As many as 60 million people in the U.S. suffer from heartburn. The vast majority of these people can find relief in over-the-counter medications from their local drugstore and by making adjustments in when and what they eat. But for some, the burning pain can actually be a symptom pointing to a more serious problem. You need to know when you can safely self-medicate and how to recognize warning signs that warrant additional medical evaluation.

Why are heartburn and heart attack symptoms sometimes confused? Heartburn is a burning sensation located in the chest. A lot of patients will say, "I feel it behind the breastbone. It's a uneasy, burning discomfort." Some people don't even call it a pain, just a an uncomfortable feeling.

While many describe their heartburn to you using an open hand to the chest (they often move the hand up and down) it’s very much different than patients who have angina from heart disease. A person who is having a heart attack might say, "… that feels like a squeezing sensation," and they will often clench their fist over the chest.

Another good clue that a person is suffering from heartburn and not heart attack is if it occurs after meals. People sometimes get it if they eat a fatty meal, for example. And another very common feature of it is it goes away with medicines that eliminate acid.

What are alarm heartburn symptoms?
There are a number of alarm symptoms that warrant a trip to a physician for evaluation. If heartburn is accompanied by food getting stuck in your chest on the way down, it could be indicating something more than just simple heartburn, and we would be concerned about it. If you have heartburn and you have also thrown up blood, or if you notice that your stools have become black, that's a sign that there could be internal bleeding. If it hurts when you swallow, whenever you're swallowing, and you're feeling pain in chest at the same time, or if you're having fevers in association with any of these symptoms, you should see a doctor. Those are just the symptoms that would say this is not just simple heartburn—that it could be more.

With just simple heartburn—meaning you have heartburn and none of these warning symptoms— some of the over-the-counter medications may work for you.

Does the acid of heartburn pose a threat?

Heartburn is usually a warning that acid is getting into the esophagus. Acid makes contact with the lining of the esophagus and it can damage the normal lining.

You could look at it as the body's way of trying to protect it. The small intestine and the stomach is normally is exposed to acid every day, and so it tends to be a more resistant type of lining.

Do many people with heartburn develop cancer of the esophagus?
Probably not. The odds are definitely in your favor not to develop any of those complications. Barrett's esophagus is found in 5 to 10% of people who have frequent heartburn symptoms—meaning at least once a week—and only 5 to 10% of people with Barrett's esophagus will develop a cancer of the esophagus. So it's a fairly small percentage of people with heartburn who are ever going to get a serious complication of the magnitude.

We don't know what causes some people with Barrett's esophagus to go on to develop cancer while