Chest pain after eating: reflux, ulcers, gallstones and the heart

Pain in the chest after a meal is most often heartburn, where stomach acid travels up towards the throat. The NHS describes heartburn as a burning feeling in the middle of the chest, often with an unpleasant sour taste, and says symptoms are often worse after eating, when lying down and when bending over.

The difficulty is that the heart, gullet, stomach and gallbladder all lie close together and their pain signals can feel alike. The NHS therefore does not ask people to diagnose the cause themselves. Its chest pain page says: do not self-diagnose, and see a GP if you are worried. The sections below describe what each condition tends to look like and, above all, the situations in which waiting is the wrong choice.

The NHS says to call 999 if you get sudden pain or discomfort in the chest that does not go away, if the pain can feel like squeezing or pressure, burning or indigestion, if it spreads to the left or right arm, the neck, jaw, stomach or back, or if chest pain comes with feeling sweaty, sick, light-headed or short of breath. These could be signs of a heart attack, and the NHS says you need immediate treatment in hospital.

The heart attack page adds other features: feeling short of breath, feeling or being sick, feeling like you have indigestion with a burning feeling in the chest and feeling full or bloated, sweating, and pale, blue or grey skin. It advises not driving yourself to A&E and, while waiting for help, sitting and resting with the back supported. It also notes aspirin 300mg may be taken if available and not allergic, and GTN spray for people who have angina.

Because a heart attack can feel like indigestion, a first episode of burning chest pain with sweating or breathlessness is not a situation to treat with antacids and wait.

The NHS lists, as things that can bring on or worsen heartburn, certain foods and drinks such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods, being overweight, smoking, pregnancy, stress and anxiety, some medicines such as anti-inflammatory painkillers, a hiatus hernia, a stomach ulcer and a bacterial infection in the stomach.

It suggests eating smaller, more frequent meals, trying to lose weight if overweight, finding ways to relax, avoiding trigger foods, not eating within 3 or 4 hours before bed, not wearing clothes tight around the waist, not smoking and not drinking too much alcohol. A pharmacist can recommend antacids or alginates, which help in the short term but should not be taken regularly for long periods.

See a GP, says the NHS, if lifestyle changes and pharmacy medicines are not helping, if you have heartburn most days, or if you also have food getting stuck in the throat, frequent vomiting or weight loss for no reason. A GP may prescribe a proton pump inhibitor such as omeprazole or lansoprazole and may refer you for a gastroscopy.

The NHS describes the main symptom of a stomach ulcer as tummy pain that is usually in the upper part of the tummy, may feel like burning and is often worse at night, with indigestion, heartburn, bloating and feeling or being sick. It names infection with H. pylori bacteria and regular use of anti-inflammatory painkillers such as ibuprofen as the main causes. See a GP if indigestion does not go away with treatment or tummy pain keeps coming back.

Gallstone pain, the NHS says, can feel severe, be constant, last longer than 30 minutes and up to several hours, and be in the middle of the tummy or just under the ribs on the right side, with feeling or being sick. It advises an urgent GP appointment or NHS 111 for pain that lasts longer than 30 minutes, and 999 or A&E for sudden severe tummy pain, pain spreading from the tummy to the back with vomiting, a very high temperature or feeling hot, cold or shivery, or yellow skin or eyes.

The NHS ulcer page lists emergencies too: vomiting bright red blood or something resembling coffee grounds, blood in the stool or black sticky stools, severe tummy pain, a tummy that is painful to touch, or chest pain that started suddenly.

The following are patterns the NHS pages describe. They are for orientation and cannot replace an assessment, particularly because the heart attack page itself recognises that indigestion-like symptoms can be cardiac.

The NHS says to see a GP if you have chest pain that comes and goes, or chest pain that goes away quickly but you are still worried, because it is important to make sure it is nothing serious. A clinician can ask about the pattern, the timing relative to meals, your medicines and risk factors for heart disease, and can arrange tests such as an ECG, blood tests or a gastroscopy where suitable.

The NHS says you are more likely to have heart problems if you are older or at risk of coronary heart disease, for example if you smoke, are living with obesity, have high blood pressure, diabetes or high cholesterol, or have family members who had heart attacks or angina under the age of 60.