistent nausea and vomiting or if you are losing weight for no obvious reason. You should also see your doctor if your symptoms do not improve after following two weeks of home treatment and pharmacy advice.

The doctor will ask you about your medical history, what symptoms you’ve been having and how long you’ve had them for and what treatments you’ve tried. They will likely examine your tummy by pressing on your stomach and having a listen to it with their stethoscope. Your doctor may prescribe you a medication to take every day for a month that will help decrease the amount of acid your stomach produces called a proton pump inhibitor (known for short as a PPI). If this doesn't work, they may change the dose or give you an alternative that works slightly differently.

Depending on the length, severity of symptoms and the examination of your abdomen your doctor may also consider sending you for a camera test to look at your oesophagus, called a gastroscopy.