One possible reason for your heartburn returning is that your medication may be masking the problem. Traditional heartburn medication works by suppressing the acid levels in your stomach but you have to remember that your stomach is meant to be a highly acidic place. The acid in your stomach is there to breakdown food and protect you by killing off bacteria and parasites. By reducing the acid levels in your stomach the medication reduces the damage to the esophaghus when the acid reflux occurs but it doesn’t tackle the underlying reason for the reflux. This means that when you stop taking the medication your acid levels return to their previous levels and the heartburn returns.
Apart from physical causes of heartburn such as pregnancy or obesity placing pressure on the stomach, the most widespread theory for the cause of heartburn puts the blame squarely with the production of excess stomach acid. There is however another school of thought which believes that heartburn is caused by insufficient acid in the stomach. This theory believes that where there is insufficient hydrochloric acid the stomach is no longer able to deal with bacteria and parasites, or foods that are not easily tolerated, such as wheat or dairy products, and the lining of the stomach becomes inflamed. It is this inflammation which is made worse by contact with stomach acid causing the symptoms of heartburn.
The acid levels in the stomach work to both close the lower esophageal sphincter (LES) to protect the delicate tissues of the esophaghus and to trigger opening of the pyloric valve, between the stomach and the small intestine. If the pyloric valve is not opened to release the stomach contents the undigested food will become rancid and start to ferment causing gas and bloating . This gas and bloating places more pressure on the LES, increasing the probability that acid reflux will produce symptoms of heartburn.