Heartburn
Heartburn occurs when the acid contents of the stomach pass backwards up into the food pipe (called the gullet or oesophagus). This is also known as stomach acid reflux.
Most people have stomach acid reflux at some point in their lives, either as heartburn or acid regurgitation.
What causes heartburn?
Heartburn typically occurs after eating a large meal or drinking a lot of alcohol. Some people get heartburn when they bend over or lie down.
The frequency of stomach acid reflux varies from one person to another. For most people, it happens very rarely. But weekly or daily incidents of heartburn or acid regurgitation may occur.
Is heartburn dangerous?
Heartburn is annoying and may have a detrimental effect on a person's wellbeing. Sometimes the tendency for heartburn may develop into a mucous membrane inflammation in the food pipe, also known as oesophagitis.
In the worst cases, oesophagitis may become complicated with ulcers, which, in rare cases, may bleed or cause chronic anaemia.
Occasionally, reflux oesophagitis may become complicated if scars cause a tightening or narrowing (stricture) in the food pipe.
A gullet stricture can prevent swallowing. This is a serious condition, which requires immediate examination and treatment.
How does gastric acid end up in the food pipe?
At the lowest part of the food pipe there is a ring of muscle (sphincter) where it passes through a hole in the diaphragm.
What increases the risk of heartburn?
Obesity
This causes high pressure inside the stomach, and the contents of the stomach may then be pushed up into the food pipe.
Weight loss will reduce the chance of stomach acid reflux.
Pregnancy
Large meal portions
The risk will be greater after large (and especially fatty) meals, where the food is in the stomach for a long time before it passes on to the intestines.
If you avoid eating more than is necessary, the risk of stomach acid reflux is reduced.
Lying down
You can avoid this to some extent by raising the head-end of your bed (see tips below).
What can I do to help myself?
What medicines treat heartburn?
Antacids usually contain a mixture of magnesium and aluminium salts, calcium carbonate or sodium bicarbonate.
Those containing high amounts of sodium may not be suitable for pregnant women or those on a sodium restricted diet, such as people with high blood pressure or heart disease.
Antacids are available as tablets that can be sucked or chewed and liquids. The choice is down to personal preference, but liquids may work faster and tablets may have a longer lasting effect.
Antacids can reduce the absorption of certain other medicines from the gut, so if you are taking any other medicines you should always check with your pharmacist before taking an antacid at the same time.
Alginates
Sodium alginate is a substance that forms a 'raft' that floats on top of the stomach contents. The raft prevents stomach acid from passing back into the food pipe and protects the food pipe from the acid.
Products containing alginates, eg Gaviscon, are particularly useful for heartburn caused by pressure on the stomach, such as during pregnancy. They are also available as tablets and liquid.
H2 antagonists
They work by blocking histamine receptors in the stomach, which prevent the cells in the stomach from producing too much acid.
This type of medicine may not be suitable for people with liver or kidney problems. They should only be used for a maximum of two weeks without consulting your doctor.
Cimetidine has the potential to interact with various medicines, both bought and prescribed, so you should always check with your pharmacist before taking it with any of your existing medicines.
When should I consult my doctor?
Your doctor will decide whether a further examination or more effective medicine is needed.
There is often no known reason for increases in heartburn. But occasionally one of the factors below may contribute.
In people who are overweight, the fat in their abdominal cavity exerts more pressure on the stomach.
The enlarged uterus (womb) presses on the stomach. This causes the same kind of high pressure inside the stomach as in people who are overweight.
The risk of stomach acid reflux increases with more food in the stomach.
If you lie down, the chance of stomach acid reflux increases due to gravity.
Some antacid products also contain sodium alginate.
H2 antagonists include medicines such as cimetidine (eg Tagamet), ranitidine (eg Zantac 75), nizatadine (eg Axid)
and famotidine (eg Pepcid). All of these can now be bought from pharmacies by adults over 16 years of age.
If heartburn or acid regurgitation occurs often, or the symptoms are very annoying, consult your doctor. You should also consult a doctor if you: 
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