Heartburn is a burning sensation in the chest. Heartburn that does not go away can result from gastroesophageal reflux disease (GERD), a hiatal hernia, Barrett’s esophagus, or esophageal cancer.

Heartburn refers to the burning sensation in the chest that happens as a result of stomach acid. This is called acid reflux.

Occasional acid reflux is normal. However, if a person experiences persistent or frequent heartburn, it may be due to other medical conditions.

This article examines the causes of persistent heartburn and when to contact a doctor.

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Heartburn occurs as a result of acid reflux.

Between the lower esophagus and stomach is a tight ring of muscle called a sphincter. It stays closed until the combination of saliva chewed food reaches it. At this point, it relaxes to allow food to pass to the stomach.

Once food has passed through, it closes and prevents food and stomach acid from traveling back up the food pipe.

After a large meal, the stomach may stretch. This loosens the esophageal sphincter. In some people, the sphincter also opens without identifiable reason.

Stomach contents can travel up the esophagus, causing pain and irritation.

GERD occurs when acid reflux happens regularly. If a person experiences heartburn more than twice per week, it may be a sign of GERD.

About 20% of people in the United States have GERD.

Not everyone with GERD will experience heartburn. Other symptoms might include:

Treatment

A doctor may recommend lifestyle changes and over-the-counter (OTC) or prescription medications to treat GERD.

OTC antacids can help to treat mild symptoms of GERD. However, a person will require different medications for more severe cases of GERD.

To treat more severe cases of GERD, a doctor may suggest H2 blockers or proton pump inhibitors (PPIs).

H2 blockers are medications that slow down acid production in the stomach. They can also help to heal the esophagus. A person can buy these as OTC medications, or a doctor can prescribe them.

PPIs also lower the amount of acid the stomach makes. They are effective at treating GERD symptoms and better at healing the esophagus lining than H2 blockers.

If treatment with medication is unsuccessful, a medical professional may recommend surgery.

Lifestyle changes could include:

A hiatal hernia occurs when the upper part of the stomach bulges through an opening in the diaphragm.

The diaphragm is a thin muscle layer that runs horizontally through the abdomen. A separation in the muscle may allow a portion of the stomach to push through the diaphragm.

A hiatal hernia can make it easier for stomach contents to flow into the esophagus, resulting in heartburn. It can also cause:

Treatment

Initially, a doctor may suggest lifestyle changes, antacids, or other medications to control heartburn.

Some lifestyle recommendations a healthcare professional might make include:

  • eating small meals
  • avoiding trigger foods
  • quitting smoking, if applicable
  • avoiding alcohol
  • achieving and maintaining a healthy BMI

Learn more about foods to eat and avoid for a hiatal hernia.

If initial treatments do not help, surgery to fix the hernia may be an option.

Barrett’s esophagus is a condition in which the normal lining of the esophagus begins to change, possibly in order to better withstand stomach acid. The changed lining is similar to that which lines the intestine.

Researchers do not yet fully understand what causes Barrett’s esophagus, but GERD increases the possibility of developing it.

Barrett’s esophagus does not cause symptoms on its own. However, people who develop it often experience heartburn and GERD.

Those who develop Barrett’s esophagus have an increased risk of developing a rare cancer called esophageal adenocarcinoma. Precancerous cells are identifiable in tissue samples that doctors take from Barrett’s tissue during an upper endoscopy.

Treatment

To observe signs of cancer development, a doctor will suggest monitoring Barrett’s esophagus using a periodic upper endoscopy. During this procedure, they place a small camera through the mouth and into the esophagus to examine it.

In addition, the doctor may prescribe PPIs to help relieve heartburn, prevent additional damage to the esophagus, and heal existing damage.

There are also two endoscopic procedures to treat Barrett’s esophagus: endoscopic ablative therapy and endoscopic mucosal resection.

Both procedures remove Barrett’s tissue from the esophagus. The body then heals the esophagus with normal tissue cells.

Surgery may also be an option. A surgeon may perform an esophagectomy to remove the portion of the esophagus that is affected by the condition. A surgeon uses a part of the large intestine to rebuild the removed area.

With esophageal cancer, malignant cells develop in the tissue of the esophagus. It begins in the lining of the esophagus and extends into the rest of the structure.

The two most common forms of esophageal cancer are squamous cell carcinoma and adenocarcinoma.

Several things can increase the risk of esophageal cancer, including:

  • smoking
  • heavy alcohol use
  • Barrett’s esophagus
  • age

Symptoms that cancer is present in the esophagus can include:

  • pain or difficulty swallowing
  • weight loss
  • pain behind the sternum
  • hoarseness
  • cough
  • heartburn
  • a growth under the skin — this is rare and only occurs if the cancer has metastasized

Treatment

A doctor will evaluate the cancer cells and condition of the esophagus to determine the type and stage of cancer. Surgery to remove the affected part of the esophagus is the most common treatment.

A doctor may also recommend other treatments, such as:

Other treatments, including monoclonal antibody therapy, are undergoing research in clinical trials.

The Office on Women’s Health notes that hormone changes during pregnancy slow down the digestive system’s muscles and can also cause the esophageal sphincter to relax. This can result in food and acid traveling back up the esophagus, leading to heartburn.

In later pregnancy, the uterus puts pressure on the stomach, causing heartburn more frequently.

The doctor can determine whether antacids or other medications are safe to take during the pregnancy.

Learn more about acid reflux during pregnancy.

If a person’s heartburn is persistent and frequent, they should contact a doctor. However, a person can try the following to help reduce their symptoms of heartburn:

  • eating small meals more often instead of three meals a day
  • eating slowly
  • avoiding greasy or fried food
  • drinking fluids between meals rather than with food
  • avoiding citrus and spicy food
  • avoiding lying down soon after eating
  • elevating the head and upper body when sleeping
  • achieving and maintaining a healthy BMI
  • avoiding or stopping smoking
  • avoiding alcohol

It is usual for people to experience heartburn every once in a while. However, consistent heartburn can indicate a more serious health concern.

People should contact a doctor if they suspect they have developed GERD, OTC antacids and H2 blockers are no longer controlling heartburn, or they have pain or difficulty with swallowing.

People should also contact a doctor if their chest pain feels more like pressure, squeezing, or constriction rather than burning.

These are possible signs of a heart attack.

Learn more about how to distinguish between a heart attack and heartburn.

Heartburn occurs when food and stomach acid travel back up the esophagus from the stomach, causing a burning sensation. OTC medications like antacids or H2 blockers may relieve the pain.

Heartburn occurring more than twice per week is a symptom of GERD and may require stronger or prescription medications.

Persistent heartburn can also be a symptom of other conditions, such as Barrett’s esophagus, hiatal hernia, or esophageal cancer.

If heartburn does not resolve after taking antacids, a person should visit a doctor for evaluation. They may recommend stronger medications, lifestyle modifications, or an endoscopy procedure to further evaluate symptoms.