Heartburn warning: Top GP reveals red-flag symptoms that could signal something sinister - and when to seek help
A top GP has warned that while heartburn is something almost everyone experiences from time to time, persistent symptoms can be a red flag for serious disease.In most cases the condition is nothing to worry about, and if severe can be tackled with simple over-the-counter remedies. But Bristol-based GP and University of Bristol lecturer Dr Dan Baumgardt, writing in The Conversation, cautioned that ongoing problems should be checked by a doctor as they can sometimes signal acid reflux or, more rarely, cancer.'Indigestion is common but not always harmless,' he said. 'Over-the-counter treatments can provide relief and many benign conditions often prove to be the underlying cause. 'But in some cases, persistent symptoms may signal a more serious underlying condition, including cancer.'Indigestion – or dyspepsia – is the medical term for discomfort in the upper abdomen, often after meals, and can include bloating, nausea or a burning sensation in the chest.Acid reflux – when stomach acid repeatedly flows back into the gullet – is a common cause, and the burning pain this produces is what most people describe as heartburn. Everyday factors can make symptoms more likely. A top GP has warned that while heartburn is something almost everyone experiences from time to time, persistent symptoms can be a red flag for serious disease A hiatus hernia, where part of the stomach pushes through the diaphragm into the chest, affects around a third of over-50s and makes reflux more common.Eating large, spicy or fatty meals, drinking coffee or alcohol, being overweight, pregnant or a smoker can all trigger flare-ups, explains Dr Baumgardt, writing in The Conversation. Some medicines – including antidepressants, ibuprofen, anti-inflammatories and iron tablets – can also set them off.After a heavy meal or a stomach bug, short-term indigestion is expected and usually clears within days.But persistent or unexplained symptoms can point to more serious problems. Inflammation of the oesophagus, stomach or duodenum may be caused by Helicobacter pylori, a common bacterial infection that is the leading cause of ulcers.Treatment may involve antibiotics and acid-suppressing drugs such as omeprazole. Left untreated, ulcers carry serious risks of bleeding or perforation. Doctors also warn that in some cases what feels like indigestion or heartburn can actually be a sign of a heart problem, such as ischaemic heart disease, where narrowed arteries restrict blood flow and cause chest pain. More worryingly, ongoing indigestion can occasionally be a symptom of upper gastrointestinal cancers. Having problems swallowing (dysphagia), feeling or being sick, heartburn or acid reflux and symptoms of indigestion, such as burping a lot, can all be signs of cancerRed-flag signs include difficulty swallowing, unexplained weight loss, persistent upper abdominal pain and feeling full quickly after eating. In severe cases, patients may vomit blood, requiring urgent hospital care. To investigate, doctors may arrange an endoscopy, where a camera is passed down the throat to examine the stomach and gullet.Other cancers – including of the pancreas and ovaries – can sometimes cause indigestion among other symptoms, while even heart disease can mimic its signs.Guidelines from the National Institute for Health and Care Excellence (NICE) recommend urgent investigation for patients with difficulty swallowing, abdominal lumps, unexplained weight loss, or abdominal pain with indigestion, particularly in the over-50s.Investigation may also be considered for persistent symptoms that do not respond to treatment, or in people with anaemia, a history of ulcers or a family history of upper gastrointestinal cancer.The risks underline why doctors warn against self-diagnosis. 'It's important not to ignore persistent symptoms, and not to rely on over-the-counter remedies alone,' Dr Baumgardt said.'A GP can put the pieces together and decide on the most appropriate plan.' In most cases heartburn is nothing to worry about, and if severe can be tackled with simple over-the-counter remedies.The warning comes amid debate over the long-term use of common acid-suppressing medicines. In a viral TikTok video, pharmacist Deborah Grayson, known as the 'Godmother of Pharmacology', cautioned that while drugs like omeprazole can ease reflux and heartburn in the short term, they may cause bloating, nausea, weight gain and vitamin deficiencies if taken for extended periods.PPIs (proton pump inhibitors) are among the UK's most prescribed drugs, with 73 million NHS prescriptions issued in England in 2022–23 at a cost of £190 million.Mrs Grayson said: 'Omeprazole is useful if you've got gastritis or erosion of the oesophagus, but if it's just simple heartburn, longer-term use can have greater impacts on the body.'
