Heartburn is a burning sensation behind the breastbone — it occurs when stomach acid flows back up into the esophagus (reflux). At the junction between the esophagus and the stomach sits a sphincter (the lower esophageal sphincter), which normally prevents stomach contents from rising. When this mechanism is disrupted, reflux occurs.²
Occasional heartburn (e.g. after a heavy meal) is usually harmless. It becomes a problem when reflux occurs regularly:
Damage to the mucous membrane (esophagitis) is visible during gastroscopy. It affects a portion of GERD patients.
NERDNon-erosive reflux disease — still a considerable burden
Typical symptoms, but the mucous membrane looks normal during gastroscopy. More common than the erosive form. It can still cause a considerable burden.
Heartburn and gastritis (inflammation of the stomach lining) are different conditions, but they 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. Losing weight is often the single most effective measure
Hiatal hernia — part of the stomach slips through the diaphragm into the chest; common especially in older people and promotes reflux
Smoking — can reduce the tone of the sphincter and decrease saliva production
Alcohol — relaxes the sphincter and directly irritates the mucous membrane
Dietary and behavioral triggers
Eating shortly before bedtime — lying down promotes reflux
Burning behind the breastbone — often after eating, when lying down or bending over
Acid regurgitation — a 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 need to clear the throat — acid can irritate the larynx (laryngopharyngeal reflux)
Sore throat — chronic, especially in the morning; a lump-in-the-throat feeling
Tooth enamel erosion — often noticed first by the dentist
Worsening of asthma — acid in the airways can trigger a 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 primary care doctor or a gastroenterologist if heartburn occurs regularly, persists for several weeks, or does not improve despite lifestyle changes and/or taking a PPI.
Warning signs — get medical evaluation promptly:
Difficulty swallowing or pain when swallowing · Unintentional weight loss · Blood in vomit or black stools · Chest pain — always get it checked if you're unsure · First occurrence at an older age
Heartburn or heart attack? When in doubt, call 112!
Heartburn usually burns, depends on body position, gets worse after eating and improves with antacids. A heart attack feels like pressure or tightness, often radiates into the arm, jaw or back — accompanied by cold sweats, nausea and a sense of anxiety. When in doubt, ALWAYS call 112.
5. Diagnosis
Clinical diagnosis: For most patients, typical symptoms and a response to a PPI are enough to make the diagnosis. With typical reflux and no warning signs, gastroscopy is often not necessary.¹
Gastroscopy: For warning signs, treatment failure, first onset at an older age or before a planned operation. It can reveal esophagitis, Barrett's esophagus, a hiatal hernia or a Helicobacter infection.
pH monitoring (24h): The gold standard for unclear reflux. It measures acid exposure in the esophagus over 24 hours (via a probe or a wireless capsule).
Impedance-pH monitoring: A newer technique that also detects non-acid reflux — e.g. for symptoms that persist despite taking a PPI.
They strongly inhibit stomach acid production and are considered the first-line treatment for GERD. How to take: Usually in the morning on an empty stomach, some time before breakfast. Duration: Individual — from a few weeks to longer-term therapy in the case of 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 for them reviewed by your doctor regularly.² Don't stop abruptly: A rebound effect is possible. Taper off slowly as recommended by your doctor. Learn more: Stopping medication.
H2 blockers (e.g. famotidine)
Weaker acid suppression than PPIs, but often a faster onset of action. Available without a prescription. Can be useful for night-time reflux or as an add-on to a PPI.
Alginates (e.g. Gaviscon)
They form a protective layer on top of the stomach contents — acting as a kind of reflux barrier. Well tolerated, fast-acting and suitable as an as-needed medication.
Antacids (e.g. Maalox, Rennie)
Neutralize stomach acid directly. Fast relief, but usually only short-lived. They generally do not heal esophagitis.
Surgery (fundoplication)
For some patients with severe reflux that does not respond adequately to medication, or with a mechanical cause (e.g. a large hiatal hernia), surgery may be considered. The decision to operate is usually made by specialized centers.
7. Home remedies and lifestyle — what really helps
Lifestyle changes are considered the foundation of any reflux treatment and can in some cases reduce the need for medication:¹˒²
Weight loss — considered the single most effective measure if you are overweight
Raise your upper body when sleeping — e.g. a wedge pillow or by raising the head of the bed (don't just stack pillows, as that can bend the abdomen)
Sleep on your left side — studies generally show less reflux than when lying on the right side
Have your last meal a few hours before bedtime
Smaller, more frequent meals instead of a few large ones
Identify and avoid your individual triggers (e.g. fatty food, coffee on an empty stomach, alcohol, chocolate, peppermint)
Quit smoking — can improve sphincter function
Avoid tight clothing and belts — they put pressure on the abdomen
Chew gum after eating — stimulates saliva production (saliva can neutralize acid)
Reduce stress
Milk and baking soda: short-term only
Milk can provide short-term relief but stimulate acid production over the long term — water is usually the better choice. Baking soda neutralizes acid quickly, but it should not be used regularly because of possible side effects (high sodium load, CO₂ formation, rebound).
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. With a PPI it usually heals within a few weeks.
Stricture (narrowing): Scarred narrowing caused by chronic inflammation. Typical symptom: increasing difficulty swallowing. It can usually be treated endoscopically.
Barrett's esophagus: Years of reflux can change the tissue of the esophageal lining (metaplasia). It is considered a precancerous condition. Regular gastroscopy check-ups with biopsies are recommended. If dysplasia is present, endoscopic treatment may be an option. Long-term PPI therapy is often recommended.¹
Barrett's esophagus: putting the cancer risk in perspective
Based on current knowledge, the absolute risk of cancer with Barrett's esophagus is fairly low. Regular check-ups allow early detection and treatment before a cancer develops.
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PPI in the morning on an empty stomach, logging your heartburn triggers, checking for interactions — brite keeps track for you.
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Health tracking — Log your heartburn episodes, triggers and meals. Track your history
Digital medication plan — all your medications clearly laid out for your gastroenterologist, GP and pharmacy. Go to medication plan
Occasional heartburn usually isn't. However, chronic heartburn can lead to esophagitis, Barrett's esophagus or a narrowing of the esophagus. If warning signs occur (difficulty swallowing, blood, unintentional weight loss), you should get a medical evaluation promptly.¹
In the short term, cold milk can sometimes buffer the acid a little. Over 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).
Long-term use can make medical sense (e.g. with Barrett's esophagus or severe esophagitis) — usually under medical supervision. The need for them should be reviewed regularly. In many cases, stepping down to the lowest effective dose or using them only as needed can be enough.²
After abruptly stopping a PPI, stomach acid production can be temporarily increased (a rebound effect). Tapering off slowly as recommended by your doctor is therefore usually advisable. Learn more: Stopping medication.
Years of reflux change the tissue of the esophageal lining (metaplasia). It is considered a precancerous condition, but the absolute risk of cancer is, based on current knowledge, fairly low. Regular gastroscopy check-ups allow early detection. Long-term PPI therapy is often recommended.¹
Heartburn usually burns, depends on body position and mostly improves with antacids or a PPI. A heart attack feels like pressure or tightness, often radiates into the arm, jaw or back, accompanied by cold sweats, nausea or a sense of 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 cavity. It is especially common in older adults and promotes reflux, but it doesn't necessarily cause symptoms. The reflux is usually treated with medication; surgery is mostly 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 need to clear the throat — often even without classic heartburn.
Weight loss (if you are overweight) is considered the single most effective measure. In addition: have your last meal a few hours before sleeping, raise your upper body, and quit smoking. PPIs are considered the first-line medication.¹˒²
Medical disclaimer: This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. Always get chest pain checked — when in doubt, call the emergency number 112. If you have difficulty swallowing, blood in your vomit or black stools, seek medical help promptly. PPIs should not be stopped abruptly (rebound effect). The choice of medication and dosage is always determined individually by your treating doctor. Last updated: April 2026.
