Heartburn is not as harmless as it seems: when it cannot be ignored

Two gastroenterologists explain that heartburn is a symptom often caused by reflux, hiatal hernia, or functional disorders. Those at risk include people with obesity, smokers, and individuals over 50. Complications include esophagitis and Barrett's esophagus. Diagnosis begins with symptom assessment, and treatment ranges from lifestyle changes to surgery.

Two gastroenterologists, Dr. Dan Livovsky from Shaare Zedek Medical Center and Professor Amir Klein from Rambam Health Care Campus, explain that heartburn is a symptom, not a disease in itself. In most cases it is caused by gastroesophageal reflux, but other causes include hiatal hernia, weakening of the valve between the stomach and esophagus, and functional heartburn. Those at risk include people with obesity, smokers, and individuals over 50; men experience more severe symptoms. Smoking reduces saliva production, which neutralizes acid. Some medications, such as GLP-1 drugs (Ozempic, Wegovy), can worsen reflux. Stress intensifies the sensation of heartburn but does not increase acidity. Prolonged exposure to stomach acid can cause esophagitis, Barrett's esophagus, and, in rare cases, esophageal cancer. Diagnosis begins with symptom assessment; alarming signs (difficulty swallowing, pain, bleeding, weight loss) warrant gastroscopy. Treatment includes lifestyle changes, and if necessary, medication or surgery.