Constant heartburn usually means stomach acid is repeatedly washing back into your esophagus, a condition called gastroesophageal reflux disease (GERD). When heartburn happens more than twice a week for several weeks, it’s no longer just an occasional nuisance. Something is allowing acid to escape your stomach on a regular basis, and the cause is often a combination of factors rather than a single one.
How Acid Escapes Your Stomach
At the bottom of your esophagus sits a ring of muscle that opens to let food down and then closes to keep acid where it belongs. This valve is the primary gatekeeper against reflux, and when it malfunctions, heartburn becomes a recurring problem. Two main patterns of dysfunction drive chronic reflux: the valve relaxes too frequently at the wrong times, or it stays weak and can’t maintain enough baseline pressure to hold acid back.
The root cause is primarily faulty nerve signaling to that muscle, though the muscle itself can also weaken over time. Your diaphragm normally acts as a backup, squeezing around the valve to reinforce the seal. When both systems underperform, acid has a much easier path upward. This is why heartburn can feel like it came out of nowhere and then never really goes away. The problem isn’t that you’re producing too much acid. It’s that the barrier meant to contain it has become unreliable.
A Hiatal Hernia Can Make It Worse
A hiatal hernia occurs when the upper part of your stomach pushes up through the opening in your diaphragm. This displaces the valve from its normal position and undermines the diaphragm’s ability to reinforce it. Not everyone with a hiatal hernia has heartburn, and not everyone with chronic heartburn has a hiatal hernia, but a large one can allow food and acid to back up into the esophagus more easily. If your heartburn started gradually and has gotten progressively worse, a hiatal hernia may be contributing.
How Body Weight Affects Reflux
Carrying extra weight, especially around your midsection, physically increases the pressure inside your abdomen. That pressure pushes against your stomach and forces its contents upward toward the esophageal valve. It also disrupts the anti-reflux mechanisms at the junction between your stomach and esophagus. This is one reason heartburn often develops or worsens with weight gain, even modest amounts. People with obesity have roughly double the prevalence of Barrett’s esophagus (a complication of chronic reflux) compared to the general population: 1.9% versus 0.8%.
Foods and Drinks That Fuel It
Spicy foods don’t actually relax the esophageal valve, but they activate pain receptors in the esophageal lining, which makes any existing reflux feel significantly worse. The burning sensation you get after spicy food isn’t necessarily more acid. It’s heightened sensitivity to the acid already there.
Caffeine and chocolate work differently. Both contain compounds called methylxanthines that relax the smooth muscle of the esophageal valve, reducing its ability to stay closed. Coffee, tea, and chocolate are common triggers for this reason. Fatty foods slow stomach emptying, which keeps acid sitting in the stomach longer and increases the window for reflux. Alcohol and carbonated drinks can also relax the valve or increase stomach pressure.
If you have heartburn “all the time,” your diet may not be the root cause, but it can be amplifying a structural or muscular problem that already exists.
Medications That Trigger Reflux
Several common medications can cause or worsen chronic heartburn, and many people don’t realize the connection. Some irritate the esophageal lining directly, mimicking heartburn pain. These include ibuprofen, aspirin, certain antibiotics, iron supplements, and bisphosphonates (often prescribed for osteoporosis).
Others weaken the esophageal valve itself, making reflux more frequent. This group includes calcium channel blockers and other blood pressure medications, opioid pain relievers, sedatives like benzodiazepines, tricyclic antidepressants, overactive bladder medications, and progesterone. If your heartburn became constant around the time you started a new medication, that timing is worth noting. Stopping or switching medications should always be done with your prescriber, but identifying the connection is the first step.
Why It’s Worse at Night
Lying down removes gravity from the equation. When you’re upright, gravity helps keep stomach contents down. The moment you recline, acid can flow more easily toward your esophagus. Eating close to bedtime makes this dramatically worse. One study found that people who went to bed less than three hours after their last meal were over seven times more likely to experience reflux compared to those who waited four hours or more.
If nighttime heartburn is a major part of your problem, two changes can help. First, finish eating at least three hours before you lie down. Second, sleep on your left side. The American Gastroenterological Association recommends this position because of how the stomach and esophagus are oriented. When you lie on your left, gravity pulls stomach contents away from the valve. Elevating the head of your bed by about six inches (using a wedge or bed risers, not just extra pillows) also reduces nighttime acid exposure.
When Constant Heartburn Becomes Risky
Chronic acid exposure changes the tissue lining your esophagus. Over years, this can lead to Barrett’s esophagus, a condition where the normal esophageal cells are replaced by cells that resemble intestinal lining. About 3% of people with GERD develop Barrett’s, but that number climbs to 12% when GERD is combined with other risk factors like obesity, age over 50, or male sex. Barrett’s itself is not cancer, but it creates a small ongoing risk: without any precancerous changes, the yearly risk of progressing to esophageal cancer is 0.1% to 0.33%.
These numbers are low in any given year, but they accumulate over decades. This is why heartburn that happens constantly for months or years deserves evaluation, not just symptom management. Difficulty swallowing, unintentional weight loss, or vomiting blood are signs that reflux may have already caused significant damage.
What Treatment Looks Like
Proton pump inhibitors (PPIs), the most commonly prescribed acid-suppressing medications, are effective for most people. Fewer than 1% to 2% of patients need to stop taking them due to side effects. However, long-term use has been linked in observational studies to increased fracture risk, kidney concerns, and a higher chance of certain gut infections. A meta-analysis found that PPI users had a 30% higher risk of fractures at any site compared to nonusers, and roughly 1.5 to 2 times the risk of a specific bacterial gut infection called C. diff. Associations with neurological conditions like Parkinson’s disease have also appeared in population studies, though a clear cause-and-effect relationship hasn’t been established for most of these risks.
For mild or moderate symptoms, lifestyle changes alone can be enough. Losing weight if you carry extra abdominal fat, adjusting meal timing, identifying trigger foods, and changing sleep position address the mechanical causes rather than just suppressing acid. For people with a large hiatal hernia or severe reflux that doesn’t respond to medication, surgical repair of the valve is an option that can provide long-term relief.
The most important thing to understand about constant heartburn is that it has a physical explanation. Your esophageal valve isn’t working properly, something is increasing pressure on your stomach, or both. Identifying which factors apply to you turns a vague, frustrating symptom into something you can actually address.