Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Heartburn has nothing to do with the heart. It's stomach acid washing up into the gullet, and the burning behind the breastbone is the gullet lining objecting. Almost everyone gets it occasionally; the useful questions are what's triggering yours, which of the four pharmacy treatments fits the pattern, and when it has stopped being a pharmacy problem.
What does heartburn feel like?
A burning sensation in the centre of the chest, rising towards the throat, often within an hour of eating or when lying down or bending over. It may come with a sour or bitter taste at the back of the mouth, a feeling of food coming back up, bloating and belching, a persistent cough or hoarse voice, and nausea. Heartburn, acid reflux and indigestion get used interchangeably: reflux is the acid coming up, heartburn is the burning it causes, and indigestion is the broader discomfort after eating. Reflux that happens most weeks is called GORD (or GERD), and that's a GP conversation.
What causes heartburn?
The valve at the top of the stomach relaxing when it shouldn't. Big or late meals, fatty and spicy food, coffee, alcohol, chocolate and tomatoes, smoking, being overweight, pregnancy, stress, tight waistbands and some medicines (ibuprofen and aspirin, some blood pressure tablets) all make it more likely. A hiatus hernia, where part of the stomach slides up through the diaphragm, is a common cause of heartburn that keeps returning.
How to get rid of heartburn: the four treatments
Antacids such as Rennie neutralise acid within minutes and last an hour or two: the right thing for the occasional flare after a curry. Alginates such as Gaviscon Advance form a floating raft on top of the stomach contents so acid can't come up; they work in minutes and last for hours, which makes them the best choice for night-time reflux, for pregnancy, and for the taste-in-the-throat kind. Proton pump inhibitors (esomeprazole, as Nexium Control, and omeprazole) switch off acid production at the source: one tablet a day, taking one to four days to reach full effect, for heartburn that's happening two or more days a week. They're for adults, for a 14-day course without a doctor, and they aren't for instant relief, so pair the first days with an alginate. H2 blockers (famotidine) sit between the two in speed and strength. Everything here is in our heartburn range.
Does milk help heartburn?
For about ten minutes. Milk is mildly alkaline and coats the gullet, so it soothes briefly, but its fat and calcium then stimulate more acid, and many people feel worse half an hour later. A glass of water, an antacid, or an alginate does the job without the rebound. Baking soda in water works as a crude antacid but is high in salt and not for regular use.
How to stop heartburn coming back
Smaller meals, the last one three to four hours before bed; raising the head of the bed by 10 to 20cm (blocks under the legs, not extra pillows, which bend you at the waist); losing weight if you carry it around the middle; stopping smoking; and working out which of the trigger foods is actually yours rather than avoiding all of them. Left side sleeping helps too, because of where the stomach sits.
How long does heartburn last, and when to see a GP
An episode usually passes within a couple of hours, faster with treatment. See a GP if you get heartburn most days, if pharmacy treatment hasn't controlled it after two weeks, or if you've needed a PPI course more than once in a few months. Get seen urgently for difficulty or pain when swallowing, food sticking, unexplained weight loss, vomiting blood or black stools, or symptoms starting for the first time over 55. And if chest pain is crushing, spreads to the arm or jaw, or comes with breathlessness or sweating, treat it as a heart problem and call 999. Our guide to relieving constipation covers the other end of the gut, and our pharmacist can help you pick between the treatments.
Heartburn treatments compared
| Treatment | Works in | Lasts | Best for | Watch out for |
|---|---|---|---|---|
| Antacid (calcium carbonate, e.g. Rennie) | Minutes | 1 to 2 hours | Occasional heartburn after a meal | Constipation at high doses; leave 2 hours before other tablets |
| Alginate (Gaviscon Advance) | Minutes | Up to 4 hours | Night-time reflux, pregnancy, taste in the throat | Leave 2 hours before other medicines; high sodium in some liquids |
| H2 blocker (famotidine) | About an hour | Up to 12 hours | Predictable heartburn, taken before the trigger meal | Adults only; 2 weeks max without advice |
| PPI (esomeprazole, omeprazole) | 1 to 4 days to full effect | 24 hours per dose | Heartburn 2+ days a week | 18+, 14-day course, then GP if still needed; rebound acid when stopping |
Trigger foods: a checklist, and what to eat instead
The usual suspects are coffee and strong tea, alcohol (especially wine and spirits), chocolate, peppermint, tomato-based sauces, citrus and fizzy drinks, fried and fatty food, spicy food, onions and garlic, and large portions of anything. Not all of them will be yours; cut them one at a time for a week each and keep the ones that make no difference. What sits well: oats, bananas and melon, lean protein, green vegetables, rice and potatoes, ginger tea, and water rather than fizz. Eat slowly and stop before you're full; a stomach stretched by volume is the commonest trigger of all.
Heartburn at night
Lying flat lets acid pool in the gullet, which is why night heartburn lasts longer and hurts more. The fixes, in order: the last meal three to four hours before bed; the head of the bed raised 10 to 20cm on blocks (extra pillows just fold you at the waist and make it worse); sleeping on your left side, which keeps the stomach below the gullet; an alginate at bedtime; and a PPI in the morning if it's happening most nights. A persistent night cough, hoarseness on waking or a sour taste in the morning are often reflux you're sleeping through.
Heartburn and indigestion in pregnancy
Around half of pregnant women get heartburn, mostly in the last three months as the womb presses on the stomach and pregnancy hormones relax the valve. Small frequent meals, not lying down after eating, and an alginate such as Gaviscon are the standard approach and safe; antacids are fine in moderation. Avoid ibuprofen and aspirin. If that isn't enough, a GP or midwife can prescribe a stronger option; several are used in pregnancy. It resolves after the birth.
Taking a PPI, and stopping it
Take esomeprazole or omeprazole once a day, 30 to 60 minutes before breakfast, for up to 14 days without a doctor. It can take a few days to work, so use an alginate for breakthrough symptoms early on. Don't stop dead after weeks of use: the stomach over-produces acid for a few days afterwards (rebound), which people mistake for the problem returning. Step down to every other day for a week with an antacid to hand, then stop. If you need a second course within a few months, see a GP rather than buying another pack; long-term PPI use has its own considerations and needs a reason.
Frequently asked questions
Can I take Gaviscon and omeprazole together?
Yes. Take the omeprazole in the morning before food and Gaviscon after meals or at bedtime; leave two hours between Gaviscon and other tablets, as it can affect their absorption.
How to get rid of heartburn during pregnancy?
Small meals, not lying down after eating, and an alginate such as Gaviscon, which is widely used in pregnancy. Check with a pharmacist or midwife before anything else.
Is heartburn dangerous?
Occasional heartburn isn't. Years of untreated reflux can damage the gullet lining, which is why daily symptoms deserve a GP's attention rather than a permanent antacid habit.
Heartburn or a heart attack?
Heartburn burns and is worse lying down or after food; it doesn't spread to the arm or jaw or come with sweating and breathlessness. If you're unsure, especially with exertion or in someone with heart risk factors, call 999. Nobody is criticised for that call.