Causes and Management of Constant Heartburn

Heartburn occurs when stomach acid backs up into the esophagus, causing burning, irritation, or pain in the chest. This pain often appears or is made worse after eating. Occasional heartburn is often caused by overeating and poor diet and may not be a need for concern. But constant heartburn may indicate an underlying health issue that should be investigated.

This article discusses the causes and treatment options for persistent heartburn.

Possible Causes

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) can cause constant heartburn that occurs more than twice a week over a period of several weeks.

The main symptom is heartburn (pain or burning in the chest), but you may also experience:

• Sore throat
• Hoarseness
• Difficulty swallowing
• Feeling like there is a lump in your throat

Gastrointestinal Disease

There are several gastrointestinal diseases that can cause constant or recurrent heartburn. These include:

• Peptic ulcers: Peptic ulcers are painful sores that occur in the stomach. Heartburn can be a symptom of ulcers, but in contrast to other causes of heartburn, ulcer symptoms may improve when you eat and get worse when your stomach is empty. Other symptoms of ulcers are weight loss, bloating, nausea, and vomiting.
• Hiatal hernia: Hiatal hernia is a condition in which the stomach protrudes through the diaphragm. Hiatal hernia is very common and causes heartburn and other symptoms associated with acid reflux, including difficulty swallowing.
• Esophageal motility disorders: Esophageal motility disorders are disorders that prevent the normal rhythmic motion, called peristalsis, that moves food down the esophagus. Some examples include achalasia, jackhammer esophagus, nutcracker esophagus, and distal esophageal spasm.

Esophagitis

Esophagitis is a broad term that refers to any inflammation of the esophagus. Symptoms include:

• Heartburn
• Difficulty swallowing
• Pain when swallowing
• Hoarseness or sore throat

Esophagitis can be caused by many things, including viruses or other germs, medications, or frequent vomiting.

Eosinophilic esophagitis is a type of esophagitis in which an excess number of white blood cells, called eosinophils, are present in the tissue of the esophagus. It is thought to be related to allergies.

Additional Symptoms

Depending on the underlying cause of your constant heartburn, additional symptoms can often include generalized indigestion, such as bloating and stomach pain.

If stomach acid is coming up your esophagus at night while you are lying down, you may wake up with a sore throat, bad breath, or hoarseness.

Treatment

Dietary and Lifestyle Changes

It is helpful for some individuals who have constant heartburn to avoid certain foods that may trigger their symptoms.

Foods that are associated with heartburn include:

• Fried and fatty foods
• Chocolate
• Carbonated beverages
• Caffeine
• Alcohol
• Foods high in citric acids, such as oranges or lemons

It may be helpful to eat smaller meals throughout the day rather than infrequent large meals.

If you suffer from acid reflux, it may be helpful to elevate your upper body at night while sleeping.

Medications

There are several different medications that can be used to treat heartburn. Some only treat immediate symptoms, but others can actually heal damaged tissue in the esophagus.

Many of these medications are available over the counter, but they are still capable of producing side effects. Long-term use of any of these medications is not recommended unless you are specifically told to use them regularly by your healthcare provider:

• Antacids: Examples of antacids include Tums or Rolaids (calcium carbonate), or Maalox liquid (aluminum hydroxide, magnesium hydroxide, and simethicone). These medications neutralize stomach acid, which can relieve symptoms, but do nothing to treat the underlying condition.
• H2 (histamine 2) blockers: These medications prevent the formation of acid in the stomach. Examples of H2 blockers include Pepcid (famotidine), and Tagamet (cimetidine). Zantac (ranitidine) is not recommended and was removed from the market in April 2020 due to concerns about possible harmful impurities when stored at high temperatures for long periods of time.
• Proton pump inhibitors: Examples of proton pump inhibitors (PPIs) include Prevacid (lansoprazole), Prilosec (omeprazole), and Dexilant (dexlansoprazole). Like H2 blockers, PPIs also reduce stomach acid but tend to be more potent in their effects. They are also capable of helping to heal damaged esophageal tissue. They are widely prescribed for a variety of acid-related diseases and some (including Prevacid and Prilosec, but not Dexilant) are available over the counter.
• Baclofen: Baclofen is a different class of medication completely. It is a skeletal muscle relaxant that is occasionally prescribed to relax the lower esophageal sphincter so that it remains closed and prevents stomach acid from regurgitating back into the esophagus. Baclofen is only available with a prescription.

Don't hesitate to talk to your healthcare provider or pharmacist if you have questions about any of these medications.

Surgery

Surgery is usually reserved for individuals whose symptoms cannot be controlled with medications or lifestyle changes.

A Nissen fundoplication is a procedure in which the upper part of the stomach, called the fundus, is wrapped around the lower part of the esophagus. This serves to reinforce the lower portion of the esophagus and prevents food from coming back up through the esophageal sphincter.

Another procedure that may be used is a LINX device implantation. A LINX device uses magnets to keep the lower esophageal sphincter closed the majority of the time but still allows it to open so that food can pass through to the stomach.

Heartburn Prevention

The following tips can help to prevent or minimize symptoms of heartburn:

• Avoid overeating and instead eat smaller, more frequent meals throughout the day.
• Limit your alcohol intake.
• Identify food triggers and avoid them.
• Remain upright for approximately one hour after eating.
• Do not eat right before bedtime.
• Elevate your upper body while sleeping rather than lying flat.
• Stop smoking.
• Manage stress.
• Maintain a healthy body weight.

When to See a Healthcare Provider

You should see a healthcare provider to determine the underlying cause and for proper treatment if:

• You have constant heartburn that won't subside
• Your symptoms of heartburn are becoming more severe or frequent
• You have taken an over-the-counter PPI for the recommended two weeks and your symptoms return
• You experience vomiting or difficulty swallowing with your heartburn
• You have hoarseness or wheezing
• You experience unexpected weight loss

Untreated acid disorders can lead to complications, including Barrett's esophagus (damage to the lining of the esophagus), esophageal cancer, or scarring or narrowing of the esophagus.

You should seek care immediately if you vomit blood or material that looks like coffee grounds (this could be blood). You should also seek care immediately if you notice blood in your stools or have black or tar-like stools (this also might be blood).

If your vomiting is large, green, yellow, or forceful, you should seek care urgently by going to an emergency room.

Summary

Constant heartburn can be a symptom of an underlying condition, such as GERD, esophagitis, or other gastrointestinal disorders. If you experience frequent heartburn or heartburn more than once a week for several weeks, consult a healthcare provider for diagnosis and treatment.

A Word From Verywell

Heartburn is a common and uncomfortable condition. Fortunately, symptoms can be greatly improved with adequate diagnosis and treatment. Don't hesitate to contact your healthcare provider if you experience constant heartburn.