Acid reflux (heartburn): symptoms, treatment and warning signs
Acid reflux treatment starts with habit changes, such as eating at least 3 hours before lying down and raising the head of your bed, and can include medicines that lower stomach acid. If you have no warning signs, the doctor can assess you by video. Chest pain that could be your heart is an emergency: call 911.
Can we help by telehealth? Yes, we can help by telehealth.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Severe or squeezing chest pain that spreads to the arm, jaw or back, or comes with shortness of breath, a cold sweat or dizziness
- Vomit with blood or that looks like coffee grounds
- Black, tarry or bloody stools
- Trouble swallowing or food getting stuck
- Unexplained weight loss
Help lines:
- 911 — Emergencies
- 1-800-981-0023 — Línea PAS (mental-health crisis line)
- 988 — Suicide & Crisis Lifeline
- 1-800-222-1222 — Poison Help
First: heartburn or a heart problem?
Heartburn feels like burning in the middle of the chest, and a heart attack can also be felt in the chest. If the pain is severe or squeezing, spreads to your arm, jaw or back, or comes with shortness of breath, a cold sweat, nausea or dizziness, do not wait for a video visit: call [911](tel:911).
This matters even more if you have high blood pressure, diabetes or high cholesterol, or if you smoke.
Acid reflux symptoms
The most common symptoms are:
- Heartburn: a painful, burning feeling in the middle of the chest
- Regurgitation: stomach contents coming back up into the throat or mouth
- Nausea
- Trouble swallowing
- A chronic cough or hoarseness
Reflux and GERD
Occasional reflux, for example after a big meal, is common. When the muscle at the bottom of the esophagus becomes weak or relaxes when it should not, reflux becomes frequent or long-lasting, and it is called gastroesophageal reflux disease (GERD). Not everyone with GERD has heartburn; some mainly have a cough or hoarseness.
Habits that help
These changes, recommended by the NIDDK, help many people and are the first step of treatment:
- Eat at least 3 hours before you lie down or go to bed.
- If reflux bothers you at night, raise the head of your bed 6 to 8 inches with a foam wedge or pillows under your head and upper back.
- Lose weight if you are overweight.
- Quit smoking.
- Notice which foods bother you. Common ones are acidic foods (citrus, tomatoes), alcohol, chocolate, coffee and other caffeine, high-fat foods, mint and spicy foods.
Acid reflux treatment with medication
There are three main groups. Antacids relieve mild symptoms but should not be used every day without medical advice. H2 blockers reduce how much acid the stomach makes. Proton pump inhibitors are the most effective at lowering acid and healing the esophagus; like any medicine, they can have side effects.
If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances. If you already take a reflux medicine and need it renewed, see prescription refills.
When you need an endoscopy or a specialist
The doctor will refer you to a gastroenterologist, who may do an endoscopy, if your symptoms do not improve with habit changes and medicine, or if you have any of these signs:
- Trouble or pain when swallowing
- Unexplained weight loss
- Loss of appetite
- Vomiting that will not stop
- Vomit with blood or that looks like coffee grounds
- Black or bloody stools
Reflux, weight and Puerto Rico
Losing weight is one of the steps that helps reflux most. In Puerto Rico, adult obesity rose from 26.3% in 2011 to 36.2% in 2024, according to BRFSS surveillance data published by the Puerto Rico Institute of Statistics. If you want a plan for your weight and your reflux, the doctor can go through it with you during the visit.
Reflux in children and teens
Spitting up is very common in babies. We see children from 6 months old, with a parent or legal guardian on camera; the doctor is a general practice physician, not a pediatrician. A child who vomits forcefully, vomits green or blood, is not gaining weight or refuses to eat needs an in-person evaluation with a pediatric specialist.
Video visit: US$79 · Pay by card · See the price and what is included
Before you book
- You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
- We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
- Real-time video only; we do not do phone-call visits.
- We do not prescribe controlled substances.
Frequently asked questions
- How can I tell heartburn from a heart problem?
- You cannot always tell at home. If chest pain is severe or squeezing, spreads to your arm or jaw, or comes with shortness of breath, sweating or dizziness, call 911. Do not treat it as heartburn until a doctor has ruled out your heart.
- Which foods make reflux worse?
- Common triggers are citrus, tomatoes, alcohol, chocolate, coffee, high-fat foods, mint and spicy foods. Everyone is different, so notice which ones bother you.
- Can acid reflux be treated by telehealth?
- Yes, if you have no warning signs. In an online doctor visit, the doctor reviews your symptoms, suggests changes and, if appropriate, prescribes a medicine. If there are warning signs, she will refer you for an in-person evaluation.
- When does reflux need an endoscopy?
- When there is trouble swallowing, unexplained weight loss, bleeding or vomiting that will not stop, or when treatment is not working. A gastroenterologist does the endoscopy in person.
Sources
- NIDDK (NIH): Symptoms and causes of GER and GERD in adults (accessed 2026-09-30)
- NIDDK (NIH): Treatment for GER and GERD in adults (accessed 2026-09-30)
- NIDDK (NIH): Eating, diet and nutrition for GER and GERD in adults (accessed 2026-09-30)
- Puerto Rico Institute of Statistics: World Obesity Day (BRFSS data, Spanish) (accessed 2026-09-30)