Constant heartburn may be a sign of gastroesophageal reflux (GERD) or gastritis, but it can also occur with factors that interfere with adequate digestion, like poor diet, nervousness or wearing very tight clothes. In women, constant heartburn can also be a sign of pregnancy.

If the underlying cause is not obvious, you should see a doctor for assessment. Constant heartburn should particularly be evaluated if it presents with other symptoms, such as bloating, abdominal discomfort, coughing up blood and chest pain.

Regardless of the cause, treatment for constant heartburn involves the use antacids to reduce stomach acidity in addition to changes in eating habits. In rare cases, surgery may be recommended.

What causes constant heartburn?

Constant heartburn can be a sign of:

1. GERD

GERD is characterized by the backflow of acidic stomach content into the esophagus, causing intense discomfort.

The most common symptom of GERD is heartburn, but it can also present with chest pain, a dry cough, or even respiratory problems such as asthma and pneumonia. Read more about the symptoms of GERD and what can cause it.

What to do: Some simple measures can be taken to alleviate discomfort, such as avoiding lying down right after eating, sleeping with the head of your bed elevated, and maintaining a GERD diet by avoiding the consumption of coffee, alcohol, and fatty foods.

Learn more about the GERD medications your doctor can prescribe to help manage your symptoms.

2. Hiatal hernia

A hiatal hernia is a condition that triggers reflux and is therefore another one of the main causes of constant heartburn. Typically, hiatal hernias are more common in people who are overweight, who smoke, or who exercise excessively.

Symptoms are mild and very similar to those of GERD. They include indigestion especially when laying down after eating, bending over, or lifting heavy objects.

What to do: Be sure to eat slowly, several times a day. Avoid heavy meals at least two hours before going to sleep, and sleep with the head of the bed elevated. You should also avoid fatty foods, acidic food, alcohol, and cigarettes. Patients who are overweight or obese should also aim to lose weight.

3. Gastritis

Gastritis is irritation or inflammation that occurs in the stomach. It is caused by infections, stress, allergies, use of some medications and changes in the immune system. Symptoms depend on the type of gastritis and may include abdominal pain and discomfort, nausea and vomiting, indigestion and a feeling of being full even after a small meal.

Read more about how to identify gastritis symptoms.

What to do: Patients with gastritis are advised to reduce the consumption of foods that increase acidity in the stomach, such as spicy foods, alcohol, coffee, fatty foods or whole milk. Learn more about the gastritis diet your doctor may recommend.

It is also important to avoid fasting for a long time, as this can lead to a greater accumulation of gastric acid in the stomach, which worsens inflammation. Your doctor may prescribe medications that reduce acid production, like antacids. See the gastritis treatment your doctor may consider.

4. Esophagitis

Esophagitis is characterized by inflammation in the esophagus, which occurs mainly due to reflux. It can also be a consequence of an allergic reaction to a certain food. The symptoms of esophagitis are very similar to those of gastritis, but in addition to these, there may also be difficulty swallowing, loss of appetite, and a feeling that swallowed food is stuck in the throat.

What to do: Corticosteroid medicines can help to coat the esophagus and control the inflammation caused. Some adjustments to the diet should also be made, such as eliminating foods with wheat flour, milk, dairy products, seafood, nuts, eggs and soy, If the esophagitis was triggered by an allergy, it is important to identify the trigger.

5. Pregnancy

In pregnant women, heartburn may be present from the beginning of pregnancy. It occurs due to the hormonal changes that are normal during pregnancy, as well as the growth and heaviness of the belly. With increased progesterone production, the stomach muscles also unintentionally relax, causing acids to backflow into the esophagus, leading to constant heartburn.

Learn more about what causes heartburn during pregnancy.

What to do: Pregnant women who experience heartburn are advised to eat more frequently, to eat smaller portions throughout the day, to avoid drinking too many fluids during meals, to avoid lying down immediately after a meal and to wear comfortable clothes. Check out other home remedies for heartburn during pregnancy that you can incorporate.

6. Food intolerance

A food intolerance is characterized by difficulty in digesting a certain type of food, such as lactose or gluten. Digestion is slower because the body typically does not have the enzymes necessary for breaking down certain nutrients. This leads to an accumulation of these nutrients in the stomach causing gastric discomfort, colic, nausea, diarrhea, headaches and constant heartburn.

It is also very common in people with a food intolerance to experience symptoms such as bloating, abdominal pain, excessive tiredness, itching or spots on the skin.

Check-out our online gluten intolerance symptoms quiz if you suspect your may have a gluten intolerance.

What to do: It is important to identify the type of food that is causing the intolerance, which can be done by maintaining a food diary.. Once the trigger food has been identified, it is important to completely cut it out of the diet. Another way to alleviate the symptoms of food intolerance is to use medicines with enzymes, which help with digestion.

7. Wearing tight clothes

Wearing uncomfortable and tight clothing can cause pressure on the stomach, causing acidic stomach content to rise into the esophagus. This can lead to acid reflux and heartburn.

What to do: You should opt for light and comfortable clothing that does not fit tightly on the stomach or belly.

8. Poor eating habits

Poor eating habits, like frequently eating fatty foods, fried foods, spicy foods and sugary foods can also cause constant heartburn. These tends take longer to digest and remain in the stomach, which can irritate the stomach lining.

Excessive intake of caffeinated beverages or alcohol can also increase your risk for developing GERD or gastritis.

What to do: You should avoid consuming these foods or consume them in moderation. Ideally you should opt for a healthy and diverse diet that is rich in fresh fruits and vegetables.

9. Smoking

Smoking can weaken the esophageal sphincter, which is found between the stomach and esophagus. This sphincter will contract when there is food in the stomach, however back-flow of stomach content into the esophagus can occur when it is weakened.

This can lead to GERD and other symptoms like burning, throat irritation or difficulty breathing.

What to do: Ideally you should quit smoking to resolve the heartburn and the worsening of GERD. gastroesophageal reflux. Speak to your doctor about options for smoking cessation, like bupropion or varenicline. See the main remedies to stop smoking.

10. Stress and anxiety

Stress and anxiety can increase the release of hormones (like cortisol) that stimulate stomach acid production and lead to heartburn.

Other symptoms may also appear as a result, such as nausea, stomach pain, diarrhea or constipation. Read more about stress-induced gastritis and how it presents.

What to do: You should consult a psychologist if you experience physical symptoms a result of your stress and/or anxiety. The doctor can help you to understand how your thoughts affect emotions and behaviors, and develop tools to deal with stressful or anxious situations.

Very intense stress or anxiety should be assessed by psychiatrist or general practitioner who can recommend the most appropriate treatment.