Heartburn
Everything you need to know about Heartburn - symptoms, causes, treatment options available in Australia, and when to see a doctor. Evidence-based medical information.
Overview
Heartburn, a common symptom of gastro-oesophageal reflux disease (GORD), is characterised by a burning sensation behind the sternum, typically triggered by meals or changes in posture. This condition arises from the backflow of stomach acid into the oesophagus, leading to irritation of the oesophageal lining. The pathophysiology involves a dysfunction of the lower oesophageal sphincter (LES), which normally acts as a barrier to prevent gastric contents from refluxing. Factors such as obesity, pregnancy, and certain dietary habits can exacerbate this condition by increasing intra-abdominal pressure or relaxing the LES [1].
Statistics and Prevalence in Australia
In Australia, heartburn is a prevalent issue, with a 2025 study indicating that 35.7% of adults experience heartburn occasionally, 17.1% sometimes, 11.9% often, and 1.0% always [5]. Despite its commonality, heartburn is often underreported in national health statistics, as it is typically included within broader gastrointestinal studies rather than as a standalone condition [2][4].
Symptoms and Clinical Presentation
Heartburn primarily presents as a burning sensation in the chest, often after eating or when lying down. Early symptoms include mild discomfort and a sour taste in the mouth. Advanced symptoms can involve severe chest pain, chronic cough, or even asthma-like symptoms due to acid aspiration. Red flags that necessitate immediate medical attention include dysphagia (difficulty swallowing), unexplained weight loss, and gastrointestinal bleeding [1][3].
Causes and Risk Factors
The primary cause of heartburn is the dysfunction of the LES, but several risk factors can contribute to its development. These include obesity, smoking, dietary habits (such as high-fat foods, caffeine, and alcohol), and certain medications that relax the LES. Additionally, conditions like hiatal hernia and pregnancy can increase the risk of heartburn by altering the anatomical or hormonal environment [1][3].
Diagnosis
In Australia, the diagnosis of heartburn is primarily clinical, based on symptom presentation. The Royal Australian College of General Practitioners (RACGP) recommends a symptom-based approach, reserving endoscopy for patients with alarm symptoms or those who do not respond to empirical treatment [1][3]. Additional diagnostic tests, such as pH monitoring or oesophageal manometry, may be considered if the diagnosis is unclear or if symptoms persist despite treatment [1][2].
Treatment Options in Australia
Treatment for heartburn in Australia follows a stepwise approach. First-line therapy includes lifestyle modifications, such as weight loss, dietary changes, and smoking cessation. Pharmacological treatments include antacids, H2-receptor antagonists, and proton pump inhibitors (PPIs), which are available through the Pharmaceutical Benefits Scheme (PBS) for eligible patients [1][3]. In refractory cases, surgical options like fundoplication may be considered, particularly when lifestyle and pharmacological interventions fail [1].
Living with Heartburn
Managing heartburn involves a combination of medical treatment and lifestyle adjustments. Patients are encouraged to eat smaller, more frequent meals, avoid lying down immediately after eating, and elevate the head of the bed to prevent nocturnal symptoms. Regular follow-up with healthcare providers is essential to monitor treatment efficacy and adjust management plans as needed [1][3].
Prevention
Preventing heartburn involves addressing modifiable risk factors. This includes maintaining a healthy weight, avoiding trigger foods and beverages, and adopting a balanced diet rich in fruits, vegetables, and whole grains. Regular physical activity and stress management techniques can also play a role in reducing the frequency and severity of heartburn episodes [1][3].