GP warns persistent heartburn can signal serious disease, including cancer

A Bristol-based GP has warned that while heartburn is common and usually benign, persistent or unexplained symptoms can be a red flag for more serious conditions, including acid reflux complications and, in rare cases, cancer.

Dr. Dan Baumgardt, a GP and University of Bristol lecturer writing in The Conversation, said over-the-counter treatments often relieve short-term indigestion but cautioned that "indigestion is common but not always harmless." He urged patients not to rely solely on self-care when symptoms persist or worsen, and to seek medical advice so a clinician can "put the pieces together and decide on the most appropriate plan."

Indigestion, or dyspepsia, describes discomfort in the upper abdomen after eating and can include bloating, nausea and a burning sensation in the chest commonly called heartburn. Acid reflux, in which stomach acid repeatedly flows back into the gullet, is a frequent cause. Everyday factors that increase the likelihood of symptoms include eating large, spicy or fatty meals, drinking coffee or alcohol, being overweight, pregnancy, and smoking. Certain medicines — including some antidepressants, ibuprofen and other non-steroidal anti-inflammatory drugs, and iron supplements — can also trigger reflux.

Short-term indigestion after a heavy meal or a stomach infection typically resolves within days and is unlikely to be serious. But Dr. Baumgardt and national guidelines flag several red-flag symptoms that should prompt urgent medical assessment: difficulty swallowing (dysphagia), unexplained weight loss, persistent upper abdominal pain, feeling full quickly after eating, and vomiting blood. In severe cases, abdominal lumps or anaemia are further indications for rapid investigation.

The National Institute for Health and Care Excellence (NICE) recommends urgent investigation for people with difficulty swallowing, abdominal lumps, unexplained weight loss, and abdominal pain accompanied by indigestion, particularly in those aged 50 and over. NICE also advises considering investigation for persistent symptoms that fail to respond to treatment, or in patients with a history of ulcers or a family history of upper gastrointestinal cancer.

Diagnostic investigation often includes endoscopy, a procedure in which a flexible camera is passed down the throat to inspect the oesophagus, stomach and upper small intestine. Endoscopy can detect inflammation, ulcers and tumours. Inflammation of the oesophagus, stomach or duodenum may be caused by Helicobacter pylori, a common bacterial infection and the leading cause of peptic ulcers; treatment generally combines antibiotics with acid-suppressing medications.

Left untreated, ulcers carry risks of bleeding and, rarely, perforation. Ongoing reflux can also lead to complications such as oesophagitis or Barrett's oesophagus, a condition that may increase the risk of oesophageal cancer and is monitored by specialists.

Doctors note that not all indigestion-like symptoms arise from the digestive tract. Heart disease, including ischaemic heart disease, can produce chest discomfort that patients may mistake for heartburn. Other cancers, including pancreatic and ovarian tumours, may present with indigestion among a broader set of symptoms.

The warning comes amid debate over the long-term use of proton pump inhibitors (PPIs), such as omeprazole, which suppress stomach acid and are effective for many reflux-related problems. Pharmacist Deborah Grayson, in a widely viewed social media post, cautioned that prolonged PPI use can be associated with side effects including bloating, nausea, weight gain and potential vitamin deficiencies. PPIs are among the most prescribed drug classes in the UK: NHS England data show about 73 million PPI prescriptions were issued in 2022–23 at a cost of roughly £190 million.

Clinicians say the balance of benefits and harms should guide treatment. Short courses of PPIs can be appropriate for diagnosed gastritis, oesophageal erosion or ulcer disease, while simple, intermittent heartburn may be managed with lifestyle changes and over-the-counter remedies. Persistent, progressive or unexplained symptoms warrant GP assessment so that appropriate tests and specialist referrals can be arranged.

Dr. Baumgardt emphasised the importance of not ignoring ongoing symptoms: "It's important not to ignore persistent symptoms, and not to rely on over-the-counter remedies alone." He advised patients with red-flag signs to seek prompt medical attention so clinicians can determine whether investigation or treatment is needed.