Heartburn is a burning sensation felt in the chest, typically behind the breastbone. It occurs when stomach acid flows back up into the esophagus, the tube connecting your mouth to your stomach. While occasional, mild heartburn is common, “long lasting” heartburn refers to a recurring or chronic form of this discomfort, indicating a more persistent issue.
Understanding Persistent Heartburn
Persistent heartburn goes beyond a temporary burning feeling, often signaling an underlying medical condition. This recurring sensation arises when the lower esophageal sphincter (LES), a muscle at the bottom of the esophagus, relaxes inappropriately or weakens, allowing stomach acid to flow back into the esophagus. Unlike the stomach, the esophagus lacks a protective lining against this acid, leading to irritation and inflammation.
When heartburn becomes chronic, occurring two or more times a week, it is often diagnosed as Gastroesophageal Reflux Disease (GERD). This persistent acid exposure can disrupt daily life, making tasks uncomfortable. Individuals with GERD may experience sleep disturbances, difficulty enjoying meals, and limitations in physical activities due to intensified symptoms when lying down or engaging in strenuous movements.
Common Causes
Gastroesophageal Reflux Disease (GERD) is a primary cause of long-lasting heartburn. Lifestyle factors contribute to persistent heartburn. Smoking, for example, can relax the LES, making acid reflux more likely. Obesity also increases abdominal pressure, pushing stomach acid into the esophagus. Eating large meals, especially close to bedtime, or wearing tight clothing can exacerbate symptoms by increasing pressure on the abdomen and stomach.
Certain foods and beverages are dietary triggers for heartburn. These include fatty or fried foods, which take longer to digest and can relax the LES, alongside spicy foods, citrus fruits, tomatoes, chocolate, caffeine, alcohol, and peppermint. Carbonated drinks can also increase pressure on the LES, contributing to reflux. Avoiding these triggers can help manage symptoms.
Some medications can induce or worsen heartburn. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can irritate the esophagus and affect the stomach’s protective lining. Certain blood pressure medications, such as calcium channel blockers and beta blockers, and some asthma medications like theophyllines, can relax the LES, promoting acid reflux. Other medications linked to heartburn include some antibiotics, bisphosphonates for osteoporosis, and certain antidepressants.
Anatomical issues, such as a hiatal hernia, can cause long-lasting heartburn. This occurs when the upper part of the stomach pushes through the diaphragm into the chest cavity, disrupting the normal function of the LES and making it easier for stomach acid to reflux.
Other medical conditions can be associated with persistent heartburn. Pregnancy, for instance, can lead to heartburn due to increased abdominal pressure from the growing fetus and hormonal changes, particularly higher progesterone levels, which relax the LES. Gastroparesis, a condition involving delayed stomach emptying, can also contribute to acid reflux and heartburn by increasing pressure within the stomach.
Managing Symptoms and Finding Relief
Managing persistent heartburn begins with lifestyle modifications that can reduce symptoms. Achieving and maintaining a healthy weight is beneficial, as excess abdominal fat can put pressure on the stomach and promote acid reflux. Quitting smoking is important, as nicotine weakens the lower esophageal sphincter, making it easier for acid to escape. Elevating the head of the bed by 6 to 9 inches can also help prevent nighttime reflux by allowing gravity to keep stomach acid down.
Dietary adjustments alleviate heartburn. Eating smaller, more frequent meals throughout the day, rather than large ones, can reduce pressure on the digestive system and lead to less acid production. Chewing food thoroughly and avoiding eating within two to three hours before lying down also gives the stomach adequate time to digest. Avoiding personal trigger foods, such as fatty foods, spicy foods, acidic fruits, chocolate, caffeine, and alcohol, can reduce symptoms.
Over-the-counter (OTC) medications offer relief. Antacids, such as Tums or Rolaids, work by neutralizing stomach acid and provide quick, temporary relief. Histamine-2 (H2) blockers, like famotidine (Pepcid AC), reduce the amount of acid the stomach produces and offer longer-lasting relief, starting within one to three hours. Proton pump inhibitors (PPIs), including omeprazole (Prilosec OTC) and lansoprazole (Prevacid 24HR), are stronger acid reducers that block acid production and are used for frequent heartburn, taking one to four days for full effect.
When OTC options are insufficient, prescription medications may be necessary. These include higher-strength H2 blockers and PPIs, which are prescribed for more severe or persistent symptoms. Stronger PPIs, such as dexlansoprazole (Dexilant) or pantoprazole (Protonix), are effective at inhibiting stomach acid production and can help heal esophageal damage. Prescription medications are used for longer periods under medical supervision. If self-management techniques and medications do not resolve symptoms, or if symptoms are severe, professional medical evaluation is recommended.
Potential Complications and When to Consult a Doctor
Untreated long-lasting heartburn can lead to several complications due to chronic acid exposure to the esophageal lining. Esophagitis is inflammation of the esophagus caused by stomach acid breaking down its tissue, leading to pain, bleeding, or ulcers. Over time, this damage can result in esophageal strictures, where scar tissue narrows the food pathway, making swallowing difficult.
Barrett’s esophagus is a more serious complication, a precancerous condition where the normal cells lining the lower esophagus are replaced by abnormal cells due to repeated acid exposure. This condition increases the risk of esophageal adenocarcinoma, a type of esophageal cancer. Untreated reflux can cause tooth erosion, sinus problems, and worsen lung conditions like asthma due to acid reaching the airways.
It is important to consult a doctor if heartburn occurs more than twice a week, if symptoms persist despite using over-the-counter medications, or if they interfere with daily life. Warning signs that necessitate immediate medical attention include difficulty or pain when swallowing, persistent nausea or vomiting, unexplained weight loss, or the presence of black or bloody stools, which can indicate internal bleeding. Chest pain that feels like pressure, squeezing, or constriction, especially if accompanied by pain in the arm or jaw or difficulty breathing, should also prompt immediate medical evaluation, as these could be signs of a heart attack. A doctor may use diagnostic procedures such as an upper endoscopy or pH monitoring to measure acid levels, to confirm a diagnosis and assess for complications.