It can cause cough, asthma‑like symptoms or more

What is heartburn?

Heartburn is an unpleasant sensation felt as a burning pain in the stomach area. This pain can radiate behind the breastbone and even into the throat. Heartburn occurs when stomach acid flows back into the oesophagus, causing irritation and inflammation. Unlike the stomach, the oesophagus lacks a protective mucous layer against aggressive stomach acid. The backflow of acid, also called reflux, therefore causes symptoms such as a burning sensation behind the sternum.

In addition to chest burning, a sour taste in the mouth and acid regurgitation are among the most common symptoms of heartburn. Affected people often experience an uncomfortable feeling of fullness, pressure in the upper abdomen, or even nausea. In severe cases the pain can spread to the throat. Heartburn frequently occurs after eating or when bending over, especially if the affected area is irritated by the returning acid.

Another feature of reflux disease is that the symptoms can affect other parts of the body, such as the throat, which may feel scratchy, or the airways, leading to complaints like hoarseness, cough, or even asthma-like symptoms. These symptoms often go unnoticed and are not linked to reflux, so the underlying condition may remain untreated for longer.

What are the most common causes of heartburn?

In most cases heartburn arises because the muscular closure mechanism between the oesophagus and the stomach does not function properly. This allows stomach acid to flow back into the oesophagus and irritate the mucosa. One possible cause is a hiatal hernia, where the natural narrowing between the oesophagus and stomach widens and the stomach partially slips into the chest cavity. This reduces the diaphragm's supportive role in closing the gastric outlet.

Various factors can promote acid reflux. These include increased abdominal pressure, for example due to overweight, pregnancy or tight clothing. A large meal volume can also expand stomach volume and promote reflux. Certain body positions, such as lying down or bending forward, favour the occurrence of heartburn.

Certain foods and stimulants can also play a role. In particular, fatty and sugar‑rich foods, alcohol and nicotine are associated with increased reflux. Some medications, including certain blood pressure drugs, muscle relaxants and hormonal contraceptives, can also worsen symptoms.

Stress can likewise influence the occurrence of heartburn. Many affected people report that stressful situations worsen their complaints. In some cases, impaired oesophageal motility may play a role if the oesophagus cannot clear gastric juice quickly enough or is particularly sensitive to acid.

What are the consequences of heartburn?

Frequent heartburn can lead to significant long-term health problems. One of the most common consequences is chronic oesophagitis (reflux oesophagitis), which develops when the mucosa is irritated by repeated contact with stomach acid. If this inflammation is left untreated, ulcers may form that sometimes bleed and cause pain when swallowing. In addition, the inflammatory reaction can lead to scarred narrowing of the oesophagus (strictures), which makes eating difficult and can cause swallowing problems.

A particularly serious consequence is so‑called Barrett's oesophagus. This involves pathological changes in the cells of the lower oesophagus. This cellular change is considered a possible precancerous condition and increases the risk of developing oesophageal cancer, especially if the oesophagus is exposed to aggressive stomach acid for many years.

Besides these serious consequences, many patients already find the acute symptoms distressing. Persistent heartburn can significantly reduce quality of life, for example through ongoing burning behind the breastbone, chronic cough or hoarseness. An unpleasant taste in the mouth and dental damage from rising acid are also possible.

When should you see a doctor for heartburn?

Heartburn occurs occasionally in many people and can often be controlled well with over‑the‑counter medication and lifestyle changes. However, if symptoms occur regularly or persist, a medical consultation is advisable. Only a medical examination can clarify the exact cause and enable appropriate treatment.

Exercise particular caution if, in addition to heartburn, symptoms such as difficulty swallowing, unexplained weight loss, a bloated abdomen, repeated or bloody vomiting, or black stools occur. These signs can indicate serious conditions such as chronic reflux disease or, more rarely, severe problems like stomach cancer. Early diagnosis is crucial to minimise health risks.

In most cases the general practitioner is the first point of contact. After a thorough examination they can either start an appropriate therapy or refer to a specialist in digestive diseases (gastroenterologist).

How is heartburn diagnosed?

The diagnosis of heartburn begins with a detailed medical history in which the doctor asks specifically about the duration, frequency and severity of the complaints. It will also be determined whether symptoms are worsened by factors such as lying down, eating or stress, and whether accompanying symptoms such as nausea or stomach pain are present. Based on this information, reflux disease can often be identified.

For mild complaints a so‑called proton pump inhibitor test may be performed. Patients take a medication that suppresses stomach acid production for two to four weeks. If the symptoms improve, this suggests reflux disease.

Further investigations are carried out for more precise assessment. An endoscopy (gastroscopy) allows direct visualisation of the mucosa of the oesophagus and stomach. Inflammations, narrowings or tissue changes can be detected and, if necessary, biopsies taken. This examination is particularly useful if additional symptoms such as persistent vomiting, weight loss or blood in the stool occur.

Additionally, a 24‑hour pH monitoring can be performed to measure acidity in the lower oesophagus. A thin probe is passed through the nose and connected to a small recording device. This test is useful when endoscopy has not produced a clear finding or symptoms persist despite therapy.

Oesophageal manometry (oesophageal pressure measurement) can further assess the function of the oesophageal musculature. A pressure‑sensitive probe evaluates oesophageal motility. Other tests may be necessary for unclear complaints or suspected alternative conditions.

What you can do against heartburn: useful tips

• Drink plenty of water or unsweetened tea to dilute gastric juice in the oesophagus and promote its return to the stomach. Prefer still water or teas without carbonation.
• For acute heartburn, medicinal clay dissolved in a glass of water can help. Often one teaspoon is enough.
• Drink raw potato juice to neutralise stomach acid and form a protective layer on the mucous membranes. This home remedy has proven particularly useful during pregnancy.
• Try a “KüKaLeiWa” cure (caraway, chamomile, linseed, water) to stimulate digestion and relieve reflux.
• For occasional heartburn, starchy foods can help because they bind excess stomach acid. These include rusk, white bread, potatoes or bananas. 
• A glass of milk or a handful of nuts also act to neutralise stomach acid. 
• Reduce consumption of caffeinated drinks such as coffee or black tea, as they can also promote heartburn.
• Avoid fatty, fried or heavily spiced foods as they increase stomach acid production.
• If you only suffer occasional heartburn, try diluted apple cider vinegar with meals. Apple cider vinegar can neutralise stomach acid.
• Some people experience improvement after taking a spoonful of mustard after eating, as the mustard oils have a supportive effect.
• Short‑term relief can also be achieved with half a teaspoon of bicarbonate in a glass of water, but it should not be used regularly. Also pay attention to a stomach‑friendly diet.
• Eat smaller meals so the stomach contents do not overload the sphincter. Antacids can help relieve symptoms by neutralising stomach acid and easing the oesophagus.
• Take a digestive walk after meals to relieve the stomach and prevent reflux, and avoid eating at least four hours before bedtime to prevent nighttime heartburn.
• Wear comfortable clothing that does not press on the stomach to avoid reflux.
• Create a comfortable sleep environment by raising the head of the bed 10 to 15 cm to make it harder for stomach acid to rise.
• Sleep on your left side to minimise stomach acid backflow. Avoid sleeping on your stomach, as this may promote heartburn.

Heartburn can have various causes, but with the right treatment and prevention the complaints are usually well controlled. Early medical consultation is advisable to avoid long‑term complications.