Heartburn that does not go away

Heartburn happens when stomach acid flows back into the oesophagus. It is felt as a burning sensation behind the breastbone, often after a meal, when bending over or at night in bed. Many people know it after a festive lunch, and a single episode like that is no reason for concern.

Reflux becomes a question when it recurs. Besides heartburn, it shows as a sour or bitter taste in the mouth, belching, a feeling of a lump in the throat, hoarseness in the morning and a long-lasting cough that few people link to the stomach. Some people have no heartburn at all and only a cough or hoarseness, so the cause long goes unrecognised.

The first thing you can do yourself is to arrange your meals. Smaller, more frequent meals put less strain on the stomach than one large one. Make your last meal at least three hours before lying down. If heartburn wakes you at night, raise the head of the bed by a few centimetres with a support under the mattress, not with extra pillows under your head, which only fold the body.

Then come the well-known triggers: body weight, smoking, alcohol, coffee, chocolate, heavily spiced and fatty food, fizzy drinks and tight belts. The list varies between people more than it seems, so it is useful to write down for a week what you ate and when the burning started. Giving up everything on the list at once rarely helps; it makes sense to cut out what really recurs in your notes.

Over-the-counter medicines make sense for a limited time. If the symptoms do not settle after a few weeks, or come back as soon as you stop taking the medicine, this is not a sign that you need a higher dose but that the cause is worth examining. The same applies if you have been treating heartburn for months and have come to take it for granted.

Some signs cannot wait: difficulty or pain when swallowing, a feeling that food gets stuck, vomiting blood, black stools, unintended weight loss, persistent vomiting, and anaemia in a lab report. With these, book quickly, regardless of how long you have had heartburn.

Pain behind the breastbone does not always come from the stomach. If it appears on exertion, if it comes with a cold sweat, nausea or shortness of breath, or if it spreads to the arm, neck and jaw, call 112. The similarity between reflux pain and heart pain is real, and in this case guessing is not worth it.

A gastroscopy shows the lining of the oesophagus, stomach and duodenum directly, and if needed tissue samples are taken during the test or a test for the bacterium Helicobacter pylori is carried out. At the centre it is done with a referral from the Health Insurance Institute of Slovenia (ZZZS) and on a self-pay basis; whichever route you take, a doctor assesses the test beforehand, checking whether there is a sound reason for it. If you receive a sedative during the test, you must not drive that day and you need someone to accompany you.