Heartburn vs. Acid Reflux: What's the Difference?

Acid reflux part of Gastroesophageal Reflux Disease (GERD) occurs when stomach acid backs up into the esophagus, irritating the tissue.

Is heartburn a symptom of acid reflux? Heartburn, or acid indigestion, is a symptom of acid reflux, so named because the esophagus lies just behind the heart, and that is where the burning sensation is felt.

Heartburn is a symptom of acid reflux. Heartburn describes a feeling of burning, pain, or discomfort in the chest that can be quite uncomfortable. You also may have a sour or bitter taste in the throat and mouth, and it usually occurs after you eat a big meal or when you lay down.

Not everyone with GERD will experience heartburn. Other symptoms of acid reflux include regurgitation of acid into the throat or mouth, a bitter taste in the mouth, upset stomach, belching, nausea after eating, feeling full, stomach and upper abdomen bloating, dry cough, wheezing, hoarseness, feeling of tightness in the throat, and in some people, vomiting.

Common causes of acid reflux (and therefore heartburn) include:

• Drinking alcohol
• Smoking
• Obesity
• Poor posture (slouching)
• Certain medications (calcium channel blockers, theophylline, nitrates, antihistamines)
• Certain foods (fatty and fried foods chocolate, garlic and onions, caffeinated drinks, acidic foods such as citrus fruits and tomatoes, spicy foods, mint)
• Eating large meals
• Eating too quickly
• Eating before bedtime
• Hiatal hernia
• Pregnancy
• Diabetes
• Increase in stomach acid (from stress, Zollinger-Ellison syndrome, stomach tumors)
• Weight gain

Adjusting some of these habits can have a significant impact on the symptoms of acid reflux.

Foods that may cause or aggravate acid reflux and heartburn include:

• Fried and fatty foods
• Chocolate
• Garlic and onions
• Caffeinated beverages
• Acidic foods such as citrus fruits and tomatoes
• Spicy foods
• Mint

Avoiding these food items can help reduce acid heartburn symptoms in individuals who are prone to them.

Heartburn, a symptom of acid reflux, feels like a burning pain or discomfort in the chest, around the area of the heart.

Acid reflux may include heartburn symptoms. Other common symptoms of acid reflux include:

• A warm or acidic taste at the back of the throat
• Sore throat
• Upset stomach (dyspepsia)
• Abdominal pain or discomfort
• Nausea, a feeling of fullness
• Bloating
• Feeling tightness in the throat
• It may feel difficult to swallow, or you may feel like you have food stuck in your throat.

Acid reflux (GERD) and heartburn may cause chest pain, when after eating or when lying down. See your doctor if you have any chest pain that is not diagnosed because chest pain may be a sign of a heart attack or another serious heart condition.

If you have been diagnosed as having acid reflux by your doctor or other health care professionals, and your symptoms change suddenly or worsen acutely, seek medical care right away to make sure this chest pain is not associated with a heart attack or other serious medical conditions.

A medical doctor can often diagnose GERD (gastroesophageal reflux disease) and heartburn by your description of the symptoms you experience.

You may see a gastroenterologist, a medical specialist in disorders of the gastrointestinal (GI) tract, who may order an upper GI series. This is a series of X-rays of the esophagus, stomach, and upper part of the intestine often used to rule out other health conditions. An upper GI endoscopy is where a flexible probe with a tiny camera at the end is passed down your throat to see the esophagus. This helps diagnose how severe your acid reflux is and can also rule out other health complications.

If your symptoms are not clear from acid reflux, your doctor may perform other tests to rule out important conditions like heart attack, ulcers, lung problems, esophagus problems, and gastritis.

In some cases, reflux and heartburn symptoms you experience may be relieved with diet and lifestyle changes such as:

• Avoid eating close to bedtime.
• Don’t lie down soon after eating.
• Don’t eat large meals. Eating smaller, more frequent meals throughout the day may make a difference.
• Avoid trigger foods that can aggravate symptoms, such as fatty or greasy foods, chocolate, caffeine, mint, spicy foods, citrus, and tomato-based foods.
• Avoid alcohol.
• Don’t smoke.
• Lose weight, if overweight.
• Maintain good posture.
• Talk to your doctor if you take any medications that may cause symptoms of acid reflux and heartburn to see if there are alternatives. Do not stop taking any prescribed medications without first consulting your doctor.
• Over-the-counter (OTC ) acid reflux treatments such as antacids (Maalox, Mylanta, Tums, and Gaviscon), or histamine-2 receptor blockers (H2 blockers) [cimetidine (Tagamet) and famotidine (Pepcid, Zantac 360)] may be used.

If diet and lifestyle changes and OTC medications don’t make a difference in relieving your condition, your doctor may prescribe medications to treat your reflux and heartburn, such as:

• Proton pump inhibitors (PPIs): esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix)
• Coating agents: sucralfate (Carafate)
• Promotility agents: metoclopramide (Reglan, Clopra, Maxolon) and bethanechol (Duvoid, Urabeth, Urecholine)

Most of the time, diet and lifestyle changes can help relieve or cure symptoms of acid reflux (GERD) and heartburn. In some cases, over-the-counter or prescription drugs may be needed.

In rare cases, a last resort to cure acid reflux is a surgery called fundoplication. During this surgery, a surgeon wraps part of the stomach around the esophagus like a collar, which works to increase pressure in the lower esophagus to keep acid from backing up.

• Can you have acid reflux without experiencing heartburn? Yes, individuals can experience acid reflux without heartburn. This condition, often referred to as "silent reflux," may cause symptoms such as chronic cough, throat clearing, or a sensation of a lump in the throat, rather than the typical burning sensation. Research suggests that some patients may have these atypical symptoms without experiencing heartburn.
• How are heartburn and acid reflux diagnosed? Heartburn and acid reflux are usually diagnosed based on the patient’s medical history and symptom evaluation. In some cases, physicians may also recommend additional diagnostic tests, such as upper endoscopy, pH monitoring, or esophageal manometry, to assess the severity and underlying causes of the condition. These approaches help ensure accurate diagnosis and appropriate treatment.
• What are the common causes of heartburn and acid reflux? Common causes of heartburn and acid reflux include a relaxed lower esophageal sphincter, which allows stomach acid to flow back into the esophagus. Contributing factors may include obesity, smoking, and dietary choices such as high-fat or spicy foods, along with excessive caffeine and alcohol consumption. Other factors can include certain medications, stress, and conditions such as hiatal hernia and pregnancy. Identifying these triggers is crucial for effective management and prevention.
• Which treatments are effective for heartburn vs. acid reflux? Treatments for heartburn typically involve antacids and H2 blockers to provide quick relief from symptoms, while proton pump inhibitors (PPIs) are often recommended for more persistent cases. For acid reflux, a combination of lifestyle changes — such as weight loss, dietary adjustments, and elevating the head during sleep — along with medications like PPIs, is commonly effective in reducing symptoms and preventing complications. A comprehensive approach that addresses both medications and lifestyle changes is key to optimal management.
• Can heartburn be a sign of a more serious condition than acid reflux? Yes, heartburn can sometimes indicate more serious conditions, such as gastroesophageal reflux disease (GERD), esophagitis, Barrett's esophagus, or even esophageal cancer. Persistent or severe heartburn, especially when accompanied by symptoms like difficulty swallowing, weight loss, or gastrointestinal bleeding, may signal damage to the esophagus or other underlying health issues that require medical evaluation. It is important to seek medical advice if heartburn is frequent, severe, or accompanied by other concerning symptoms.
• Are the dietary recommendations different for heartburn and acid reflux? Dietary recommendations for heartburn and acid reflux are generally similar, emphasizing the avoidance of foods that can worsen symptoms, such as spicy, fatty, or acidic foods, caffeine, and alcohol. However, individual sensitivities may vary, so it's important to tailor dietary choices to personal reactions. A common approach for both conditions includes eating smaller, more frequent meals and avoiding eating close to bedtime.
• How long does heartburn last compared to acid reflux? Heartburn typically lasts from a few minutes to several hours and is often relieved by antacids or lifestyle changes. In contrast, acid reflux can be a more persistent issue, with symptoms that may occur frequently over days or weeks, especially in individuals with gastroesophageal reflux disease (GERD). Monitoring the duration and frequency of symptoms is essential for effective management and treatment.
• Can lifestyle changes help with both heartburn and acid reflux? Yes, lifestyle changes can significantly help manage both heartburn and acid reflux. Incorporating strategies such as regular physical activity, maintaining a healthy weight, avoiding trigger foods, eating smaller more frequent meals, and not lying down immediately after eating can alleviate symptoms for both conditions. Additionally, elevating the head during sleep and quitting smoking can further improve outcomes.