Many causes: A referral to a gastroenterologist may be necessary to rule out physiological/anatomical causes such as hiatal hernia or low muscle tone as the causes of intractable heartburn. You should also be aware that many psychotropic medications can cause or exacerbate heartburn in a small number of individuals. FYI, tricyclic antidepressants have H2 receptor blocking actions (similar to ranitidine).
Answered 9/26/2016
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