Heartburn is a burning feeling in your chest caused by reflux of your stomach contents (including acid and bile) travelling back up into your oesophagus. You would not normally notice reflux but if it happens regularly symptoms may start to appear.

These include:

• a burning feeling;
• pain just under your breastbone or in your chest;
• belching; an acid taste in your mouth;
• and a hoarse voice.

Sometimes you may feel pain when you swallow. Heartburn is often worse after rich meals, citrus fruits, hot drinks or alcohol.

The reasons for developing reflux are not always clear. Some people do seem more likely to get reflux - especially those who smoke, drink too much alcohol or put on weight, or women who are pregnant. Wearing tight clothes, bending down or bending forwards and eating rich, fatty foods all seem to increase the chances of suffering from reflux. None of these things may apply to you or your friend or relative and there are people who seem to lead healthy lives and still suffer from reflux symptoms.

If your reflux symptoms are mild you should be able to control them by:

• being careful about what you eat;
• eating smaller meals;
• not eating late at night;
• and avoiding bending down.

You can normally control more serious symptoms by taking tablets which suppress acid. There are different brands of tablet but they are made up of two main types called histamine receptor antagonists and proton pump inhibitors. These can be used together if the symptoms are very serious. These tablets are normally very effective, though they can cause side effects[P2]. You may not want to take regular medication, in which case you may want to consider an anti-reflux operation. The most common type of operation is called a 'fundoplication' which involves wrapping the top of your stomach around the lower end of your oesophagus. This can often be carried out using keyhole surgery.

Your doctor may want to refer you for investigations to find out whether or not the reflux is causing damage to your oesophagus. This is normally done by endoscopy, where a video camera examines your oesophagus in great detail and tiny pieces of tissue are taken (biopsy). This procedure is done by passing a thin, flexible tube through your mouth and down into your oesophagus. Although this sounds uncomfortable, your throat will be made numb or you can be sedated (made drowsy). You will not need a full anaesthetic. The endoscopy may find inflammation called oesophagitis and sometimes Barrett's oesophagus. Both of these problems are often linked to a hiatus hernia. This is when the top of your stomach has moved (herniated) above your diaphragm muscle (the muscle which normally helps to prevent your stomach contents from moving up into your oesophagus). Sometimes, if it isn't clear whether reflux has caused your symptoms, oesophageal pH studies may be useful. These involve passing a fine tube through your nose and into your oesophagus. The tube has probes attached, which are sensitive to acid. A recorder checks how much acid is in your oesophagus, normally over 24 hours. In the past, an X-ray and a drink of a substance called barium (called a barium swallow) would be used to check your oesophagus. However, they do not show as much as an endoscopy and samples cannot be taken, so an endoscopy is always used unless it is not possible to do so for some reason.

We recommend that if you have frequent heartburn symptoms you should ask to have an endoscopy to check whether your oesophagus is damaged.

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