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What Causes Heartburn? A Checklist Your daily habits may be triggering your heartburn.

While most heartburn sufferers may recognize the symptoms of the condition, few are aware of how it starts. The root cause of heartburn stems from a weakened lower esophageal sphincter (LES), or when the LES relaxes abnormally.1

The LES is a circular band of muscle at the bottom of your esophagus, and it acts like a 'valve' as it enters the stomach. Normally when you swallow, your LES relaxes to let food and liquid flow into your stomach, and then it closes again. For some people, though, the LES may open too often or not close tight enough. When this happens, the acid in your stomach can flow back up into your esophagus. Since your esophagus doesn't have the same protective lining that your stomach does, the acid can irritate its more sensitive tissues, triggering heartburn and discomfort. Foods That May Trigger Heartburn

Although the actual cause of heartburn is physical, people generally view their heart- burn triggers as the root cause. Though scientifically that’s not the case, it’s still worth noting which behaviors can trigger the experience of heartburn. Food, for instance, is a common heartburn trigger.2

Check out this list of common offenders to see if any could be triggering your heart- burn:

Tomatoes, tomato sauce, and ketchup Oranges, grapefruit, and other citrus fruits and juices Garlic Vinegar Onions Chocolate Coffee, tea, or other caffeinated products Alcohol Peppermint Fried & fatty foods Carbonated drinks Mustard, pepper, and other spices3

Habits That May Trigger Heartburn

Many people realize that their behaviors around mealtime, or the activities they take part in, also can cause heartburn.4 Here are some habits that could be triggering your heartburn symptoms:

Eating large meals or eating too fast Laying down right after eating Eating close to bedtime

Drinking alcohol or smoking Pressure on the stomach from frequent bending over or tight clothes Stress and/or anxiety Exercising soon after eating5

Medications That May Trigger Heartburn

There are some medications that can cause heartburn, because they may relax the LES. You may want to talk to your pharmacist or doctor about your heartburn if you're taking any of the following:

Medications for asthma or allergies Prescription blood pressure or angina pills Medication for a urinary tract infection Muscle relaxants Prescription pain killers

Antidepressants6

Physical Changes & Conditions That May Trigger Heartburn

It's true that your meals, habits, or even medication could be triggering your heart- burn. But the fact is that heartburn is a real condition with biological causes. Here are some physical reasons you could be suffering from heartburn:

Pregnancy Acid Reflux GERD or Acid Reflux Disease Weak esophageal muscles Stomach emptying muscles Obesity Anxiety or depression Hiatal hernia Peptic ulcer6

What Behaviors Can Trigger Heartburn? From your eating habits to your clothing choices, here are the most common culprits.

Everyone has rituals—from enjoying their morning coffee to snacking in the midst of a busy day—and most are harmless. There are, however, a few daily habits that could be contributing to your heartburn. Eating Habits

If you’ve ever had a large meal or eaten too fast, there’s a good chance you experi- enced heartburn afterwards. This occurs because you added too much food, too quickly, so your stomach had to work overtime to process it.

It's healthier to have three small meals a day that are supplemented by healthy snacks whenever you feel hunger coming on. You won't get too full, which will prevent your stomach from overproducing the acid that causes heartburn.1

It’s also important to eat slowly. Remember to put your fork and knife down between bites, and to chew your food 20 times before swallowing.2 Lastly, avoid eating too close to your bedtime.3 General Habits

Your general behaviors also can cause heartburn. After eating, avoid lying down flat, so as not to put pressure on the stomach and increase your chances for reflux. Wait two to three hours after eating before going to bed.

It’s also important to avoid working out after a meal, so the contents of your stomach aren’t bouncing around during an exercise routine. After you’ve eaten, wait 30 mi- nutes to one hour before exercising. Clothing Choices

Wearing clothing or belts that are too tight around the abdomen can put constant pressure on your stomach. When pressure builds, acid has no place to go but up and out. An easy fix, without costing you a dime, is to loosen your belt a notch or two.

How You Can Reduce Heartburn Although you may not always be able to prevent heartburn, there are several things you can do to reduce your chances of triggering it.

Looking for heartburn relief? It might be time to switch up your routine. Here are some changes that may help:

Change your sleeping position

Sleeping on your left side and with your upper body elevated by a 6-to-10-inch wedge- shaped pillow may help reduce your heartburn. Relax

Start by taking deep breathes. If you’re feeling stressed at the office, take a break— go outside to get some air and walk around the block. You may be surprised what the change of pace can do. Yoga and meditation also can be great stress relievers. Eat healthier

Consider including foods that are low in fat and high in protein, and make sure that you stop eating before you’re full. Rethink your workout

Exercises like sit-ups and crunches can increase pressure on your stomach, pushing acid into the esophagus to trigger heartburn pain.1 Other activities like running cause you to bounce, increasing your risk of getting heartburn. You may want to try calmer activities like walking. Consider speaking with a personal trainer to see what’s less likely to trigger heartburn. Maintain a healthy weight

Extra pounds can put pressure on your stomach, causing acid to back up into your

esophagus.1

Eat smaller meals

Instead of three big meals, try eating smaller ones with snacks in between. This will help reduce acid production in your stomach, and lower your chances for heartburn.2 Avoid certain foods

While spicy foods are the most commonly reported food that triggers heartburn, they can vary from person to person. Carbonated drinks, high-fat foods, caffeine, citrus fruits, and even chocolate can cause heartburn.1 Quit smoking

Smoking is a well-known trigger for heartburn. The nicotine and other chemicals in cig- arettes can relax the lower esophageal sphincter as they enter the body. Quitting, or at least cutting back, can help with your heartburn symptoms and improve your over- all health.3

Gastroesophageal reflux disease (GERD)

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Mayo Clinic

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Overview

How GERD occurs in the esophagus How heartburn and GERD occur

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.

Most people can manage the discomfort of GERD with lifestyle changes and over-the- counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms. Symptoms

Common signs and symptoms of GERD include:

A burning sensation in your chest (heartburn), usually after eating, which might be worse at night Chest pain Difficulty swallowing Regurgitation of food or sour liquid Sensation of a lump in your throat

If you have nighttime acid reflux, you might also experience:

Chronic cough Laryngitis New or worsening asthma Disrupted sleep

When to see a doctor

Seek immediate medical care if you have chest pain, especially if you also have short- ness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack.

Make an appointment with your doctor if you:

Experience severe or frequent GERD symptoms Take over-the-counter medications for heartburn more than twice a week

Request an Appointment at Mayo Clinic Causes

GERD is caused by frequent acid reflux.

When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stom- ach. Then the sphincter closes again.

If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed. Risk factors

Conditions that can increase your risk of GERD include:

Obesity Bulging of the top of the stomach up into the diaphragm (hiatal hernia) Pregnancy Connective tissue disorders, such as scleroderma Delayed stomach emptying

Factors that can aggravate acid reflux include:

Smoking Eating large meals or eating late at night Eating certain foods (triggers) such as fatty or fried foods Drinking certain beverages, such as alcohol or coffee Taking certain medications, such as aspirin

Complications

Over time, chronic inflammation in your esophagus can cause:

Narrowing of the esophagus (esophageal stricture). Damage to the lower esopha- gus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. An open sore in the esophagus (esophageal ulcer). Stomach acid can wear away tis- sue in the esophagus, causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult. Precancerous changes to the esophagus (Barrett's esophagus). Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associ- ated with an increased risk of esophageal cancer.

Diagnosis

Endoscopy

Endoscopy

Your doctor might be able to diagnose GERD based on a physical examination and his- tory of your signs and symptoms.

To confirm a diagnosis of GERD, or to check for complications, your doctor might rec- ommend:

Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach. Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications. An endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for com- plications such as Barrett's esophagus. Ambulatory acid (pH) probe test. A monitor is placed in your esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder. The monitor might be a thin, flexible tube (catheter) that's threaded through your nose into your esophagus, or a clip that's placed in your esophagus during an endos- copy and that gets passed into your stool after about two days. Esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordi- nation and force exerted by the muscles of your esophagus. X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine. You may

also be asked to swallow a barium pill that can help diagnose a narrowing of the esophagus that may interfere with swallowing.

Treatment

Nissen fundoplication GERD surgery

The ring of beads between the esophagus and stomach Substitute for esophageal sphincter

Your doctor is likely to recommend that you first try lifestyle modifications and over- the-counter medications. If you don't experience relief within a few weeks, your doc- tor might recommend prescription medication or surgery. Over-the-counter medications

The options include:

Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids and Tums, may provide quick relief. But antacids alone won't heal an inflamed esophagus dam- aged by stomach acid. Overuse of some antacids can cause side effects, such as diar- rhea or sometimes kidney problems. Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac). H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription. Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter pro- ton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).

Prescription medications

Prescription-strength treatments for GERD include:

Prescription-strength H-2-receptor blockers. These include prescription-strength fa- motidine (Pepcid), nizatidine and ranitidine (Zantac). These medications are generally well-tolerated but long-term use may be associated with a slight increase in risk of vi- tamin B-12 deficiency and bone fractures. Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Pro- tonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Although generally well- tolerated, these medications might cause diarrhea, headache, nausea and vitamin B-12 deficiency. Chronic use might increase the risk of hip fracture.

Medication to strengthen the lower esophageal sphincter. Baclofen may ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter. Side ef- fects might include fatigue or nausea.

Surgery and other procedures

GERD can usually be controlled with medication. But if medications don't help or you wish to avoid long-term medication use, your doctor might recommend:

Fundoplication. The surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usu- ally done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete. LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The Linx device can be implanted using minimally invasive surgery.

Request an Appointment at Mayo Clinic Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. Lifestyle and home remedies

Lifestyle changes may help reduce the frequency of acid reflux. Try to:

Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus. Stop smoking. Smoking decreases the lower esophageal sphincter's ability to func- tion properly. Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches. If you can't elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows isn't effective. Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed. Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite. Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine. Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.

Alternative medicine

No alternative medicine therapies have been proved to treat GERD or reverse damage to the esophagus. Some complementary and alternative therapies may provide some relief, when combined with your doctor's care.

Talk to your doctor about what alternative GERD treatments may be safe for you. The options might include:

Herbal remedies. Licorice and chamomile are sometimes used to ease GERD. Herbal remedies can have serious side effects and might interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy. Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of GERD. Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.

Preparing for your appointment

You may be referred to a doctor who specializes in the digestive system (gastroenter- ologist). What you can do

Be aware of any pre-appointment restrictions, such as restricting your diet before your appointment. Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment. Write down any triggers to your symptoms, such as specific foods. Make a list of all your medications, vitamins and supplements. Write down your key medical information, including other conditions. Write down key personal information, including any recent changes or stressors in your life. Write down questions to ask your doctor. Ask a relative or friend to accompany you, to help you remember what the doctor says.

Questions to ask your doctor

What's the most likely cause of my symptoms? What tests do I need? Is there any special preparation for them? Is my condition likely temporary or chronic? What treatments are available? Are there any restrictions I need to follow? I have other health problems. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment anytime you don't understand something. What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

When did you begin experiencing symptoms? How severe are they? Have your symptoms been continuous or occasional? What, if anything, seems to improve or worsen your symptoms? Do your symptoms wake you up at night? Are your symptoms worse after meals or lying down? Does food or sour material ever come up in the back of your throat? Do you have difficulty swallowing food, or have you had to change your diet to avoid difficulty swallowing? Have you gained or lost weight?

Nonulcer stomach pain

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Mayo Clinic

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Overview

Nonulcer stomach pain is a term for recurring signs and symptoms of indigestion that have no obvious cause. Nonulcer stomach pain is also called functional dyspepsia (dis- PEP-see-uh) or nonulcer dyspepsia.

Nonulcer stomach pain is common and can be long lasting. The condition can cause signs and symptoms that resemble those of an ulcer, such as pain or discomfort in your upper abdomen, often accompanied by bloating, belching and nausea. Symptoms

Signs and symptoms of nonulcer stomach pain may include:

A burning sensation or discomfort in your upper abdomen or lower chest, some- times relieved by food or antacids Bloating Belching An early feeling of fullness when eating Nausea

When to see a doctor

Make an appointment with your doctor if you experience persistent signs and symp- toms that worry you.

Seek immediate medical attention if you experience:

Bloody vomit Dark, tarry stools Shortness of breath Pain that radiates to your jaw, neck or arm Unexplained weight loss

Causes

It's not clear what causes nonulcer stomach pain. Doctors consider it a functional dis- order, which means it's not found to be caused by a specific disease or diagnosable disorder. Risk factors

Factors that can increase the risk of nonulcer stomach pain include:

Female sex Older age Use of certain over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others), which can cause stomach problems Smoking Anxiety or depression History of childhood physical or sexual abuse

Diagnosis

Endoscopy

Endoscopy

Your doctor will likely review your signs and symptoms and perform a physical exami- nation. A number of diagnostic tests may help your doctor determine the cause of your discomfort and rule out other disorders causing similar symptoms. These may in- clude:

Blood tests. Blood tests may help rule out other diseases that can cause signs and symptoms similar to those of nonulcer stomach pain. Tests for a bacterium. Your doctor may recommend a test to look for a bacterium called Helicobacter pylori (H. pylori) that can cause stomach problems. H. pylori test-

ing may use your blood, stool or breath. Using a scope to examine your digestive system. A thin, flexible, lighted instrument (endoscope) is passed down your throat so that your doctor can view your esophagus, stomach and the first part of your small intestine (duodenum). This will also allow the doctor to collect small pieces of tissue from your duodenum to look for inflammation.

Treatment

Nonulcer stomach pain that is long lasting and isn't controlled by lifestyle changes may require treatment. What treatment you receive depends on your signs and symp- toms. Treatment may combine medications with behavior therapy. Medications

Medications that may help in managing the signs and symptoms of nonulcer stomach pain include:

Over-the-counter gas remedies. Drugs that contain the ingredient simethicone may provide some relief by reducing intestinal gas. Examples of gas-relieving remedies in- clude Mylanta and Gas-X. Medications to reduce acid production. Called H-2-receptor blockers, these medica- tions are available over-the-counter and include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75). Stronger versions of these medications are available in prescription form.

Medications that block acid 'pumps.' Proton pump inhibitors shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps.

Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR), omeprazole (Prilosec OTC) and esopremazole (Nexium). Other proton pump inhibitors also are available by prescription. Medication to strengthen the esophageal sphincter. Prokinetic agents help your stomach empty more rapidly and may help tighten the valve between your stomach and esophagus, reducing the likelihood of upper abdominal discomfort. Medication to increase the rate of stomach emptying. Doctors may prescribe the medication metoclopramide (Reglan) if they find that emptying of your stomach is de- layed, but this drug doesn't work for everyone and may have significant side effects. Low-dose antidepressants. Tricyclic antidepressants and drugs known as selective serotonin reuptake inhibitors (SSRIs), taken in low doses, may help inhibit the activity of neurons that control intestinal pain. Antibiotics. If tests indicate that a common ulcer-causing bacterium called H. pylori is present in your stomach, your doctor may recommend antibiotics.

Behavior therapy

Working with a counselor or therapist may help relieve signs and symptoms that aren't

helped by medications. A counselor or therapist can teach you relaxation techniques that may help you cope with your signs and symptoms. You may also learn ways to re- duce stress in your life to prevent nonulcer stomach pain from recurring. Request an Appointment at Mayo Clinic Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. Lifestyle and home remedies

Your doctor may recommend lifestyle changes to help you control your nonulcer stom- ach pain. Make changes to your diet

Changes to your diet and how you eat might help control your signs and symptoms. Consider trying to:

Eat smaller, more-frequent meals. Having an empty stomach can sometimes pro- duce nonulcer stomach pain. Nothing but acid in your stomach may make you feel sick. Try eating a small snack, such as a cracker or a piece of fruit.

Avoid skipping meals. Avoid large meals and overeating. Eat smaller meals more fre- quently. Avoid trigger foods. Some foods may trigger nonulcer stomach pain, such as fatty and spicy foods, carbonated beverages, caffeine, and alcohol. Chew your food slowly and thoroughly. Allow time for leisurely meals.

Reduce stress in your daily life

Stress-reduction techniques may help you control your signs and symptoms. To reduce stress, spend time doing things that you enjoy, such as hobbies or sports. Relaxation therapy or yoga also may help. Alternative medicine

People with nonulcer stomach pain often turn to complementary and alternative med- icine to help them cope. No complementary or alternative treatments are proved to cure nonulcer stomach pain. But when used along with your doctor's care, comple- mentary and alternative treatments may provide relief from your signs and symptoms.

If you're interested in complementary and alternative treatments, talk to your doctor about:

Herbal supplements. Herbal remedies that may be of some benefit for nonulcer stomach pain include a combination of angelica, peppermint leaf, clown's mustard plant, German chamomile, caraway, licorice, milk thistle, celandine and lemon balm. These supplements may relieve some of the symptoms of nonulcer stomach pain, such

as fullness and gastrointestinal spasms.

Artichoke leaf extract may reduce other symptoms of nonulcer stomach pain, includ- ing vomiting, nausea and abdominal pain. Relaxation techniques. Activities that help you relax may help you control and cope with your signs and symptoms. Consider trying meditation, yoga or other activities that may help reduce your stress levels.

Preparing for your appointment

Make an appointment with your family doctor or a general practitioner if you have signs or symptoms that worry you. If nonulcer stomach pain is suspected, your doctor may refer you to a specialist in digestive diseases (gastroenterologist). What you can do

Take these steps to prepare for your appointment:

Be aware of any pre-appointment restrictions. At the time you make the appoint- ment, ask if there's anything you need to do in advance, such as restrict your diet. Write down any symptoms you're experiencing, including any that may seem unre- lated to the reason for which you scheduled the appointment. Write down key personal information, including any major stresses or recent life changes. Make a list of all medications, as well as any vitamins or supplements you take. Consider taking a family member or friend along. Sometimes it can be difficult to re- member all the information provided during an appointment. Someone who accompa- nies you may remember something that you missed or forgot. Write down questions to ask your doctor.

Questions to ask your doctor

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your visit. List your questions from most important to least impor- tant in case time runs out.

For nonulcer stomach pain, some basic questions to ask include:

What is likely causing my stomach discomfort? What are other possible causes for my stomach discomfort? What kinds of tests do I need? Is my stomach discomfort likely temporary or chronic? What are my treatment options? What are the alternatives to the primary approach that you're suggesting? I have other health conditions. How can I best manage them together? Are there any restrictions that I need to follow? Should I see a specialist? What will that cost, and will my insurance cover it?

Is there a generic version of the medicine you're prescribing me? Are there brochures or other printed material that I can take with me? What web- sites do you recommend? What will determine whether I should plan for a follow-up visit?

In addition to the questions you've prepared, don't hesitate to ask your doctor other questions that occur to you during your appointment. What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

When did you first begin experiencing symptoms? Have your symptoms been continuous or occasional? How severe are your symptoms? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? Have you lost weight?