Related Condition Centers

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

Plus, what to do when your chest feels like it’s on fire.
illustration of person with acid reflux stomach
Heartburn is a common symptom of acid reflux.Denis Novikov / Getty Images

We’ve all felt the pain of heartburn after eating a delicious burger. On the quest for relief, you’ve probably found yourself asking: What’s the difference between heartburn and acid reflux, anyway? And what the heck does GERD mean?

In the moment, those buzzwords and questions may not seem to matter as much as finding something that will make the awful sensation stop, but understanding what’s going on in your digestive tract—especially if this is a frequent problem for you—can be the key to preventing future episodes. Here’s a simple breakdown of what causes acid reflux, how heartburn plays a role in the condition, and what you should know to keep both out of your future and finally enjoy your meals in peace.

First, what is acid reflux?

To understand why stomach acid might move in the wrong direction, let’s start with a quick anatomy refresher: The tube that stems from your mouth to your stomach is your esophagus, and at the very end of your esophagus is your lower esophageal sphincter (LES), which is a bundle of muscle that acts as a valve above your stomach1.

This valve allows food to pass through into the stomach and, when operating properly, prevents powerful stomach acids—which break down what you just ate—from splashing back up into the esophagus.

That’s the ideal operation. But when there’s weakness or relaxation in your LES, then the valve doesn’t close as tightly as it should. That’s when you’re at higher risk of stomach acid and partially digested food coming up into the esophagus. This upward flow is called gastroesophageal reflux, according to the National Institue of Diabetes and Digestive and Kidney Diseases (NIDDK).

Many people who aren’t familiar with acid reflux may assume the issue is happening just near the stomach, “but acid can come all the way up the esophagus, especially if you’re lying down,” Gokulakrishnan Balasubramanian, M.D., a gastroenterologist who focuses on esophageal, neurogastroenterology, and motility disorders at the Ohio State University Wexner Medical Center, tells SELF. “For example, you may get acid damage in the vocal cords or trachea, and that acid may then go down into the lungs as well, so you could have coughing or other respiratory symptoms.”

What’s the difference between heartburn vs. acid reflux?

Heartburn is just what that term implies: You feel a burning pain in your chest just behind the breastbone. Asking whether you have heartburn or acid reflux is actually a trick question because heartburn is simply considered a symptom of acid reflux, per the NIDDK. If you have heartburn, you’re experiencing some form of reflux. It’s similar to asking whether you have swollen gums or gingivitis—the former is a symptom of the latter.

However, not everyone who has acid reflux experiences heartburn, just as you may not have swollen gums even though you struggle with gingivitis. But it’s more likely that you will deal with heartburn since it’s the most common symptom of acid reflux, says Dr. Balasubramanian. Heartburn implies that your acid reflux has come up to the level of your heart, and it’s usually worse after eating common trigger foods like chocolate or tomatoes or when lying down after eating or drinking. You may also have a bitter or acidic taste in the mouth, which Dr. Balasubramanian says is an effect of the acid traveling higher up your throat.

How is acid reflux diagnosed?

First, your primary care doctor or a gastroenterologist will ask about your symptoms before doing any type of imaging or lab tests. Beyond heartburn, symptoms of acid reflux include:

  • Difficulty swallowing or feeling like food is caught in your throat
  • Nausea
  • Regurgitation of undigested or partially digested food, which may lead to vomiting
  • Coughing, which implies acid may be affecting your throat or lungs
  • Chest pain, particularly burning
  • Sore throat or feeling of your vocal cords getting “burned”
  • Breathing issues if acid is in your lungs
  • Bad breath
  • Difficulty sleeping, and/or waking up with pain

Although that’s an unpleasant list, one important symptom to pay close attention to is chest pain, says Dr. Balasubramanian. Heartburn can feel uncomfortable and be localized to the chest, with pain or burning that can radiate to your throat. However, cardiac chest pain—which can be a precursor to or signify a heart attack—is also important to note because it can present similarly to heartburn. Possible signs of a heart attack can also include shortness of breath, pain in the arms, pressure or fullness in your chest, or pain in the back, neck, jaw, or stomach. If you have any concern that you are experiencing cardiac chest pain, it is crucial to seek urgent medical attention. 

What causes acid reflux?

Having heartburn very occasionally can usually be traced to what you’re eating or the way you’re eating, Atif Iqbal, M.D., medical director of the Digestive Care Center at MemorialCare Orange Coast Medical Center in California, tells SELF. For example, he explains that having a large meal might cause your LES to loosen a bit as your stomach expands and that could cause a little acid to splash up into the esophagus. Combining lots of trigger foods can also spur symptoms. According to the U.S. National Library of Medicine, triggers foods are unique to each person, but the most common culprits include:

  • Alcohol
  • Caffeine
  • Carbonated drinks
  • Chocolate
  • Citrus fruits and juices
  • Peppermint and spearmint
  • Spicy or fatty foods, full-fat dairy products
  • Tomatoes and tomato sauces

If you’re experiencing reflux more often, however, it’s possible you could have other factors at play. “Food is the biggest factor, but definitely not the only one,” says Dr. Iqbal. “If you’re getting acid reflux regularly and you’ve tried changing what you eat and it’s not helping, then you should get it checked out.”

According to the Cleveland Clinic, other things that can raise your reflux risk can include:

  • Pregnancy: The pressure on the abdomen from a growing belly pushes the stomach upward, which is why heartburn is common for pregnant women.
  • Medications: Some drugs used to treat other conditions can cause the LES to relax, prompting reflux symptoms. These include painkillers, sedatives, antidepressants, and those used for allergies, high blood pressure, or asthma, among others.
  • Hiatal hernia: This type of hernia develops when the junction between your stomach and your esophagus slides up and down, weakening the functionality of the junction’s ability to prevent stomach contents from refluxing up into the esophagus.
  • Age: Acid reflux can occur at any age, but Dr. Iqbal says it tends to be more common in people over age 55.
  • Family history: Studies suggest2 there may be a genetic component for some people that leads to LES relaxation, delayed stomach emptying, and impairment in clearing acid promptly.

So, what’s the difference between GERD vs. acid reflux?

When acid reflux becomes chronic—which means it occurs more than twice a week and is usually increasing in severity—then it’s considered a more serious condition called gastroesophageal reflux disease (GERD). “We diagnose GERD based on frequency and severity,” Dr. Balasubramanian says. “It’s when acid reflux becomes an ongoing problem that affects your quality of life.”

Researchers estimate that about 20% of people in the U.S. have GERD, per the NIDDK. Without treatment, the condition can sometimes cause complications, including an issue called Barrett’s esophagus, which increases your risk of developing esophageal cancer, the NIDDK explains. Up to 15% of people with GERD go on to develop Barrett’s esophagus. GERD can also increase chronic inflammation in the esophagus, known as esophagitis.

Diagnosing GERD is usually based on your symptoms, but the diagnosis can be reinforced with imaging and testing, such as an endoscopy, in which your doctor inserts a thin, flexible tube down your throat to examine the condition of your esophagus and stomach, according to the Mayo Clinic. You may also have a monitor placed in your esophagus to track stomach acid activity, which is called an ambulatory acid probe test. 

How to treat heartburn caused by acid reflux

While GERD often requires a comprehensive, long-term treatment plan, occasional heartburn caused by acid reflux can often be managed with over-the-counter medications and especially lifestyle changes, says Dr. Balasubramanian.

In addition to adjusting your diet so you’re eating smaller meals more frequently—and avoiding trigger foods that seem to be problematic for you—an antacid like Tums, Maalox, or Gaviscon can help neutralize stomach acid to ease the burning feeling. That tends to help about 70 to 80% of people who only get heartburn occasionally, says Dr. Balasubramanian. Over-the-counter Pepcid can also help; this medication is classified as an H2 blocker that reduces the amount of acid that’s released by the glands in the lining of your stomach.

However, if you are diagnosed with GERD and heartburn is a consistent problem for you, you should talk with your doctor about other options. In this case, the first line of defense includes prescription options like proton pump inhibitors (PPIs), as they block the production of stomach acid.4 In certain cases, surgery may be an option to reinforce the lower esophageal sphincter so it is better at doing its job—this is called a fundoplication procedure. Your doctor can help you assess the pros and cons of your treatment plan to ensure the benefit outweighs any possible risk of side effects based on your personal health history.

“Even if your symptoms seem mild, it’s important to recognize how often they’re happening,” says Dr. Balasubramanian. “Like other conditions, getting it checked early may prevent the reflux from getting worse, when it may be harder to treat.”

Sources:

  1. StatPearls, Physiology, Lower Esophageal Sphincter
  2. World Journal of Clinical Cases, Risk Factors for Gastroesophageal Reflux Disease and Analysis of Genetic Contributors
  3. World Journal of Gastrointestinal Pharmacology and Therapeutics, Crohn’s Disease of Esophagus, Stomach, and Duodenum
  4. The American Journal of Gastroenterology, ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease

Related: