Severe Heartburn: What Helps Constant, Persistent Symptoms

Medically reviewed by Robert Burakoff, MD, MPH

Symptoms of severe heartburn might be caused by gastroesophageal reflux disease (GERD). GERD is a chronic condition and can be disruptive and painful. The symptoms can be so bad that they are difficult to tell apart from a heart attack. 

Learn more about severe heartburn and GERD and when symptoms might mean that treatment is needed.

Is Severe Heartburn GERD?

Having heartburn from time to time is not uncommon. However, when it happens as often as a few times a week, or the symptoms become severe, it may be GERD.

GERD is a chronic condition, which means that it is a long-lasting problem. In GERD, the lower esophageal sphincter (LES) that is supposed to keep food from coming up from the stomach isn't working properly.

People with GERD may find symptoms worsening after eating, when lying down, and may interfere with sleeping. They may also realize they take over-the-counter (OTC) antacids frequently after meals.

The symptoms of GERD may include:

• Chest pain

• Chronic cough

• Difficulty in swallowing

• Heartburn (a painful burning feeling in the chest)

• Hoarse voice

• Nausea

• Regurgitation (the contents of the stomach back up into the esophagus or even the mouth)
  

When It Might Be GERD

If symptoms are happening a few times a week, are interfering with daily activities or sleep, or over-the-counter antacids aren't helping, see a healthcare provider to be evaluated for GERD.

When Severe Heartburn Could Be an Emergency

Heartburn isn't an emergency. But it can lead to painful or disruptive symptoms and may seem like an emergency. 

It can be difficult to tell the difference, however, between actual emergency symptoms and those that are from GERD. Symptoms that are a reason to seek care immediately include:

• Chest pain, especially if it is persistent and severe

• Problems swallowing

• Vomit with blood or vomit that looks like coffee grounds

• Vomiting that won't stop
  

Symptoms that are a reason to see a healthcare provider as soon as possible include:

• Black, tarry, or bloody stools

• Pain when swallowing

• Unexplained weight loss
  

If it's unclear whether symptoms are from GERD, a complication, or another serious health problem, seek care right away. A healthcare provider can help determine the cause and prescribe treatment. 

Symptoms of a Heart Attack

These symptoms of a heart attack are a reason to go to the emergency department or call 911:

• A feeling of pressure, fullness, or squeezing in the center of the chest that is stabbing or dull and goes on for longer than a few minutes or comes and goes
  

• Being short of breath, which may also be accompanied by chest pain

• Cold sweat or clammy skin 
  

• Irregular heartbeat
  

• Light-headedness, weakness, or dizziness
  

• Nausea, indigestion, and sometimes vomiting
  

• Pain that spreads to one or both arms, back, neck, jaw, or stomach
  

• Symptoms that come on after exercise or with stress

Related: Can GERD (Acid Reflux) Cause Heart Palpitations?

At-Home Measures to Help With Chronic Heartburn

Chronic heartburn is a reason to see a healthcare provider for guidance and treatment. However there are some at-home measures you can take that might help.

For some people, avoiding foods that are likely to cause symptoms may help. It's different for each person. However, these are the foods that may be more likely to result in symptoms:

• Alcoholic beverages

• Carbonated beverages

• Chocolate

• Coffee

• Garlic

• High-fat foods (such as French fries, ice cream, fatty cuts of red meat)

• Mint

• Onions

• Spicy foods

• Tea

• Tomatoes
  

Does Drinking Water Help?

Sipping small amounts of water (not gulps) while eating may also help with some symptoms of GERD. This may help food to move down into the esophagus.

The American College of Gastroenterology also recommends weight loss for people with GERD who are overweight or have obesity, as well as avoiding tobacco products, including smoking.

Medications to Take for Severe Heartburn

Severe symptoms are a reason to see a healthcare provider, who might prescribe medication or suggest other treatments. However, there are some drugs available over the counter (OTC; without a prescription) that may help with heartburn symptoms. 

OTC drugs include: 

• Antacids such as Mylanta, Rolaids, and Tums

• Histamine-2 (H2) blockers such as including Axid AR (nizatidine), Pepcid Complete or Pepcid AC (famotidine), Tagamet HB (cimetidine)

• Proton pump inhibitors (PPIs) such as Nexium 24HR (esomeprazole), Prevacid 24HR (lansoprazole), Prilosec OTC (omeprazole magnesium), and Zegerid OTC (omeprazole and sodium bicarbonate
  

A pharmacist can advise you on the differences among these drugs and help you choose one. These drugs are sometimes only meant to be used for a short period of time (such as two weeks) unless a healthcare provider gives different directions.

Related: The Different Types of GERD Medication and When They’re Used

Severe Heartburn and Sleep: Tips for Better Sleep

Some people may find their GERD symptoms are worse at night. This can make sleeping more challenging. However, there are some helpful steps you can take before going to bed.

If heartburn symptoms are interfering with sleep, it might be worth trying the following:

• Avoiding exercise after eating

• Avoiding lying down until about three hours after eating

• Elevating the head of the bed or sleeping with the head on a wedge pillow

• Eating smaller meals

• Stopping smoking
  

Related: How an Acid Reflux Pillow Can Lessen Symptoms of GERD

Considering Your Surgical Options

Unfortunately, even with medication and lifestyle changes, some people may find symptoms are severe or interfere with daily life. In some cases, a healthcare provider may want to recommend surgery as a treatment. 

Symptoms of regurgitation especially may be helped by surgery. Surgery might also be recommended when medications aren't helpful, symptoms are severe, or there are complications (such as a hiatal hernia).

Some surgical procedures for GERD use an endoscope or a special tool passed through the mouth and into the esophagus. 

Other procedures are performed laparoscopically. This means that several small incisions are made rather than one large one. Specialized tools are inserted into these small openings to complete the surgery. Recovery is usually shorter than with open surgery.

A healthcare provider will explain the different types of surgery. Here are some types of GERD surgery:

• Endoluminal gastroplication or the Bard EndoCinch system procedure: This may be used less often than other types of procedures or surgeries. It is done with an endoscope, and specialized tools are used to sew stitches into the LES. This shortens the muscle by creating a pleat in it, which may help tighten the valve.
  

• Fundoplication: In this surgery, tissue from the stomach is removed. It is then wrapped around the LES to strengthen it. The stomach tissue may go partially or fully around the LES. The most common type is a Nissen fundoplication, in which the entire sphincter is wrapped in the stomach tissue.
  

• Linx surgery: This procedure typically isn't performed. It involves inserting magnetized titanium beads around the LES. The beads help close the LES and avoid stomach contents from coming back up.
  

• Stretta procedure: This is done with the use of an endoscope. A specialized tool applies energy in the form of low-frequency heat to parts of the LES. This creates small cuts. These cuts then heal, which creates scar tissue, which is thicker than esophageal tissue. This makes the muscles stronger and less likely to open up and allow stomach contents to come back through.
  

• Transoral incisionless fundoplication (TIF): In this procedure, a specialized tool is inserted through the mouth and down into the esophagus. A new valve is created by folding over the tissue at the bottom of the esophagus. This repaired valve may work better to stay closed, which can stop food from coming back up into the esophagus.
  

All procedures and surgeries have some risks. Talk to a healthcare provider about the different options for treatment and which one might be your best choice.

Does Severe Heartburn Ever Go Away?

For some people, making lifestyle changes might help in reducing or eliminating symptoms. For others, a course of medication may also help for a time or for long term. Surgery may also give long-term relief.

It's unlikely that severe symptoms will go away without treatment or lifestyle changes. A healthcare provider can help determine which treatments to start first and when more intensive ones might be needed.

Related: How Gastroesophageal Reflux Disease (GERD) Is Diagnosed

Summary

It's sometimes difficult to tell whether symptoms such as chest pain are from GERD or a serious condition. Severe symptoms are a reason to seek care—immediately if they might be an emergency. Having heartburn more than a few times a week is a reason to get an evaluation and decide what treatment to try. Lifestyle changes, medications, and surgery might all be used to treat severe heartburn.

Read the original article on Verywell Health.