Functional Heartburn

The nerves in the gullet lining appear to be over-sensitive, so that normal stretching, small amounts of reflux or even normal sensations are felt as burning. Stress, anxiety, low mood and poor sleep can make this sensitivity worse, as the brain and gut are closely connected. It often overlaps with other functional gut conditions such as functional dyspepsia (upper abdominal discomfort) and irritable bowel syndrome.

Many people who are told they have reflux and do not improve on acid-reducing medicines turn out to have functional heartburn or another functional condition. It is more commonly diagnosed in people with persistent heartburn despite treatment.

If you fast during Ramadan, ask your doctor how to take your medicines safely around suhoor and iftar. Rich, fried or spicy iftar foods and strong tea or coffee can aggravate heartburn for some people.

Doctors first confirm that a structural or acid-related disease is not the problem. An upper endoscopy (a thin camera passed through the mouth to look at the gullet and stomach) is usually normal. Then, usually after the person has stopped acid-reducing medicines for a time under medical advice, reflux monitoring is done: a thin probe or a small capsule measures how much acid reaches the gullet over one or more days and whether symptoms match the acid episodes. Sometimes a test of gullet movement (manometry) is also used to exclude muscle disorders such as achalasia. Functional heartburn is diagnosed when all of these are normal. Never stop your medicines before tests unless your doctor tells you to.

Because the brain-gut connection matters, caring for stress and sleep is part of treatment.

• Try relaxation, slow breathing or mindfulness regularly

• Keep a regular sleep routine

• Be physically active most days

• Stop smoking; avoid excess alcohol

• Do not keep increasing acid medicines on your own if they are not helping; talk to your doctor

Food is rarely the main driver, but sensible eating can reduce flare-ups.

• Eat smaller meals and avoid lying down soon after eating

• Notice whether particular foods (very spicy, acidic or fatty) bother you and limit those

• Do not restrict your diet heavily; keep a balanced intake

Acid-reducing medicines often do not help functional heartburn, so treatment shifts to calming nerve sensitivity. Your doctor decides what to try.

• If proton pump inhibitors (stomach-acid blockers) have not helped, your doctor may advise reducing or stopping them gradually

• Low-dose medicines that reduce gut nerve sensitivity (certain antidepressant-type medicines) are often used; they are prescribed for pain modulation, not because the problem is "all in your mind"

• Other nerve-modulating medicines may be considered in specialist care

• Always take these medicines exactly as prescribed and report side effects

Procedures are mainly for testing. Anti-reflux surgery does not help functional heartburn.

• Endoscopy, reflux monitoring and manometry are used to make the diagnosis

• Anti-reflux surgery or endoscopic anti-reflux procedures are not recommended when reflux has been excluded as the cause

• Gut-focused psychological therapies, such as cognitive behavioural therapy or hypnotherapy, are effective for some people

Functional heartburn is not dangerous and does not cause cancer. Symptoms can be long-lasting, but most people improve once the right kind of treatment is used, particularly treatments that target nerve sensitivity rather than acid.

• How do you know my heartburn is not caused by acid?

• Should I keep taking my acid-reducing medicine?

• Which treatment targets nerve sensitivity, and what are its side effects?

• Could psychological therapy help, and where can I find it?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.