Heartburn is caused by stomach acid and contents refluxing from the stomach into the esophagus. Generally it is caused by inappropriate transient lower esophageal sphincter relaxation. Most people with severe acid reflux have some evidence of a hiatal hernia which can cause acid trapping and impair acid emptying. I would recommend: -Avoiding foods that are spicy, acidic and high in fat, caffeine, alcohol, tobacco, anticholinergic medications, nitrates, smooth muscle relaxants which can all affect lower esophageal sphincter relaxation. -lose weight -avoid first and second hand smoking -avoid laying down after meals -elevated head of the bed at night with blocks or bricks -See a doctor for upper endoscopy for routine screen of cancers and infections of the esophagus, as well as hiatal hernia. -medications you can try: Omeprazole, pantoprazole, ranitidine, esomperazole