How to Treat Persistent Heartburn

That burning sensation in your chest, commonly known as heartburn, is caused by stomach acid traveling up into the esophagus. While occasional heartburn is normal and can be managed with over-the-counter (OTC) medications and lifestyle changes, frequent or unrelenting heartburn may signal a more serious condition that requires medical attention.

If you find yourself regularly relying on antacids or other remedies without lasting relief, it might be time to explore the underlying causes and available treatment options.

Why Won’t My Heartburn Go Away?

Persistent heartburn could be a symptom of an underlying condition, including:

• Gastroesophageal reflux disease (GERD) – a chronic condition where acid reflux damages the esophagus.
• Hiatal hernia – a condition in which part of the stomach pushes up through the diaphragm, weakening the esophageal sphincter.
• Barrett’s esophagus – a complication of GERD that alters the esophageal lining and increases the risk of cancer.
• Esophageal cancer – though rare, persistent heartburn can sometimes indicate a more serious issue.

Understanding these potential causes is the first step in determining the most effective treatment approach.

GERD: A Leading Cause of Chronic Heartburn

Gastroesophageal reflux disease (GERD) occurs when acid reflux becomes chronic, leading to inflammation and damage in the esophagus. Symptoms include:

• Frequent heartburn
• Difficulty swallowing
• Nausea or vomiting
• A chronic cough
• A sensation of food being stuck in the chest
• Anemia (in some cases)

Treating GERD

Most doctors begin treatment with OTC medications, including:

• Antacids (e.g., Tums, Maalox) to neutralize stomach acid.
• H2 receptor blockers (e.g., Pepcid, Tagamet) to reduce acid production.
• Proton pump inhibitors (PPIs) (e.g., Prilosec, Nexium, Prevacid) to block acid production more effectively.

If medications fail to provide relief, surgical options may be considered, such as:

• Laparoscopic Nissen fundoplication – a procedure that strengthens the esophageal sphincter.
• Magnetic sphincter augmentation (LINX) – a device implanted to prevent reflux.
• Transoral incisionless fundoplication (TIF) – a minimally invasive procedure to reinforce the valve between the esophagus and stomach.

Hiatal Hernia and Its Role in Acid Reflux

A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm, allowing acid to escape more easily into the esophagus. Symptoms include:

• Ongoing heartburn
• Difficulty swallowing
• Shortness of breath
• Vomiting blood (in severe cases)

Treatment Options

For mild cases, treatment focuses on acid-reducing medications, including PPIs and H2 blockers. If symptoms persist despite medication, surgery might be necessary. Surgical options include:

• Open repair – a traditional surgery to reposition the stomach.
• Laparoscopic repair – a minimally invasive alternative.
• Endoluminal fundoplication – a less invasive approach using an endoscope.

Barrett’s Esophagus: When GERD Leads to Tissue Changes

Barrett’s esophagus is a condition in which the esophageal lining changes, resembling the lining of the intestines. While Barrett’s itself doesn’t cause symptoms, many affected individuals experience chronic acid reflux, which can lead to complications over time.

Managing Barrett’s Esophagus

Doctors typically recommend long-term use of prescription-strength PPIs to control acid reflux. In more advanced cases, other interventions may include:

• Surveillance endoscopy – regular monitoring to check for precancerous changes.
• Endoscopic ablative therapies – treatments such as photodynamic therapy or radiofrequency ablation to destroy abnormal cells.
• Endoscopic mucosal resection – a procedure to remove damaged tissue.
• Surgery (esophagectomy) – a last resort for severe cases involving precancerous or cancerous cells.

Esophageal Cancer: When to Be Concerned

While heartburn is common, it’s important to be aware of symptoms that might suggest esophageal cancer, including:

• Unexplained weight loss
• Vomiting
• Persistent coughing or hoarseness
• Frequent choking while eating

Treatment Approaches

Treatment depends on the stage and type of cancer but may include:

• Chemotherapy
• Radiation therapy
• Immunotherapy (e.g., pembrolizumab/Keytruda)
• Targeted therapy (e.g., HER2 inhibitors or anti-angiogenesis therapy)
• Surgery – such as endoscopic tumor removal, stent placement, or cryotherapy.

When to See a Doctor

If your heartburn persists despite OTC medications or is accompanied by symptoms like difficulty swallowing, chronic cough, or weight loss, it’s essential to seek medical advice. While occasional heartburn is manageable, persistent symptoms could indicate a more serious condition requiring medical intervention.

Taking proactive steps—whether through lifestyle changes, medication, or medical procedures—can help you find relief and protect your long-term esophageal health.