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:
- antacids, such as Tums or Maalox
- H2 receptor blockers, such as Pepcid or Tagamet
- proton pump inhibitors, such as Prilosec, Nexium, or Prevacid
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.
Persistent heartburn may be a symptom of:
GERD occurs when acid reflux damages the esophagus. Symptoms include:
- frequent heartburn
- difficulty swallowing
- nausea or vomiting
- chronic dry cough
- feeling like food is stuck in your chest
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:
- laparoscopic Nissen fundoplication
- magnetic sphincter augmentation (LINX)
- transoral incisionless fundoplication (TIF)
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:
- persistent heartburn
- trouble swallowing
- shortness of breath
- vomiting blood
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.
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Treatment for Barrett’s esophagus
Your doctor will most likely recommend prescription-strength proton pump inhibitors. Other recommendations may include:
- repeated surveillance endoscopy
- endoscopic ablative therapies, such as photodynamic therapy and radiofrequency ablation
- endoscopic mucosal resection
- surgery (esophagectomy)
Along with heartburn, the symptoms of esophageal cancer include:
- unexplained weight loss
- frequent choking on food
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:
- 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.