Heartburn, also known as pyrosis or acid indigestion, is a burning discomfort felt in the chest or throat. It’s a symptom of acid reflux, a condition in which stomach acid backs up into the esophagus. While it’s common and usually harmless, frequent or persistent heartburn may indicate a more serious condition like gastroesophageal reflux disease (GERD).

For many people, occasional heartburn resolves on its own or with minimal intervention. However, chronic pyrosis can be disruptive and even lead to long-term complications if not managed properly. Understanding its causes, symptoms, and treatments can help you take control of this uncomfortable digestive issue.

Recognizing The Symptoms

Heartburn symptoms are often described as a burning or tight sensation in the chest, typically behind the breastbone. Symptoms may appear shortly after eating, lying down, or bending over.

Common signs of pyrosis include:

  • Burning pain in the chest or throat

  • Sour or acidic taste in the back of the mouth

  • Hoarseness or voice changes

  • A persistent cough

  • Feeling of a lump in the throat

  • Difficulty or pain when swallowing (dysphagia)

  • Nausea or vomiting

Symptoms can last from a few minutes to several hours and may worsen at night or when reclining. If you experience these symptoms more than twice a week, it could indicate GERD, a chronic and more serious form of acid reflux.

Heartburn vs. Heart Attack

It’s crucial not to confuse heartburn with a heart attack. Both can cause chest pain, but they differ in origin. Heartburn stems from acid irritation, while a heart attack involves the heart’s blood supply.

Seek emergency medical attention if you also experience:

  • Shortness of breath

  • Cold sweats

  • Dizziness or fainting

  • Radiating pain in the jaw or arms

What Triggers Heartburn?

Heartburn occurs when the lower esophageal sphincter (LES)—the muscular ring separating the stomach from the esophagus—relaxes inappropriately or fails to close tightly. This allows acidic contents from the stomach to flow backward into the esophagus, irritating its lining.

Unlike the stomach, the esophagus isn’t equipped to handle acid, leading to the classic burning sensation. While occasional reflux can be harmless, chronic exposure may damage the esophageal lining.

Common Causes of Pyrosis

A wide range of factors can trigger or worsen pyrosis:

  • Certain medications: NSAIDs, benzodiazepines, calcium channel blockers, tricyclic antidepressants, iron supplements

  • Food and drink: Spicy foods, fatty or fried foods, chocolate, onions, peppermint, tomatoes, citrus, carbonated drinks, coffee, and alcohol

  • Lifestyle habits: Smoking, overeating, or lying down soon after meals

  • Medical conditions: GERD, hiatal hernia, delayed gastric emptying, or esophageal motility disorders

Who Is at Risk?

Several risk factors increase the likelihood of developing frequent heartburn:

  • Pregnancy: Hormonal changes and pressure on the stomach make heartburn common during pregnancy (up to 45% of cases)

  • Obesity: Excess abdominal weight increases pressure on the stomach

  • Smoking: Weakens the LES and damages the esophageal lining

  • Stress and anxiety: Can influence digestive function and acid secretion

  • Dietary habits: Frequent consumption of acidic, spicy, or fatty foods

Getting Diagnosed

In most cases, your healthcare provider can diagnose pyrosis based on your symptoms. However, when symptoms are chronic, severe, or unresponsive to treatment, further testing may be necessary to identify underlying causes.

Diagnostic Tests

Upper GI Endoscopy

This test uses a flexible tube with a camera to view the esophagus, stomach, and upper small intestine. It helps identify inflammation, ulcers, or Barrett’s esophagus.

Biopsy

During an endoscopy, a small tissue sample may be taken for analysis. This helps rule out infections or abnormal cell changes.

pH Monitoring

This test measures the amount of acid in your esophagus over 24 hours. It may involve inserting a catheter through the nose or using a capsule attached to the esophageal wall.

Esophageal Manometry

A catheter measures the strength and coordination of esophageal muscle contractions during swallowing.

X-ray Imaging

A barium swallow can help detect anatomical abnormalities like hiatal hernia but is not typically used to diagnose acid reflux alone.

How It’s Treated

The primary goals in treating pyrosis are to relieve symptoms, prevent recurrence, and address any underlying conditions. Treatment may involve medications, surgery, and lifestyle modifications.

Over-the-Counter Medications

  • Antacids: Provide quick relief by neutralizing stomach acid (e.g., Tums, Mylanta)

  • H2 Blockers: Reduce acid production (e.g., famotidine, nizatidine)

  • Proton Pump Inhibitors (PPIs): Block acid production and promote healing of the esophageal lining (e.g., omeprazole, lansoprazole, pantoprazole)

OTC remedies are often effective for mild, occasional symptoms. For persistent or severe symptoms, prescription-strength medications may be necessary.

Surgical Treatments

For those with chronic or severe reflux, or when medications aren’t effective, surgical options may be considered:

  • Fundoplication: The top of the stomach is wrapped around the LES to strengthen it and prevent acid reflux.

  • Endoscopic Therapies: Use radiofrequency or other methods to reinforce or tighten the LES.

  • Bariatric Surgery: Weight-loss surgeries such as gastric bypass may help reduce reflux in obese individuals.

  • Hiatal Hernia Repair: Surgery to reposition and secure the stomach in cases of hiatal hernia.

Prevention Strategies

Preventing pyrosis often involves simple lifestyle changes that can make a big difference.

Dietary Adjustments

  • Limit or avoid trigger foods (spicy, acidic, fatty)

  • Eat smaller meals more frequently

  • Stay upright for 2–3 hours after eating

  • Keep a food diary to track symptom patterns

  • Cut down on alcohol and caffeine

Avoid Smoking

Tobacco weakens the LES and reduces saliva production, which helps neutralize acid. Quitting smoking can significantly reduce the frequency and severity of heartburn.

Weight Management

Losing excess weight helps decrease intra-abdominal pressure and reduces the risk of acid reflux. A healthy diet and regular physical activity are key components of weight control.

Improve Sleep Positioning

Avoid lying down immediately after eating, especially in the evening. Elevating the head of the bed by 6–8 inches may help keep acid in the stomach. Sleeping on your left side may also reduce reflux episodes.

Complications of Untreated Heartburn

Persistent or untreated pyrosis can lead to serious complications:

  • Esophagitis: Inflammation of the esophagus, possibly resulting in bleeding or ulcers

  • Barrett’s Esophagus: A pre-cancerous condition where esophageal tissue changes due to repeated acid exposure

  • Esophageal Strictures: Narrowing of the esophagus due to scar tissue, making swallowing difficult

  • Laryngitis and Hoarseness: Acid irritation affecting the vocal cords

  • Respiratory Issues: Chronic acid exposure may contribute to asthma or worsen existing lung conditions

  • Tooth Enamel Erosion: Stomach acid can damage teeth, leading to decay and sensitivity

Living With Pyrosis

If you experience frequent or chronic heartburn, managing your condition effectively is essential for maintaining a good quality of life. Combining medication with lifestyle changes offers the best results in most cases.

Tips for everyday management:

  • Stick to your prescribed treatment plan

  • Avoid late-night meals

  • Sleep with your head elevated

  • Chew gum to stimulate saliva (avoid peppermint or spearmint)

  • Choose non-acidic fruits and vegetables

  • Limit processed and fried foods

Managing stress and avoiding common triggers will also reduce the likelihood of flare-ups.

Final Thoughts

Heartburn, or pyrosis, is an uncomfortable yet common condition affecting people of all ages. While occasional heartburn is generally harmless, persistent symptoms should not be ignored, as they may indicate GERD or other digestive disorders. Thankfully, with proper care, dietary awareness, and treatment, most individuals can live comfortably and symptom-free.