Heartburn is a burning sensation behind the breastbone — it occurs when stomach acid flows back into the esophagus (reflux). At the junction between the esophagus and the stomach there is a sphincter (the lower esophageal sphincter) that normally prevents stomach contents from rising. If this mechanism is impaired, reflux occurs.²
Occasional heartburn (e.g. after a heavy meal) is usually harmless. It becomes problematic when reflux occurs regularly:
Typical symptoms, but the mucosa looks normal during gastroscopy. More common than the erosive form. Can still cause a significant burden.
Heartburn and gastritis (inflammation of the stomach lining) are different conditions but can occur at the same time.
2. Causes and risk factors
Why the sphincter can fail
Overweight/obesity — considered one of the most important risk factors; the increased abdominal pressure pushes stomach contents upward. Weight loss is often the most effective single measure
Hiatal hernia — part of the stomach slips through the diaphragm into the chest; particularly common in older people and promotes reflux
Smoking — can lower the tension of the sphincter and reduce saliva production
Alcohol — relaxes the sphincter and directly irritates the mucosa
Dietary and behavioral triggers
Eating shortly before going to bed — lying down promotes reflux
Burning behind the breastbone — often after eating, when lying down or bending over
Acid regurgitation — sour or bitter taste in the mouth
Upper abdominal pain
Regurgitation — stomach contents rise up into the mouth
Extraesophageal symptoms (atypical — often not recognized as reflux)
Chronic cough — especially at night and in the morning; reflux is one of the most common causes
Hoarseness and a constant urge to clear the throat — acid can irritate the larynx (laryngopharyngeal reflux)
Sore throat — chronic, especially in the morning; a lump-in-the-throat sensation
Tooth enamel erosion — often first noticed by the dentist
Worsening of asthma — acid in the airways can trigger bronchospasm
Chest pain — can resemble a heart attack; reflux is one of the most common causes of non-cardiac chest pain
4. When to see a doctor? Warning signs
See your GP or a gastroenterologist if heartburn occurs regularly, persists for several weeks, or does not improve despite lifestyle changes and/or taking PPIs.
Warning signs — seek prompt medical evaluation:
Difficulty swallowing or pain when swallowing · Unintended weight loss · Blood in vomit or black stools · Chest pain — always have it checked if you are unsure · First occurrence at an older age
Heartburn or heart attack? When in doubt, call 112!
Heartburn usually burns, is position-dependent, gets worse after eating and improves with antacids. A heart attack presses or squeezes, often radiates to the arm, jaw or back — accompanied by cold sweats, nausea, anxiety. When in doubt, ALWAYS call 112.
5. Diagnosis
Clinical diagnosis: Typical symptoms and a response to PPIs are sufficient for the diagnosis in most patients. For typical reflux without warning signs, gastroscopy is often not necessary.¹
Gastroscopy: For warning signs, treatment failure, a first manifestation at an older age, or before a planned operation. Can reveal esophagitis, Barrett's esophagus, a hiatal hernia or a Helicobacter infection.
pH-metry (24h): The gold standard for unclear reflux. Measures acid exposure in the esophagus over 24 hours (probe or wireless capsule).
Impedance pH-metry: A newer technique that also detects non-acidic reflux — e.g. for symptoms despite taking PPIs.
The choice depends on severity, symptom pattern and individual factors. The decision is usually made by the treating doctor.¹
PPIs (proton pump inhibitors) — first choice: omeprazole, pantoprazole, esomeprazole
Significantly inhibit stomach acid production and are considered the first choice for GERD. Intake: Usually in the morning on an empty stomach, some time before breakfast. Duration: Individual — from a few weeks to longer-term therapy in Barrett's esophagus. Long-term side effects: Among others, vitamin B12 or magnesium deficiency, an increased risk of certain intestinal infections, and possibly an increased fracture risk in older people. Have the need reviewed by a doctor regularly.² Do not stop abruptly: A rebound effect is possible. Taper slowly as recommended by your doctor. More: Stopping medications.
H2 blockers (e.g. famotidine)
Weaker acid suppression than PPIs, but often a faster onset of action. Available over the counter. Can be useful for nighttime reflux or as an add-on to PPIs.
Alginates (e.g. Gaviscon)
Form a protective layer on top of the stomach contents — acting as a kind of reflux barrier. Well tolerated, fast-acting, suitable as an on-demand medication.
Antacids (e.g. Maaloxan, Rennie)
Neutralize stomach acid directly. Fast relief, but usually only a short duration of action. They usually do not heal esophagitis.
Surgery (fundoplication)
In some patients with severe reflux that does not respond adequately to medication, or with mechanical causes (e.g. a large hiatal hernia), surgical therapy may be considered. The indication is usually determined by specialized centers.
7. Home remedies and lifestyle — what really helps
Lifestyle changes are considered the basis of any reflux therapy and can in some cases reduce the need for medication:¹˒²
Weight loss — considered the most effective single measure if you are overweight
Elevate the upper body when sleeping — e.g. a wedge pillow or raising the head of the bed (not just stacking pillows, as that can bend the abdomen)
Sleeping on the left side — studies usually show less reflux than sleeping on the right side
Last meal a few hours before going to bed
Smaller, more frequent meals instead of fewer large ones
Identify and avoid individual triggers (e.g. fatty food, coffee on an empty stomach, alcohol, chocolate, peppermint)
Quitting smoking — can improve sphincter function
Avoid tight clothing and belts — pressure on the abdomen
Chew gum after eating — stimulates saliva production (saliva can neutralize acid)
Reduce stress
Milk and baking soda: only short term
Milk can provide short-term relief, but in the long term it can stimulate acid production — water is usually the better choice. Baking soda does neutralize acid quickly, but because of possible side effects (high sodium load, CO2 formation, rebound) it should not be used regularly.
8. Complications: Barrett's esophagus
Long-term, untreated reflux can permanently change the esophagus:¹
Esophagitis: Inflammation of the esophageal lining with redness, erosions and possible pain when swallowing. Usually heals within a few weeks on PPIs.
Stricture (narrowing): Scarred narrowing due to chronic inflammation. Typical symptom: increasing difficulty swallowing. Can usually be treated endoscopically.
Barrett's esophagus: Long-standing reflux can change the mucosal tissue of the esophagus (metaplasia). Considered a precancerous condition. Regular gastroscopy checks with biopsies are recommended. In the case of dysplasia, endoscopic treatment may be an option. Long-term PPI therapy is often recommended.¹
Barrett's esophagus: put the cancer risk in perspective
According to current knowledge, the absolute cancer risk with Barrett's esophagus is rather low. Regular checks allow early detection and treatment before cancer develops.
How brite helps you with heartburn
PPIs in the morning on an empty stomach, documenting heartburn triggers, checking interactions — brite keeps track.
Intake reminder — PPIs in the morning on an empty stomach, in good time before breakfast: brite reminds you on time. Set up a reminder
Interaction check — check PPIs in combination with other medications for free. Check now
Health history — document heartburn episodes, triggers and meals. Track your history
Digital medication plan — all medications clearly organized for gastroenterology, your GP and the pharmacy. Go to medication plan
Occasionally, usually not. Chronic heartburn can, however, lead to esophagitis, Barrett's esophagus or a narrowing of the esophagus. In the case of warning signs (difficulty swallowing, blood, unintended weight loss), prompt medical evaluation should take place.¹
In the short term, cold milk can sometimes buffer the acid a little. In the long term, however, milk can even stimulate acid production. Water is usually the better choice; chewing gum after eating can also help (it stimulates saliva production).
Longer-term use can be medically appropriate (e.g. with Barrett's esophagus or severe esophagitis) — usually under medical supervision. The need should be reviewed regularly. In many cases, reducing to the lowest effective dose or an on-demand therapy can be sufficient.²
After abruptly stopping PPIs, stomach acid production can be temporarily increased (rebound effect). Tapering slowly as recommended by your doctor is therefore usually advisable. More: Stopping medications.
Long-standing reflux changes the mucosal tissue of the esophagus (metaplasia). It is considered a precancerous condition, but: according to current knowledge, the absolute cancer risk is rather low. Regular gastroscopy checks allow early detection. Long-term PPI therapy is often recommended.¹
Heartburn usually burns, is position-dependent and usually improves with antacids or PPIs. A heart attack presses or squeezes, often radiates to the arm, jaw or back, accompanied by cold sweats, nausea or anxiety. When in doubt, always call the emergency number 112.
With a hiatal hernia, part of the stomach slips up through an opening in the diaphragm into the chest. It is particularly common in older adults and promotes reflux, but does not necessarily cause symptoms. The reflux is usually treated with medication; surgery is usually not necessary.
Yes — reflux is one of the most common causes of chronic cough. Acid in the throat and larynx area (laryngopharyngeal reflux) can cause coughing, hoarseness and a constant urge to clear the throat — often even without classic heartburn.
Weight loss (if you are overweight) is considered the most effective single measure. In addition: have your last meal a few hours before sleeping, elevate your upper body, quit smoking. PPIs are considered the medication of choice.¹˒²
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Always have chest pain evaluated — when in doubt, call the emergency number 112. Seek prompt medical help in case of difficulty swallowing, blood in vomit or black stools. PPIs should not be stopped abruptly (rebound effect). The choice of medication and dosage is always determined individually by the treating doctor. Last updated: April 2026.
