Heartburn or indigestion? How to tell them apart

A burning feeling that climbs behind your breastbone. A heavy, too-full ache just under your ribs. People call both of these "indigestion," and both can show up after the same dinner. But they're often different problems, and they respond to different approaches.

Here's a side-by-side look at reflux and dyspepsia, the medical term for indigestion, so you can describe what's happening more precisely and get the right help sooner.

The quick definitions

Reflux. An international consensus defined gastroesophageal reflux disease (GERD) as a condition that develops when stomach contents flowing back up cause troublesome symptoms or complications (Vakil et al., 2006). The classic symptoms are heartburn and regurgitation, meaning a sour or bitter liquid rising into your throat or mouth.

Dyspepsia. When upper belly symptoms have no clear cause after a routine evaluation, doctors call it functional dyspepsia. The main symptoms are uncomfortable fullness after meals, feeling full too soon, and pain or burning in the upper belly, the area between the bottom of your breastbone and your belly button (Stanghellini et al., 2016).

Side by side

• Where you feel it. Reflux: behind the breastbone, sometimes up into the throat. Dyspepsia: in the upper belly, below the breastbone.
• What it feels like. Reflux: burning that rises, a sour taste, liquid or food coming back up. Dyspepsia: heaviness, early fullness, or a gnawing pain or burning that stays put.
• When it happens. Reflux: often after large meals, when bending over or when lying down. Dyspepsia: the meal-related type is triggered by eating, while the pain-predominant type doesn't only happen after meals (Stanghellini et al., 2016).
• Beyond the gut. The reflux consensus recognizes chronic cough, laryngitis, asthma and dental erosion as possible reflux-related problems (Vakil et al., 2006). Dyspepsia stays in the upper belly.

The categories aren't always neat. Some people have symptoms of both, and the Rome IV committee notes that the two types of functional dyspepsia can occur together as well (Stanghellini et al., 2016). A two-week symptom diary helps show which symptom is dominant, and that shapes what your doctor tries first.

Why hormones may matter after 40

In the Nurses' Health Study, researchers followed 51,637 postmenopausal women. Compared with women who had never used postmenopausal hormones, current users of estrogen alone had 66% higher odds of reflux symptoms, and the risk rose with higher doses and longer use (Jacobson et al., 2008).

That doesn't make hormone therapy the wrong choice, since it has other benefits and risks to weigh. But if your heartburn started around the time you began hormones, mention it to your doctor.

How doctors approach each one

Reflux. The American College of Gastroenterology's 2022 guideline states that proton pump inhibitors (PPIs) remain the medical treatment of choice for GERD, while acknowledging growing concern about long-term use and overprescribing. It also covers lifestyle, surgical and endoscopic options (Katz et al., 2022).

Dyspepsia. The joint American and Canadian guideline recommends that people under 60 have a noninvasive test for Helicobacter pylori, a common stomach bacterium, and treatment if it's positive. If that's negative or doesn't help, a trial of a PPI comes next. For people 60 and older, the guideline suggests an upper endoscopy to rule out other causes. If first steps don't work, it lists further options, including tricyclic antidepressants and prokinetic drugs, which help move food through the stomach (Moayyedi et al., 2017).

Why the difference matters. Getting the label right changes what happens next. Reflux care usually starts with acid suppression and lifestyle steps. Dyspepsia care in people under 60 usually starts with an H. pylori test, because treating the infection when it's present is part of the recommended approach. If you call everything "indigestion," you and your doctor may spend months on the wrong track.

How to describe it to your doctor

1. Point to where it hurts: behind the breastbone, or below it.
2. Describe the feeling: burning that rises and a sour taste, or heaviness and early fullness.
3. Note the timing: during meals, right after, at night or when lying down.
4. List what you take, including over-the-counter pain relievers and any hormone therapy.
5. Say how often it happens and how long it has been going on.

When to get help quickly

• Chest pain or pressure, shortness of breath, sweating, or pain spreading to your arm, jaw or back. Heart symptoms can feel like indigestion, so call 911.
• Trouble or pain swallowing, or food getting stuck
• Persistent vomiting, or vomit that looks bloody or like coffee grounds
• Black or bloody stools, anemia, or weight loss you can't explain
• New symptoms at 60 or older, or a family history of stomach cancer

Sources

1. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900-20. PMID 16928254
2. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150(6):1380-92. PMID 27147122
3. Jacobson BC, Moy B, Colditz GA, Fuchs CS. Postmenopausal hormone use and symptoms of gastroesophageal reflux. Arch Intern Med. 2008;168(16):1798-804. PMID 18779468
4. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. PMID 34807007
5. Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013. PMID 28631728

This article is for general information and isn't medical advice. Chest pain always needs prompt medical attention. Talk to your healthcare provider about ongoing heartburn or indigestion.