Heartburn is caused by stomach acid backing up into the esophagus (the tube connecting your mouth to your stomach). Also called acid reflux, it feels like a burning pain typically just behind the breastbone.

Occasional heartburn usually isn’t a cause for concern. It can be managed with lifestyle changes and over-the-counter (OTC) medications, such as:

However, if heartburn becomes more frequent, won’t go away, or stops responding to OTC medications, it may be a sign of a more serious condition that should be addressed by your doctor.

Keep reading to learn what might cause persistent heartburn and how to treat these conditions.

GERD occurs when acid reflux damages the esophagus. Symptoms include:

Treatment for GERD

You doctor will most likely start your treatment with OTC antacids and either OTC or prescription H2 receptor blockers and proton pump inhibitors.

If the medications aren’t effective, your doctor may recommend surgery, such as:

A hiatal hernia is the result of weakened muscle tissue surrounding the esophageal sphincter allowing part of the stomach to bulge up through the diaphragm. Symptoms include:

Treatment for hiatal hernia

To relieve symptoms of heartburn, your doctor may recommend antacids, proton pump inhibitors, or H2 receptor blockers. If the medication isn’t alleviating the heartburn, your doctor may suggest surgery, such as:

  • open repair
  • laparoscopic repair
  • endoluminal fundoplication

With Barrett’s esophagus, the tissue lining the esophagus is replaced by tissue similar to the tissue that lines the intestines. The medical term for this is metaplasia.


Barrett’s esophagus doesn’t cause symptoms. GERD is a problem for many people who have Barrett’s esophagus. Persistent heartburn is a symptom of GERD.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, there’s a greater likelihood of people with Barrett’s esophagus developing a rare type of cancer called esophageal adenocarcinoma.

Treatment for Barrett’s esophagus

Your doctor will most likely recommend prescription-strength proton pump inhibitors. Other recommendations may include:

Along with heartburn, the symptoms of esophageal cancer include:

Treatment for esophageal cancer

Your doctor’s recommendations for treatment will take into account a number of factors, including the type and stage of your cancer. Treatment options may include:

  • chemotherapy
  • radiation therapy
  • immunotherapy, such as pembrolizumab (Keytruda)
  • targeted therapy, such as HER2-targeted therapy or anti-angiogenesis therapy
  • surgery, such as endoscopy (with dilation or stent placement), electrocoagulation, or cryotherapy

If you have heartburn that won’t go away and won’t respond to OTC medications, see your doctor for a diagnosis. Heartburn may be a symptom of a serious condition.