Top GP warns persistent heartburn can signal serious disease and urges prompt checks

A senior general practitioner has warned that while heartburn is common, persistent or unexplained symptoms can be a red flag for serious illness including acid-related disease and, rarely, cancer, and should be assessed by a doctor.

Dr. Dan Baumgardt, a Bristol-based GP and University of Bristol lecturer, wrote in The Conversation that most cases of indigestion are benign and respond to over-the-counter remedies, but ongoing problems warrant medical review because they can indicate conditions ranging from gastro-oesophageal reflux disease to ulcers or upper gastrointestinal cancers.

Indigestion, or dyspepsia, describes discomfort in the upper abdomen often after eating and may include bloating, nausea or a burning sensation in the chest commonly referred to as heartburn. Acid reflux, which occurs when stomach acid repeatedly flows back into the gullet, is a frequent cause. A hiatus hernia, in which part of the stomach protrudes through the diaphragm, affects about one-third of people aged 50 and over and increases the likelihood of reflux.

Everyday factors can trigger short-term episodes: large, spicy or fatty meals, caffeine or alcohol, being overweight, pregnancy and smoking. Certain medicines, including some antidepressants, nonsteroidal anti-inflammatory drugs such as ibuprofen, and iron supplements, can also precipitate symptoms. After a heavy meal or a stomach infection, transient indigestion is expected and typically clears within days.

Dr. Baumgardt advised seeing a GP when symptoms persist or are unexplained. He said red-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, which requires urgent hospital care.

Doctors assess such symptoms by taking a clinical history and may recommend investigations including endoscopy, in which a camera is passed down the throat to inspect the gullet and stomach. Inflammation of the oesophagus, stomach or duodenum may be caused by Helicobacter pylori, a common bacterial infection that is the leading cause of peptic ulcers; treatment can require antibiotics together with acid-suppressing medication such as omeprazole. Untreated ulcers carry risks of bleeding or perforation.

Medical practitioners also caution that symptoms described as indigestion can sometimes signal heart problems, including ischaemic heart disease, where restricted blood flow causes chest pain. Other cancers, such as pancreatic or ovarian cancer, may present with indigestion among a range of symptoms.

Guidance from the National Institute for Health and Care Excellence recommends urgent investigation for patients with difficulty swallowing, an abdominal lump, unexplained weight loss, or abdominal pain with indigestion, particularly in people aged 50 and older. The guidance also suggests considering investigation 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 warning comes amid debate about long-term use of proton pump inhibitors, a class of drugs that includes omeprazole and is widely prescribed to suppress stomach acid. Pharmacist Deborah Grayson, in a widely viewed TikTok video, cautioned that while such medicines relieve reflux in the short term, extended use can cause side effects including bloating, nausea, weight gain and vitamin deficiencies. Proton pump inhibitors were among the most commonly prescribed medicines on the NHS, with 73 million prescriptions issued in England in 2022–23 at an estimated cost of £190 million.

Clinicians emphasise that self-diagnosis and prolonged reliance on over-the-counter remedies are not substitutes for medical assessment when symptoms are persistent or accompanied by red flags. A GP can evaluate risk factors, arrange appropriate tests and decide whether endoscopy or referral to specialists is warranted.