It burns behind your breastbone, rises up sour, and likes to show up after meals or at night when you lie down: almost everyone knows heartburn – and once in a while, it’s completely normal. But if the burning becomes a regular companion, it’s worth a closer look. Constant reflux can irritate your esophagus and shouldn’t simply be “swallowed” for years. Here you’ll learn how heartburn develops, which steps actually help and when it’s time to get it checked.
Key takeaways
- Heartburn happens when acidic stomach contents flow back up into the esophagus (reflux) – the valve at the entrance to the stomach doesn’t seal properly.
- Typical triggers: large, fatty meals, alcohol, coffee, nicotine, sweets, late-night eating and excess weight.
- Occasional heartburn is harmless – frequent heartburn (several times a week) should be checked and treated.
- Many people become symptom-free with lifestyle changes and a temporary course of acid blockers.
- Don’t confuse the two: burning and pressure behind the breastbone can also come from the heart.
How heartburn develops
Between your esophagus and your stomach sits a ring of muscle that works like a one-way valve: food goes in, stomach acid is supposed to stay in. If this valve relaxes too often, or if the pressure in your belly is too high – after a big meal, with excess weight or during pregnancy, for example – acidic stomach contents flow back up into the esophagus. Its lining isn’t built for acid: it burns. You may also get sour belching, a dry cough, a constant urge to clear your throat and a hoarse voice in the morning – the last one also occurs with so-called silent reflux, which comes without any classic burning at all.
The most common triggers
- Large, fatty and late meals: they stretch the stomach, slow down emptying and relax the valve – a big dinner followed by the couch is the classic combination.
- Alcohol, coffee and nicotine: all three loosen the valve muscle; alcohol also irritates the lining.
- Sweet and acidic foods: chocolate, soft drinks, citrus fruit and tomatoes are common personal triggers.
- Excess weight: extra pressure in the abdomen pushes stomach contents toward the valve – even moderate weight loss brings noticeable relief.
- Stress: makes you feel the acid more and tempts you into exactly the habits that promote reflux.
- Medications: some drugs (e.g., certain blood pressure and asthma medications) can relax the valve even more – it’s worth taking a look at your medication list.
Important to know: Frequent, untreated reflux can inflame the lining of the esophagus over time (reflux esophagitis) and, in rare cases, promote tissue changes. So the rule is: if you have heartburn more than twice a week, or have been taking acid blockers on your own for months, get the cause properly checked once.
Burning and pressure behind the breastbone aren’t always the stomach – the heart can feel the same way. Call for help immediately if you have:
- Pressure or tightness in your chest that spreads to your arm, back, neck or jaw
- Shortness of breath, cold sweats, nausea or dizziness along with it
- Severe symptoms during physical exertion for the first time
When in doubt, always rule out the heart first.
Call 112 (emergency)
