Symptoms · Upper abdomen and chest
Heartburn and burning after meals
The short answer
A burning feeling behind the breastbone or in the upper belly, often after a large or fatty meal or when lying down, is usually acid reflux. Smaller meals, not lying down after eating, losing weight and stopping smoking often help. See a doctor if it happens more than twice a week, does not improve, or comes with trouble swallowing, weight loss, or vomiting. Chest pain with sweating or breathlessness can be a heart problem: go to the emergency room.
How patients describe it
- Burning behind my breastbone
- A sour taste in my mouth
- Burning in the pit of my stomach
- Food coming back up
- Burning worse when I lie down
Go to the emergency room now if you have
- Chest pain or pressure spreading to the arm, jaw or back, with sweating or breathlessness
- Vomiting blood, or black stools
- Food sticking when you swallow, or you cannot swallow
- Severe upper belly pain that does not ease
- Repeated vomiting
What can cause it
Acid reflux
Burning behind the breastbone and a sour taste, worse after large meals, when bending, or lying down.
Next step: Change meals and habits; see a doctor if it continues.
Gastritis or a stomach ulcer
Burning in the upper belly that changes with food, made worse by anti-inflammatory painkillers.
Next step: See a doctor; a stomach camera test (endoscopy) may be needed.
Hiatus hernia
Reflux with food coming back up, especially after large meals.
Next step: Examination and tests; keyhole surgery is an option if medicines do not control it.
Gallstones
Pain in the upper right belly after fatty meals, sometimes felt as indigestion.
Next step: Ultrasound of the abdomen.
A heart problem
Pressure or burning in the chest that can come with effort or breathlessness.
Next step: Go to the emergency room if it is new or severe.
What you can do now
- Eat smaller meals, and finish eating at least 3 hours before lying down
- Raise the head of your bed, not just your pillows
- Cut down on fatty and spicy food, caffeine, fizzy drinks, chocolate and alcohol if they trigger it
- Stop smoking, and lose weight if you are overweight
- Avoid regular anti-inflammatory painkillers (ibuprofen, diclofenac, aspirin) unless a doctor tells you to take them
Tests your doctor may order
- A review by a doctor, and a trial of acid-reducing medicine as advised
- A stomach camera test (endoscopy) if there are warning signs or no improvement
- A test for the stomach germ Helicobacter pylori, and an ultrasound if gallstones are suspected
When is surgery needed?
- Most people need only medicines and lifestyle changes.
- Keyhole surgery for reflux or a hiatus hernia is considered when medicines do not control the symptoms or there are complications. Your surgeon will explain whether it suits you.
Questions people ask
Is heartburn dangerous?
Usually not, but long-standing reflux should be checked, because it can rarely change the lining of the food pipe.
Can I take antacids?
Occasional antacids are fine. If you need them often, see a doctor to find the cause.
How do I know it is not my heart?
You cannot always tell. Chest pain or pressure with sweating, breathlessness, or pain spreading to the arm or jaw needs the emergency room at once.
This page gives general information and does not replace the advice of your treating team. In an emergency, go to the nearest emergency room.