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Updated May 05, 2015.
Question: Why Do I Still Have Heartburn?
Answer: You are at your ideal weight, have been following a low-acid diet, are avoiding the foods that can cause heartburn, and are taking antacids -- but you still have heartburn. Why?
Despite doing everything right, there are a few reasons why you may still be suffering from heartburn:
- Underlying Condition: An important first step is to see your doctor to rule out any underlying condition that may be causing your heartburn, such as gastroesophageal reflux disease (GERD) or hiatal hernia.
- Nighttime Issues: Perhaps you have good heartburn control during the day, but are awakened at night by heartburn. It could be that you are lying too flat, you have gone to bed too soon after eating, or some other reason. You can try elevating the head of your bed, making sure you wait at least 2 to 3 hours after eating before going to bed, or lying on your left side (studies have shown that lying on the left side helps reduce the number of heartburn episodes). If these or other methods of preventing nighttime heartburn don't work, you can discuss with your doctor what else you can do, such as taking an H2 blocker.
- New Foods: Another reason you may be experiencing breakthrough heartburn is if you have been eating a new type of food that is triggering your heartburn. To see if this could be the problem, you can keep a food diary for a week or two. You would list what you eat, when you eat, and whether or not you experienced heartburn afterward. If it appears your heartburn occurs repeatedly after eating one of the foods you listed, you can avoid that food and see if your symptoms improve.
- Eating Too Much: If you know you have only eaten your "heartburn-safe" foods, perhaps you are eating too much during your meals. Having a too-full stomach can put added pressure on the lower esophageal sphincter (LES), which could force the LES to open when it shouldn't and allow stomach contents to back up into the esophagus. It is better to eat five or six smaller meals during the day rather than three larger ones. You will also want to check out these meal planning tips for preventing heartburn.
If you find that your heartburn remains even after taking these steps, it may be that you need a medication that controls the production of acid in your stomach. If you are already taking medication, such as a proton pump inhibitor (PPI), it could be that your medication is no longer working effectively. It is important to talk to your doctor about the advisability of taking medication or if your current medication is no longer controlling your symptoms. Together you can decide if starting a medication or any changes in medication or dosage is needed.
Perhaps you and your doctor feel that surgery, such as fundoplication surgery, is an option for you. While fundoplication surgery can help alleviate severe heartburn, some people find they still need medication after the surgery. You should talk to your doctor about the pros and cons of this surgery before a decision is made.
As mentioned above, the first step you should take if you experience chronic heartburn, despite the correct things you do to prevent it, is to talk to your doctor. He or she can evaluate your symptoms, along with a physical exam, and together you can formulate a treatment plan that will work for you.
Sources:
Information You Can Stomach - Heartburn and GERD FAQ. American College of Gastroenterology, 21 Jul 2010. http://www.acg.gi.org/patients/gerd/faqansw.asp
Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD). NIH Publication No. 07–0882 May 2007. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
Peikin, M.D., Steven R.. Gastrointestinal Health. New York, NY: HarperCollins Publishers, Inc., 2004.
Rinzler, Carol, and Ken DeVault, MD. Heartburn & Reflux for Dummies. Wiley Publishing, Inc, 2004