Indigestion (heartburn and reflux)

When you chew and swallow food, muscular waves known as peristalsis push it down the esophagus and through a ring of muscle called a sphincter, into the stomach. The sphincter normally keeps the stomach’s contents from travelling back the way they came.

Sometimes, even in healthy people, stomach contents squeeze back up through the sphincter and into the esophagus. This is called reflux, and it is also known as gastro-esophageal reflux disease, indigestion or heartburn. It usually feels like a burning sensation behind the breastbone.

What causes occasional heartburn#

Food inside the stomach is held in place largely by gravity, so heartburn often happens when the stomach is full or under extra pressure. Common triggers include:

• Eating a large meal
• Eating a large meal and then being physically active, such as lifting or bending
• Drinking too much coffee or alcohol
• Anxiety, which can make the stomach feel like it is churning
• Advanced pregnancy, when the womb pushes up against the stomach

Because gravity helps keep food down, it is best not to lie down straight after a big meal. Anything that puts extra pressure on the stomach, such as stooping or bending, can also force the contents up into the esophagus.

Treatment for occasional heartburn#

For most healthy people, taking an antacid and waiting for the discomfort to settle is all the treatment that is needed. If heartburn keeps coming back, it is worth looking at the causes below.

Heartburn and excess weight#

Persistent heartburn can be linked to carrying extra weight. Fat inside the abdomen reduces the amount of room available for the stomach and small intestine, which raises the pressure on the stomach and pushes its contents upward.

Losing weight, where appropriate, may reduce how often symptoms occur.

Frequent heartburn (gastro-esophageal reflux disease)#

When heartburn is frequent, several factors may be involved:

• Hiatus hernia – part of the stomach is pushed up through the diaphragm and stays there
• Dietary factors – fats, chocolate, alcohol and coffee may provoke heartburn because of their effect on the sphincter
• Smoking – giving up cigarettes can help

Possible complications#

Ongoing reflux can lead to:

• Esophagitis – inflammation of the esophagus
• Ulceration – which can cause bleeding, scarring and stricture (narrowing) of the esophagus
• Barrett’s esophagus – a premalignant change in the lining of the lower esophagus

Chronic exposure of the esophagus to stomach juices can lead to Barrett’s esophagus, which is a risk factor for cancer of the lower esophagus. If you have had long-term reflux for five years or more, talk to your doctor about whether testing for Barrett’s esophagus is appropriate for you.

Reducing your risk#

You can lower your risk of gastro-esophageal reflux disease by:

• Losing weight, if necessary
• Trying not to increase pressure in the abdomen through bending or lifting
• Raising the head of your bed to reduce reflux while sleeping
• Making dietary changes
• Giving up smoking

Talk to your doctor about which of these strategies may work best for you.

If you need care today for symptoms that are not life-threatening but you cannot get a regular appointment, services that provide same-day, non-emergency care (often with extended hours) may be able to help.

Key points#

• Reflux happens when stomach contents squeeze back into the esophagus, causing a burning feeling behind the breastbone.
• Occasional heartburn can be triggered by large meals, coffee or alcohol, anxiety and advanced pregnancy.
• For healthy people, an antacid and waiting is usually enough.
• Losing excess weight may reduce symptoms.
• Long-term reflux can lead to complications, and Barrett’s esophagus is a risk factor for cancer of the lower esophagus.

Where to get help#