If you’ve ever eaten a spicy meal too quickly or had a heavy fried dinner just before bed, you likely know the feeling of heartburn and/or indigestion. These two common digestive issues can make you feel very uncomfortable, and for some people, they occur regularly. Though heartburn and indigestion can occur together, they can also happen separately. In fact, they are two different issues.
What Is Heartburn?
“Heartburn is a burning pain in the chest, which commonly occurs after eating or lying down. It can be associated with food or sour liquid traveling up into the mouth, known as regurgitation,” says Dr. David Lin, associate chief of gastroenterology and hepatology at Santa Clara Valley Medical Center in Southern California.
Heartburn occurs when “acidic stomach contents travel back up into the esophagus, or the tube that carries food from your mouth,” Lin explains. “When this process causes bothersome symptoms or damages the esophagus, it’s called gastroesophageal reflux disease.”
What Is Indigestion?
Indigestion, on the other hand, which is also known as upset stomach, “refers to discomfort in the upper part of the abdomen. It can present with symptoms of pain, burning, bloating and early fullness,” Lin says.
“Indigestion is a layman’s term encompassing symptoms of burping, bloating, maybe heartburn,” says Dr. Hyder Z. Jamal, a gastroenterologist with St. Jude Medical Center in Fullerton, California. “The medical term close to [indigestion] is dyspepsia.”
Indigestion is a symptom rather than a condition, and Lin says it “can be caused by various diseases that affect the upper gut,” including the esophagus, stomach and intestines. Common causes of indigestion include:
- Increased nerve sensitivity.
- Food sensitivity.
- Acid reflux, or GERD.
- Infection with the Helicobacter pylori bacterium.
- Slow emptying of the stomach.
The good news is that both heartburn and indigestion can be successfully treated.
With both heartburn and indigestion, your doctor may want to do some tests to figure out what’s going on. These tests may include:
- Blood work. You doctor can check for H. pylori infection with a blood sample. If an autoimmune condition such as ulcerative colitis is suspected as causing your symptoms, your doctor may also run a test to look for certain immune system markers in the blood.
- An upper endoscopy. In this procedure, “a thin flexible tube with a camera is inserted through the mouth, after the patient has been sedated, to directly visualize the stomach and duodenum,” says Dr. Nimeesh Shah, chief, division of gastroenterology and hepatology, also with the Santa Clara Valley Medical Center. The camera on the end of the tube sends images to a computer, which allows your doctor to see what’s happening in your stomach and other parts of the upper digestive tract. In some cases, your doctor may also take a small sample of tissue form the stomach or duodenum (the first part of the small intestine) to check for conditions including H. pylori infection.
- Radiologic imaging. A radiology test called an upper GI series is also sometimes used to have a better look at what’s happening in the digestive system. Shah explains that “in this test, the patient drinks a special liquid and then undergoes X-rays,” which provide images of the stomach and small intestine that may show signs of peptic ulcers or other problems that could be contributing to symptoms of heartburn or indigestion. You may also undergo a CT scan or have ultrasound imaging as well.
- Acid testing. Also called a pH test, this procedure measures how frequently and for how long stomach acid enters the esophagus in patients with GERD. It’s completed using a thin tube that has a sensor on it that measures acid as it backs up into the esophagus.
If you’re diagnosed with GERD or heartburn, a few lifestyle changes may be the first line of defense, Lin says. These changes include:
- Avoiding food triggers. If there’s a certain food that you know tends to trigger heartburn, avoid eating that food. For example, tomatoes, alcohol, garlic, spicy foods, chocolate and coffee are all common triggers. You can try an elimination diet to determine if you have specific food sensitivities, so that you can exclude those foods going forward.
- Losing weight. Because being overweight often contributes to the development of heartburn, losing weight is usually one of the top recommendations your doctor will make in helping you control or relieve symptoms of GERD.
- Avoiding eating right before bed. If you lie down shortly after eating, that can make it easier for stomach acid to creep up into the esophagus. And if you’ve just eaten, your body will be producing more stomach acid to cope with the food in your belly. Therefore, leave several hours in between your last meal and going to be to help alleviate nighttime heartburn.
- Elevating the head of the bed during sleep. Similarly, sleeping with your head propped up can prevent stomach acid from moving into the esophagus. A thick bolster pillow or an adjustable bed can help you find a comfortable position that doesn’t cause problems.
If those interventions don’t help, you might need medications that decrease stomach acid such as:
- Antacids. These over-the-counter medications help neutralize excess acid in the stomach and can reduce pain and uncomfortable feelings associated with heartburn or indigestion.
- Histamine receptor agonists. Also called H2 blockers, these medications reduce the amount of acid the stomach produces. Examples include famotidine (Pepcid) and ranitidine (Zantac). Some H2 blockers are available over-the-counter and others are by prescription.
- Proton pump inhibitors. Also called PPIs, these medications reduce acid production. Examples include esomeprazole (Nexium) and lansoprazole (Prevacid). Some PPIs are available over-the-counter and others are by prescription.
If these medications still don’t resolve the heartburn problem, you may need to undergo surgery. Laparoscopic antireflux surgery, also called Nissen fundoplication, is sometimes used to treat GERD. It’s a minimally-invasive procedure that creates a valve mechanism in the lower part of the esophagus. This valve prevents stomach acid from coming up into the esophagus.
Lin says the underlying cause that’s creating the indigestion must be identified in order to successfully treat this problem. Interventions may include:
- Making dietary modifications.
- Taking acid-reducing medications.
- Taking an antibiotic (if a bacterial infection such as H. pylori is the cause).
- Taking medications that target nerve sensitivity.
Talk to Your Doctor
No matter whether you’re experiencing heartburn or indigestion, “if your symptoms are frequent or significant, please discuss with your primary care physician for further workup or treatment,” Lin says. You should see a doctor right away if you have any of these additional symptoms:
- Weight loss.
- Bloody or dark colored stools.
- Difficulty swallowing.
Jamal calls these signs “alarm symptoms,” and says that if there’s a family history of malignancies, such as cancer in any part of the digestive tract, you should talk to your doctor right away.
“You may need referral to a gastroenterologist, a doctor who specializes in diseases of the gut,” Lin adds, to find out what’s causing these potentially dangerous additional symptoms and treat the problem.
It’s important to seek treatment for heartburn and frequent indigestion because they may indicate a bigger problem is present. For example, “acid reflux disease is the single most important risk factor for esophageal cancer,” a disease that’s becoming more common, Jamal says.