Setting the Record Straight
UT Health Austin digestive health experts explain the difference between heartburn, acid reflux, and indigestion
Reviewed by: Tripp Buckley, MD, and Stephanie Doggett, PA-C
Written by: Lauryn Gerard
The terms heartburn, acid reflux, and indigestion are often used interchangeably. While related, these common gastrointestinal (GI) conditions and symptoms are considered separate issues. Knowing the difference is key when determining the type of care and prevention measures needed to help resolve issues, such as upset stomach, acid regurgitation, a burning chest, and more.
UT Health Austin experts, F. P. “Tripp” Buckley III, MD, board-certified surgeon and the Surgical Director of Digestive Health, a clinical partnership between UT Health Austin and Ascension Seton, and Stephanie Doggett, PA-C, licensed physician assistant in Digestive Health, explain the differences, triggers, and treatment options for these specific GI issues.
It Begins With the Esphagus
At the very bottom of the esophagus, there is a valve that separates your esophagus from your stomach called the lower esophageal sphincter (LES). Normally, the LES should be closed to keep food and stomach contents inside your stomach. When you swallow, the LES opens so that food can pass through before closing, again. If the valve does not close all the way, or if it opens when it’s not supposed to, stomach contents including acid, digestive juices, enzymes, and/or food, can flow back into the esophagus. This is known as acid reflux.
“Acid reflux is a disorder of the lower esophageal sphincter that can cause various symptoms when it occurs,” explains Dr. Buckley. “Symptoms of acid reflux include a burning in your chest, known as heartburn, regurgitation, excessive belching, and sour taste when acid and bile flow back up the esophagus and into your throat or mouth.”
Heartburn is a symptom of acid reflux. Despite its name, it does not have anything to do with your heart. Heartburn is characterized by a burning sensation behind your sternum in the middle of your chest or in your throat. Certain things can contribute to the frequency a person may experience acid reflux such as overeating, obesity, tobacco, pregnancy, foods that are high in fat or acid, alcohol, and caffeine.
“You can treat the symptoms of acid reflux with over-the-counter medications, such as antacids, which lessen the acid in your stomach and ease heartburn pain, as well as acid blockers, H2 blockers, and proton pump inhibitors,” says Dr. Buckley. “However, if you are experiencing symptoms of acid reflux several times a week for several weeks, you may have gastroesophageal reflux disease, or GERD.”
GERD is a more severe form of acid reflux where the stomach contents flowing back up into the esophagus becomes problematic and affect a person’s quality of life on a regular basis. GERD can lead to damage to the esophageal lining and even Barrett’s esophagus, a precancerous condition that can progress to esophageal adenocarcinoma, the most common form of esophageal cancer. 15-20% of patients with GERD develop Barrett’s esophagus. GERD should be treated to avoid long-term problems.
<br>Where Does That Leave Indigestion?
Indigestion, also known as dyspepsia, is a term to describe a group of persistent or recurring symptoms that contribute to abdominal pain or discomfort after you eat. Symptoms may include burning in the stomach or abdomen, abdominal pain, bloating, belching and gas, nausea and vomiting, acidic taste, or stomach growling. Indigestion is common and usually is not serious, but could be a sign of an underlying condition, such as a hiatal hernia, GERD, ulcers, certain cancers, irritable bowel syndrome, or gallbladder disease.
“Indigestion is a broad term that involves a variety of symptoms and sometimes those symptoms may be related to other conditions,” explains Doggett. “If you are experiencing persistent indigestion, it is recommended that you speak with your doctor, providing a precise description of the discomfort you are experiencing so they can try to rule out any underlying conditions that may be causing your symptoms.”
Symptoms of indigestion can often be triggered by overeating or eating too quickly; eating foods high in fat or spicy foods; drinking too much caffeine, alcohol, or carbonated beverages; smoking; anxiety; and taking certain medications. Similar to heartburn, indigestion can often be treated with over-the-counter medications and lifestyle modifications.
Curbing the Symptoms
Symptoms of acid reflux and indigestion can be alleviated by following preventive measures.
Common preventative measures include:
- Eating an earlier dinner. It’s best not to eat late at night if you suffer from GERD.
- Avoiding fatty foods. Fatty and fried foods (e.g., chips, dips, and cheeses) are slow to empty from the stomach and more likely to aggravate symptoms.
- Staying active. Exercise and weight loss can help alleviate symptoms.
- Not smoking. Nicotine weakens the muscles in the esophagus that help prevent backflow (reflux) of stomach contents.
- Nixing the juice. Citrus fruits and juices (e.g., grapefruit, orange, and tomato) are acidic and can worsen symptoms of acid reflux and indigestion.
- Seasoning lightly. Spicy foods as well as onions and garlic can be bothersome to people with GERD and indigestion.
- Limiting your alcoholic drinks. Whether it’s wine at dinner or beer during the game, alcohol can worsen symptoms.
- Limiting portion size. Eating large meals can trigger symptoms, so try implementing smaller meals spread throughout the day.
- Drinking water rather than soda or coffee. Caffeinated and carbonated beverages are both notorious heartburn and indigestion instigators.
- Watching the desserts. Chocolate might be a favorite, but often bothers people with GERD or indigestion.
- Skipping the after-dinner mint. Peppermint is another heartburn irritant.
- Giving yourself time to digest. Physical exertion after a meal can lead to reflux and abdominal discomfort.
- Not sleeping immediately after eating. Lying down within two hours after eating can cause GERD symptoms to flare up.
- Talking to your doctor. An accurate diagnosis is the first step to receiving the most effective treatment.
“While symptoms of acid reflux and indigestion can often be managed through lifestyle modifications,” shares Doggett, “you should consider a visit with your doctor to help treat any underlying causes that may lead to further complications.”