woman holding her chest on a park bench

Millions of Americans experience heartburn, or acid reflux, at least once a month. The term “heartburn” describes the feeling of acid burning the esophagus, which is just behind the heart.

What is acid reflux?

Gastroesophageal reflux disease (GERD), also called acid reflux, is the most common chronic disease in adults in the U.S. The esophagus, or food pipe, is the tube stretching from your throat to your stomach.

When you swallow food, it travels down the esophagus to the stomach, which produces acid that helps digest food. The inner lining of the stomach isn’t harmed by this acid because cells that line the stomach produce a protective mucus. The lining of your esophagus does not share these features, making it vulnerable to damage from the acid.

What causes heartburn?

Normally, a muscle at the bottom of your esophagus, called the lower esophageal sphincter, prevents reflux (or backing up) of acid. This sphincter relaxes during swallowing to allow food to pass. It then tightens to prevent flow in the opposite direction.

With acid reflux, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up. This damages the lining of the esophagus. It occurs in all healthy people without causing much damage to the esophagus.

About 10% of adults develop daily symptoms of heartburn. Nearly half of those people develop tissue injury, which causes painful swallowing and bleeding.

Symptoms of heartburn

Some people have pain from the esophagus that mirrors chest pain and can seem like heart trouble. Other people may have stomach acid that spills over and causes inflammation of the vocal cords. This can lead to chronic cough, changes in voice, esophageal spasm, or asthma.

If you have any of these symptoms of acid reflux, talk to your doctor immediately:

  • Difficulty swallowing solids or liquids
  • Severe chest pain or pressure, especially if it radiates to your arm, neck or back
  • Vomiting followed by severe chest pain
  • Vomiting blood
  • Dark stools

Early treatment of acid reflux not only improves symptoms like heartburn but also may prevent complications. Your doctor will look for signs of a serious problem, such as blood in the stool or weight loss.

Factors that contribute to heartburn

No one knows the exact cause of acid reflux. Several factors can weaken or relax the lower esophageal sphincter, causing reflux. They include:

  • Lifestyle choices, such as the use of alcohol or cigarettes
  • Poor posture
  • Obesity
  • Medications such as calcium channel blockers, theophylline, nitrates, and antihistamines
  • Diet choices such as fatty and fried foods, chocolate, garlic and onions, caffeine drinks, acidic foods, spicy foods, and mint flavorings
  • Eating habits including eating large meals or eating close to bedtime
  • Other medical conditions such as hiatal hernia, pregnancy, diabetes, and rapid weight gain

Heartburn treatments

Tagamet, Zantac, Pepcid, and Axid are a few over-the-counter medications that can help suppress acid reflux. Other familiar brand-name antacids include Gaviscon, Maalox, Mylanta, or Tums.

If you take antacids more than four times a week to control symptoms, you should see a physician. While antacids can help symptoms, they may also mask more serious problems.

In stubborn cases, physicians may prescribe stronger medications like Prilosec or Prevacid, which virtually shut off acid.

If your physician suspects a more serious problem, you may be referred to a specialist. Surgery is necessary in rare cases.

Learn more about UC Davis Health’s Department of Internal Medicine

Lifestyle changes you can make to ease acid reflux

If no infection is detected, your doctor may suggest lifestyle changes and medication. Weight gain, smoking and alcohol can all contribute to acid reflux. Your physician may recommend losing weight, quitting smoking, and avoiding alcohol.

It may also help to elevate your head slightly when you sleep because exposure to esophageal acid can be reduced through gravity. Your physician may also suggest eating smaller meals and avoiding spicy and fatty foods.

This blog was medically reviewed by Sanyukta Sanjay Pawar, a UC Davis Health internal medicine physician at Rocklin's Placer Center for Health.